Self-Assessment Questions (SAQs) for Study Session 19
Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering these questions. Write your answers in your Study Diary and discuss them with your Tutor at the next Study Support Meeting. You can check your answers with the Notes on the Self-Assessment Questions at the end of this Module.
SAQ 19.1 (tests Learning Outcomes 19.1 and 19.2)
Which of the following statements is false? In each case, explain what is incorrect.
A When the muscular walls of the blood vessels all over a woman’s body contract, the space inside the vessels becomes larger so her blood pressure falls.
B Hypertension during pregnancy reduces the blood supply from the endometrial arteries in the mother’s uterus to the fetus via the placenta.
C Hypertension reduces the amount of amniotic fluid surrounding the fetus, because the blood flow to the baby’s kidneys is reduced so it makes less urine.
D Fetal growth is not restricted in a pregnant woman with hypertension.
Answer
A is false. When the muscular walls of the blood vessels all over a woman’s body contract, the space inside the vessels becomes smaller so her blood pressure rises.
B is true. Hypertension during pregnancy reduces the blood supply from the endometrial arteries in the mother’s uterus to the fetus via the placenta.
C is true. Hypertension reduces the amount of amniotic fluid surrounding the fetus, because the blood flow to the baby’s kidneys is reduce so it makes less urine. In late pregnancy, most of the amniotic fluid comes from the baby’s urine.
D is false. Fetal growth is very likely to be restricted in a pregnant woman with hypertension, because the transfer of oxygen, nutrients and fluids to the baby via blood from the placenta is reduced.
SAQ 19.2 (tests Learning Outcomes 19.1 and 19.3)
Complete Table 19.3 with the measurements you would expect to find in women classified with the types of hypertension shown in the left-hand column.
| Type | Raised blood pressure | Proteinuria | Symptoms of severity |
|---|---|---|---|
| Gestational hypertension |
|
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| Mild pre-eclampsia |
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| Severe pre-eclampsia |
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| Superimposed pre-eclampsia |
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Answer
The completed version of Table 19.3 appears below.
| Type | Raised blood pressure | Proteinuria | Symptoms of severity |
|---|---|---|---|
| Gestational hypertension | Above 140/90 mmHg | No significant proteinuria | None |
| Mild pre-eclampsia | Between 140/90 and 160/110 mmHg | No significant proteinuria | None |
| Severe pre-eclampsia | Greater than or equal to 160/110 mmHg | With or without significant proteinura (urine dipstick test result greater than or equal to +2) | Headache, blurred vision, epigastric burning pain, decreased urine output, decreased or absent fetal kick |
| Superimposed pre-eclampsia | Higher than before the pregnancy in a known chronic hypertensive woman | Significant or worsening proteinuria | With or without symptoms of severity |
Read the following case study and then answer the questions that follow it.
Case Study 19.1 Zewditu’s story
Zewditu is a 37-year-old primigravida woman who is pregnant with twins. She is very overweight for her height. She was in good health until she reached gestational week 22, when she began to complain of headaches and swollen feet and ankles.
SAQ 19.3 (tests Learning Outcomes 19.1, 19.2, 19.3, 19.4, 19.5 and 19.6)
- a.Does Zewditu have any of the common risk factors for hypertension? If yes, what are they?
- b.Does she have any of the clinical features of hypertension? If yes, what are they and what is the underlying cause?
- c.What complications could affect Zewditu’s baby if she has untreated hypertension?
- d.What action should you take in Zewditu’s case and why?
Answer
- a.Zewditu has three of the common risk factors for hypertension: she is having her first baby after the age of 35 years; she is expecting twins; and she is obese.
- b.She has two clinical features of hypertension: headaches and swollen feet/ankles. Both are caused by oedema (swelling due to fluid collecting in the tissues). The headaches are due to oedema around the brain, and the swollen feet and ankles are due to oedema in the tissues of the lower limbs. The underlying cause of the oedema is because the high blood pressure is pushing fluid from the blood out through the vessel walls and into the surrounding tissues.
- c.The complications that could affect Zeditu’s baby if she is not treated quickly are: placental abruption, intrauterine asphyxia, intrauterine growth restriction, intrauterine fetal death, or mental retardation in later life.
- d.The first action is to measure her blood pressure and test her urine for the presence of protein. Even if the results are close to normal, she should be referred without any intervention from you to a higher health facility for further assessment, preferably on the day of the assessment. This is because even if her hypertension is currently mild, it may progress to severe pre-eclampsia in a very short period of time.
Summary of Study Session 19