Self-Assessment Questions for Study Session 21
Now that you have completed this study session, you can assess how well you have achieved its Learning Outcomes by answering the following 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 21.1 (tests Learning Outcomes 21.2 and 21.3)
Relatives call you to see a woman who is bleeding from the vagina at the 8th month of gestation.
- a.What will you do as the initial assessment?
- b.Will you initiate emergency treatment for this woman and refer her to the nearest higher health facility? Explain why, or why not.
- c.What will you tell the relatives to do?
- a.The initial assessment would be a rapid evaluation of the general condition of the woman, including her vital signs: pulse, blood pressure, respiration and temperature; check her for pallor, weakness, dizziness and confusion.
- b.Emergency treatment should begin immediately with rapid intravenous (IV) infusion with Normal Saline or Ringer’s Lactate solution. This may save her life by replacing the fluids and salts lost through the haemorrhage, so her blood pressure does not drop dangerously low.
- c.The relatives should be told to organise transport for the woman to the nearest higher level health facility.
SAQ 21.2 (tests Learning Outcomes 21.1, 21.2 and 21.3)
Which of the following statements is false? In each case, say why it is incorrect.
A You can do a vaginal examination for a pregnant women who comes to you with vaginal bleeding at gestational age of 37 weeks.
B Premature separation of a normally implanted placenta always results in external bleeding.
C Placenta previa is when the placenta is attached close to or covering the cervix.
D You may not need to refer women who present with persistent or recurrent bleeding in late pregnancy if the bleeding stops spontaneously.
A is false. You should never do a vaginal examination on a woman with late pregnancy bleeding (i.e. after 28 weeks of gestation).
B is false. Premature separation of a normally implanted placenta may result in external bleeding, but it may also cause internal bleeding.
C is true. Placenta previa is when the placenta is attached close to or covering the cervix.
D is false. You should always refer women with persistent or recurrent bleeding in late pregnancy, even if the bleeding stops spontaneously.
Read Case Study 21.1 and then answer the questions that follow it.
Case Study 21.1 Mrs X is brought to the Health Post
Mrs X is brought to your Health Post carried by her relatives on a locally made wooden bed. You are told she is 9 months pregnant. She had severe abdominal pain, which was followed by vaginal bleeding. When you examine her you see her clothes are soaked in blood. She is restless and asking for water. Her pulse is 120 beats per minute and her blood pressure is 80/50 mmHg.
SAQ 21.3 (tests Learning Outcomes 21.1 and 21.2)
- a.What are the possible causes of bleeding in this case? Explain your answer.
- b.Is Mrs X in a state of shock? Justify your diagnosis.
- a.The possible causes of bleeding in the case of Mrs X are:
- Placental abruption
- Placenta previa
- Ruptured uterus
- Ruptured varicose vein.
- b.Mrs X is in a state of shock: she is restless and thirsty, her pulse is very fast (120 beats/minute) and her blood pressure is dangerously low (80/50 mmHg).
Summary of Study Session 21