Title: Default for ANC
Course: Antenatal Care Part 1 - Ethiopia (Full)

Q: testing
- True
- False
A: False

Q: How does the MMR for Ethiopia in 2005 compare with the MMR for Africa, and the world figure?
- It is above the average figure for Africa, and above the average figure for the world.
- It is below the average figure for Africa, and below the average figure for the world.
- It is above the average figure for Africa, and below the average figure for the world.
- It is below the average figure for Africa, and above the average figure for the world. (Correct! Well done. By 2005, the MMR for Ethiopia was 673 per 100,000 live births — well below the average of 900 per 100,000 live births for Africa as a whole, but still one of the highest in the world. In 2008, the global average MMR was 400 maternal deaths per 100,000 live births.)
A: It is below the average figure for Africa, and above the average figure for the world.

Q: Imagine that the total number of people in a catchment area is 10,000, and the total number of first antenatal visits the Health Extension Practitioners (HEPs) made last year was 150. Calculate the number of pregnant women who were eligible for antenatal care services in this catchment area last year.
A: 400
Partly right: 400 (50%)
Feedback ("400"): Correct! The total number of pregnant women in this catchment area is calculated as 4% of the 10,000 population. To calculate 4% of 10,000, you multiply 10,000 by 4 and divide the result by 100. Therefore, this community is expected to have 400 pregnant women in one year, who are eligible for antenatal care, delivery and postnatal care.
Feedback ("400"): Half credit for being close. The total number of pregnant women in this catchment area is calculated as 4% of the 10,000 population. To calculate 4% of 10,000, you multiply 10,000 by 4 and divide the result by 100. Therefore, this community is expected to have 400 pregnant women in one year, who are eligible for antenatal care, delivery and postnatal care.

Q: Imagine that the total number of people in a catchment area is 10,000, and the total number of first antenatal visits the Health Extension Practitioners (HEPs) made last year was 150. What was the antenatal care coverage rate achieved by the Health Extension Practitioners last year?
A: 37.5
Partly right: 37.5 (50%)
Feedback ("37.5"): Correct! You calculate the ANC coverage rate as the total number of pregnant women attended at least once during their pregnancy by the Health Extension Practitioners for reasons relating to the pregnancy, divided by the total number of expected pregnancies in the same year. The result is expressed as a percentage by multiplying by 100. Only 37.5% of the pregnant women in this catchment area received one antenatal visit. These Health Extension Practitioners need to improve the antenatal care coverage rate in their kebele!
Feedback ("37.5"): Half credit for being close. You calculate the ANC coverage rate as the total number of pregnant women attended at least once during their pregnancy by the Health Extension Practitioners for reasons relating to the pregnancy, divided by the total number of expected pregnancies in the same year. The result is expressed as a percentage by multiplying by 100. Only 37.5% of the pregnant women in this catchment area received one antenatal visit. These Health Extension Practitioners need to improve the antenatal care coverage rate in their kebele!

Q: Assume that the total population of a community is 8,000. How many antenatal visits would the Health Extension Practitioners make in one year if they achieved focused antenatal care for every pregnant woman?
A: 1280
Partly right: 1280 (50%)
Feedback ("1280"): Correct! This community is expected to have 320 pregnant women in one year (4% of 8000), who are eligible for antenatal care, delivery and postnatal care. Then calculate the number of antenatal visits the Health Extension Practitioners would make in one year if they achieved the focused antenatal care coverage rate of 4 visits for every pregnant woman. 320 x 4
Feedback ("1280"): Half credit for being close. This community is expected to have 320 pregnant women in one year (4% of 8000), who are eligible for antenatal care, delivery and postnatal care. Then calculate the number of antenatal visits the Health Extension Practitioners would make in one year if they achieved the focused antenatal care coverage rate of 4 visits for every pregnant woman. 320 x 4 is a total of 1,280 antenatal visits.

Q: Assume that there were 480 maternal deaths, 960 neonatal deaths and 60,000 live births in Region Y in the year 2005. What was the MMR in this region in that year?
- 480 maternal deaths per 100,000 live births
- 560 maternal deaths per 100,000 live births
- 800 maternal deaths per 100,000 live births (Correct!)
- 1200 maternal deaths per 100,000 live births
A: 800 maternal deaths per 100,000 live births

Q: Infection in the uterus can get into the pelvic cavity through the vagina.
- true (It is false. Infection in the uterus can get into the pelvic cavity by passing outwards through the fallopian tubes, which are open at the ends. Infection in the uterus can pass down the vagina, and usually appears as a bad-smelling discharge from the vaginal opening in the vulva.)
- false (Correct! It is false. Infection in the uterus can get into the pelvic cavity by passing outwards through the fallopian tubes, which are open at the ends. Infection in the uterus can pass down the vagina, and usually appears as a bad-smelling discharge from the vaginal opening in the vulva.)
A: false

Q: The perineum is a muscular area between the vaginal opening and the anus.
- true (Correct! It is true. The perineum is a muscular area between the vaginal opening and the anus.)
- false (It is true. The perineum is a muscular area between the vaginal opening and the anus.)
A: true

Q: The maturation of an ovum is controlled by the female reproductive hormones.
- true (Correct! It is true. The maturation of an ovum is controlled by the female reproductive hormones.)
- false (It is true. The maturation of an ovum is controlled by the female reproductive hormones.)
A: true

Q: Glands in the cervix produce secretions which lubricate the vagina.
- true (Correct! It is true. Glands in the cervix produce secretions which lubricate the vagina.)
- false (It is true. Glands in the cervix produce secretions which lubricate the vagina.)
A: true

Q: The fundus is the narrow ‘neck’ at the bottom of the uterus.
- true (It is false. The fundus is the name for the domed top of the uterus. The narrow neck at the bottom of the uterus is called the cervix.)
- false (Correct! It is false. The fundus is the name for the domed top of the uterus. The narrow neck at the bottom of the uterus is called the cervix.)
A: false

Q: The energy for moving the sperm’s tail comes from the genetic material in its head.
- true (It is false. The energy for moving the sperm’s tail comes from the mitochondria in the structure between the head and the tail.)
- false (Correct! It is false. The energy for moving the sperm’s tail comes from the mitochondria in the structure between the head and the tail.)
A: false

Q: Contractions in the muscular walls of the uterus and fallopian tubes assist sperm to move rapidly towards the ovum.
- true (Correct! It is true. Contractions in the muscular walls of the uterus and fallopian tubes assist sperm to move rapidly towards the ovum.)
- false (It is true. Contractions in the muscular walls of the uterus and fallopian tubes assist sperm to move rapidly towards the ovum.)
A: true

Q: Implantation occurs when the blastocyst burrows into the endometrium and successfully establishes the early placenta.
- true (Correct! It is true. Implantation occurs when the blastocyst burrows into the endometrium and successfully establishes the early placenta.)
- false (It is true. Implantation occurs when the blastocyst burrows into the endometrium and successfully establishes the early placenta.)
A: true

Q: The female bony pelvis is broader and flatter than the male pelvis.
- true (Correct! It is true. The female bony pelvis is broader and flatter than the male pelvis.)
- false (It is true. The female bony pelvis is broader and flatter than the male pelvis.)
A: true

Q: The pelvic inlet is narrower than the pelvic outlet.
- true (It is false. The pelvic inlet is wider (not narrower) than the pelvic outlet.)
- false (Correct! It is false. The pelvic inlet is wider (not narrower) than the pelvic outlet.)
A: false

Q: The iliac crest is an important landmark in measuring the progress of the fetus down the birth canal.
- true (It is false. The iliac crest is the protuberance at the front of each hip bone; it is not important in measuring the progress of the fetus down the birth canal.)
- false (Correct! It is false. The iliac crest is the protuberance at the front of each hip bone; it is not important in measuring the progress of the fetus down the birth canal.)
A: false

Q: Lying flat after a meal is recommended for pregnant women because it helps digestion.
- true (It is false. Lying flat after a meal is not recommended in pregnancy and it does not help digestion. The contents of the pregnant woman’s stomach will be pushed upwards into her oesophagus in her chest if she is lying down, and the acids that digest her food can cause a burning sensation known as ‘heartburn’.)
- false (Correct! It is false. Lying flat after a meal is not recommended in pregnancy and it does not help digestion. The contents of the pregnant woman’s stomach will be pushed upwards into her oesophagus in her chest if she is lying down, and the acids that digest her food can cause a burning sensation known as ‘heartburn’.)
A: false

Q: Frequent urination in late pregnancy is normal because the uterus pushes down on the bladder.
- true (Correct! It is true. Frequent urination in late pregnancy is normal because the uterus pushes down on the bladder and it can hold less urine.)
- false (It is true. Frequent urination in late pregnancy is normal because the uterus pushes down on the bladder and it can hold less urine.)
A: true

Q: Heart rate, stroke volume and cardiac output all increase during pregnancy.
- true (Correct! It is true. Heart rate, stroke volume and cardiac output all increase during pregnancy, because the woman’s larger body, uterus and the fetus all need a larger blood flow to provide them with nutrients and oxygen.)
- false (It is true. Heart rate, stroke volume and cardiac output all increase during pregnancy, because the woman’s larger body, uterus and the fetus all need a larger blood flow to provide them with nutrients and oxygen.)
A: true

Q: Maternal goitre is caused by iron deficiency.
- true (It is false. Goitre is caused by iodine deficiency, and not by iron deficiency.)
- false (Correct! It is false. Goitre is caused by iodine deficiency, and not by iron deficiency.)
A: false

Q: Maternal diabetes often results in a big baby.
- true (Correct! It is true. Maternal diabetes often results in a big baby because the mother has too much sugar in her blood, which makes the baby fat.)
- false (It is true. Maternal diabetes often results in a big baby because the mother has too much sugar in her blood, which makes the baby fat.)
A: true

Q: Shortness of breath may be caused by anaemia, a heart problem, lung infection or a blood clot.
- true (Correct! It is true. Shortness of breath may be caused by anaemia, a heart problem, lung infection or a blood clot.)
- false (It is true. Shortness of breath may be caused by anaemia, a heart problem, lung infection or a blood clot.)
A: true

Q: What is your assessment of the gestational age in months of Abebech’s baby using fundal height measurement?
A: 7
Feedback ("7"): Correct. The gestational age based on the fundal height measurement is seven months.

Q: How many centimetres would Abebech’s abdomen measure from her pubic bone to the top of her uterus in order to confirm your fundal height measurement?
A: 28
Partly right: 27-28 (10%)
Feedback ("28"): Correct. If Abebech is really seven months pregnant, you would expect her abdomen to measure about 28 cm from her pubic bone to the top of the uterus, i.e. approximately one centimetre for each week of pregnancy dated from the LNMP. Remember the measurement may range from 26-30 cm.
Feedback ("27-28"): Try again!

Q: Is the gestational age of Abebech’s baby based on fundal height measurement consistent with the gestational age calculated from her LNMP?
- Yes (Incorrect. The gestational age based on fundal height is one month more than expected from the date of the LNMP. Therefore, the uterus is bigger than expected from the date of the LNMP.)
- No (Correct! The gestational age based on fundal height is one month more than expected from the date of the LNMP. Therefore, the uterus is bigger than expected from the date of the LNMP.)
A: No

Q: Listening to the fetal heartbeat using a stethoscope is called auscultation.
- true (Correct! Listening to the fetal heart beat using a stethoscope is called auscultation.)
- false (Incorrect. It is true. Listening to the fetal heart beat using a stethoscope is called auscultation.)
A: true

Q: When the fetal head is down and the bottom of the fetus is up in the fundus, it is called a vertical lie.
- true (Correct! When the fetal head is down and the bottom of the fetus is up in the fundus, it is called a vertical lie.)
- false (Incorrect. It is true. When the fetal head is down and the bottom of the fetus is up in the fundus, it is called a vertical lie.)
A: true

Q: In a vertex presentation, the presenting part is the baby’s bottom.
- true (Incorrect. It is false. In a vertex presentation, the presenting part is the baby’s head.)
- false (Correct! It is false. In a vertex presentation, the presenting part is the baby’s head.)
A: false

Q: Match the correct management with each of the disorders.
- Haemorrhoids | Eat a lot of vegetables and fruits, and sit in a cool bath
- Insomnia | Drink herbal teas that help her to sleep
- Leg cramps | Flex the foot and gently stroke the leg
- Mild headache | Take two paracetamol tablets with a glass of water
- Varicosities in the legs | Put the feet up and wear strong stockings
- Sweating a lot | Dress in cool clothes, bathe frequently, and use a fan

Q: Focused antenatal care focuses on the pregnant woman alone.
- true (It is false. Focused antenatal care does not focus on the pregnant woman alone (this used to happen in the traditional approach). FANC includes the woman’s partner and if possible the whole family in caring for her during pregnancy, watching for danger symptoms, and preparing for the birth, complication readiness and emergency planning.)
- false (Correct! It is false. Focused antenatal care does not focus on the pregnant woman alone (this used to happen in the traditional approach). FANC includes the woman’s partner and if possible the whole family in caring for her during pregnancy, watching for danger symptoms, and preparing for the birth, complication readiness and emergency planning.)
A: false

Q: Women in the basic component receive only 4 FANC visits, unless warning signs or symptoms are detected at any stage.
- true (Correct! It is true. Women in the basic component receive only 4 FANC visits, unless warning signs or symptoms are detected at any stage.)
- false (It is true. Women in the basic component receive only 4 FANC visits, unless warning signs or symptoms are detected at any stage.)
A: true

Q: Pregnant women do not need to prepare any equipment for labour and delivery.
- true (It is false. A pregnant woman should prepare for labour and delivery by assembling very clean cloths, a new razor blade, very clean new string, soap and a scrubbing brush, clean water for washing and drinking, buckets and bowls, supplies for making drinks, and a flashlight.)
- false (Correct! It is false. A pregnant woman should prepare for labour and delivery by assembling very clean cloths, a new razor blade, very clean new string, soap and a scrubbing brush, clean water for washing and drinking, buckets and bowls, supplies for making drinks, and a flashlight..)
A: false

Q: Breastfeeding is 100% effective at preventing a further pregnancy.
- true (It is false. Breastfeeding is not 100% effective at preventing a further pregnancy; full and exclusive breastfeeding gives good protection from pregnancy but cannot be relied on as 100% effective —especially not after 6 months from the birth or if menstrual periods return.)
- false (Correct! It is false. Breastfeeding is not 100% effective at preventing a further pregnancy; full and exclusive breastfeeding gives good protection from pregnancy but cannot be relied on as 100% effective —especially not after 6 months from the birth or if menstrual periods return.)
A: false

Q: Colostrum should be fed to the newborn baby, not thrown away.
- true (Correct! It is true. Colostrum should always be fed to the baby because it is very nutritious and gives protection against infection.)
- false (It is true. Colostrum should always be fed to the baby because it is very nutritious and gives protection against infection.)
A: true

Q: Early and exclusive breastfeeding means feeding only breastmilk from the first hour of the baby’s life until at least 6 months of age.
- true (Correct! It is true. Early and exclusive breastfeeding means feeding only breast milk from the first hour of the baby’s life until at least 6 months of age.)
- false (It is true. Early and exclusive breastfeeding means feeding only breast milk from the first hour of the baby’s life until at least 6 months of age.)
A: true

Q: Saying welcome, showing a smiling face, letting her express her concerns and doubts, helps the mother feel comfortable and develop confidence in you.
- true (Correct! It is true. Welcoming the mother, smiling and letting her express her concerns and doubts, helps her to feel comfortable and develops confidence in you.)
- false (It is true. Welcoming the mother, smiling and letting her express her concerns and doubts, helps her to feel comfortable and develops confidence in you.)
A: true

Q: You have to tell her that unless she comes on the day of her scheduled appointment, you will not see her at any other time.
- true (It is false. It is not an easy task always to come on the day of appointment for the majority of rural Ethiopian pregnant women, who typically have many personal and social responsibilities at home. It is their right to come earlier or later than the appointed date, or even not to come at all. It is the duty and responsibility of any health professional to say welcome with open hands at whatever time and date women come for their antenatal check-up.)
- false (Correct! It is false. It is not an easy task always to come on the day of appointment for the majority of rural Ethiopian pregnant women, who typically have many personal and social responsibilities at home. It is their right to come earlier or later than the appointed date, or even not to come at all. It is the duty and responsibility of any health professional to say welcome with open hands at whatever time and date women come for their antenatal check-up.)
A: false

Q: You should not allow her to ask questions till you finish telling her what she needs to know.
- true (It is false.The health service is primarily the client’s/patient’s business. The duty of the health professionals is to deliver a service which makes the client comfortable and satisfied. With that understanding, you have to be prepared to receive questions and do the best to encourage women to raise any questions which are not clear for them.)
- false (Correct! It is false. The health service is primarily the client’s/patient’s business. The duty of the health professionals is to deliver a service which makes the client comfortable and satisfied. With that understanding, you have to be prepared to receive questions and do the best to encourage women to raise any questions which are not clear for them.)
A: false

Q: A woman has sexual intercourse with a man who is HIV-positive. She is tested for HIV infection two weeks after this sexual intercourse. Her HIV test is negative. Should you trust this result?
- yes (No, you should not trust the result. The woman could be in the window period of HIV infection, so the HIV test may give a negative result even if she was infected with HIV from this sexual intercourse.)
- no (Correct! No, you should not trust the result. The woman could be in the window period of HIV infection, so the HIV test may give a negative result even if she was infected with HIV from this sexual intercourse.)
A: no

Q: Infection in the uterus may cause PROM and may also be a complication following PROM.
- true (Correct! It is true. Infection in the uterus may cause PROM and may also be a complication following PROM.)
- false (It is true. Infection in the uterus may cause PROM and may also be a complication following PROM.)
A: true

Q: PROM may occur if the uterus is over-stretched by malpresentation of the fetus, multiple pregnancy or excess amniotic fluid.
- true (Correct! It is true. Prom may occur if the uterus is over-stretched by malpresentation of the fetus, multiple pregnancy or excess amniotic fluid.)
- false (It is true. Prom may occur if the uterus is over-stretched by malpresentation of the fetus, multiple pregnancy or excess amniotic fluid.)
A: true

Q: Cervical incompetence in combination with PROM can be a cause of umbilical cord prolapse.
- true (Correct! It is true. Cervical incompetence in combination with PROM can be a cause of umbilical cord prolapse.)
- false (It is true. Cervical incompetence in combination with PROM can be a cause of umbilical cord prolapse.)
A: true

Q: The risk of a UTI can be reduced by washing hands and genitals properly.
- true (Correct! It is true. The risk of urinary tract infection (UTI) can be reduced by washing hands and genitals properly.)
- false (It is true. The risk of urinary tract infection (UTI) can be reduced by washing hands and genitals properly.)
A: true

Q: A woman is more likely to get infections of the urethra, bladder or kidneys during pregnancy than at other times.
- true (Correct! It is true. A pregnant woman is more likely to get a UTI than when she is not pregnant.)
- false (It is true. A pregnant woman is more likely to get a UTI than when she is not pregnant.)
A: true

Q: It is important to give iron tablets to prevent anaemia only at the first antenatal visit.
- true (It is false. Encouraging a woman with a UTI to drink fluids every hour while she is awake will help to reduce her bladder infection.)
- false (Correct! It is false. Encouraging a woman with a UTI to drink fluids every hour while she is awake will help to reduce her bladder infection.)
A: false

Q: 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.
- true (It 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.)
- false (Correct! It 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.)
A: false

Q: Hypertension during pregnancy reduces the blood supply from the endometrial arteries in the mother’s uterus to the fetus via the placenta.
- true (Correct! It is true. Hypertension during pregnancy reduces the blood supply from the endometrial arteries in the mother’s uterus to the fetus via the placenta.)
- false (It is true. Hypertension during pregnancy reduces the blood supply from the endometrial arteries in the mother’s uterus to the fetus via the placenta.)
A: true

Q: 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.
- true (Correct! It 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.)
- false (It 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.)
A: true

Q: There is no need to refer all incomplete abortion cases to the next higher health facility.
- true (It is false. All women with an incomplete abortion should be referred to the next higher health facility. If you leave an incomplete abortion without treatment for some time there is an increased risk that it will be complicated with infection and this could be life-threatening for the woman.)
- false (Correct! It is false. All women with an incomplete abortion should be referred to the next higher health facility. If you leave an incomplete abortion without treatment for some time there is an increased risk that it will be complicated with infection and this could be life-threatening for the woman.)
A: false

Q: In a complete abortion the tissue inside the uterus has been entirely expelled and the cervix has closed.
- true (Correct! It is true. In a complete abortion the tissue inside the uterus has been entirely expelled and the cervix has closed.)
- false (It is true. In a complete abortion the tissue inside the uterus has been entirely expelled and the cervix has closed.)
A: true

Q: Women whose abortion is complete will not be able to get pregnant again for some months.
- true (It is false. Women whose abortion is complete can get pregnant again quickly, because fertility returns within two to four weeks.)
- false (Correct! It is false. Women whose abortion is complete can get pregnant again quickly, because fertility returns within two to four weeks.)
A: false

Q: You can do a vaginal examination for a pregnant women who comes to you with vaginal bleeding at gestational age of 37 weeks.
- true (It is false. You should never do a vaginal examination on a woman with late pregnancy bleeding (i.e. after 28 weeks of gestation).)
- false (Correct! It is false. You should never do a vaginal examination on a woman with late pregnancy bleeding (i.e. after 28 weeks of gestation).)
A: false

Q: Premature separation of a normally implanted placenta always results in external bleeding.
- true (It is false. Premature separation of a normally implanted placenta may result in external bleeding, but it may also cause internal bleeding.)
- false (Correct! It is false. Premature separation of a normally implanted placenta may result in external bleeding, but it may also cause internal bleeding.)
A: false

Q: Placenta previa is when the placenta is attached close to or covering the cervix.
- true (Correct! It is true. Placenta previa is when the placenta is attached close to or covering the cervix.)
- false (It is true. Placenta previa is when the placenta is attached close to or covering the cervix.)
A: true

Q: A woman who is in shock due to loss of blood should be referred immediately without beginning IV fluid therapy.
- true (It is false. A woman who is in shock (low blood pressure and rapid pulse) due to blood loss needs IV fluid therapy to be started before referral.)
- false (Correct! It is false. A woman who is in shock (low blood pressure and rapid pulse) due to blood loss needs IV fluid therapy to be started before referral.)
A: false

Q: Remove and reposition the IV cannula if the venipuncture site swells and is painful.
- true (Correct! It is true. You should remove and reposition the IV cannula if the venipuncture site swells and is painful. This indicates that the fluid is going into the tissues instead of into the vein.)
- false (It is true. You should remove and reposition the IV cannula if the venipuncture site swells and is painful. This indicates that the fluid is going into the tissues instead of into the vein.)
A: true

Q: If you don’t have a plaster to put over the venipuncture site there is no need to stabilise the IV cannula in the vein.
- true (It is false. If you don’t have a plaster to put over the venipuncture site, you should stabilise the IV cannula by tying very clean cloth around it. If the cannula is not stabilised it can pull out of the vein.)
- false (Correct! It is false. If you don’t have a plaster to put over the venipuncture site, you should stabilise the IV cannula by tying very clean cloth around it. If the cannula is not stabilised it can pull out of the vein.)
A: false

Q: According to the Focused Antenatal Care (FANC) approach, when should a pregnant woman first come for a visit?
- At 32 weeks (Incorrect. The third visit during pregnancy should be at 32 weeks.)
- At 16 weeks (Correct! According to the focused antenatal care (FANC) approach, the first visit during pregnancy must be after 16 weeks.)
- At 36 weeks (Incorrect. The fourth visit of pregnancy should be after 36 weeks)
A: At 16 weeks

Q: What is the leading cause of maternal death?
- Unsafe abortion (Incorrect. Unsafe abortion is one of the causes of maternal death but not the leading one.)
- High blood pressure (Incorrect. High blood pressure is one of the causes of maternal death but not the leading one.)
- Haemorrhage or bleeding after childbirth (Correct! The leading cause of maternal death is haemorrhage or bleeding after childbirth)
A: Haemorrhage or bleeding after childbirth

Q: In Region X in 2002, there were 10 maternal deaths and 10,000 live births. What was the maternal mortality ratio in Region X per 100,000 live births in that year?
A: 100
Feedback ("100"): Correct! The MMR for this region in 2002 is 100
  Hint: Try again. Calculate: number of maternal deaths/ the number of live births x 100,000 live births

Q: Assume that there were 480 maternal deaths, 960 neonatal deaths and 60,000 live births in Region Y in the year 2005. Calculate the neonatal mortality rate in this region in that year.
A: 16
Feedback ("16"): Correct! There were 16 neonatal deaths per 1000 live births
  Hint: Try again. Calculate: number of neonatal deaths/number of live births in the same year x 1,000 live births

Q: What are the main causes of newborn death or neonatal mortality?
- HIV/AIDS and preterm birth (Incorrect. These are some of the causes of neonatal mortality but not the main causes.)
- Infection, asphyxia, and preterm birth (Correct! The main causes of neonatal mortality are Infection, asphyxia, and preterm birth)
- Diarrhea, Pneumonia, and Tetanus (Incorrect. These are some of the causes of neonatal mortality but not the main causes.)
A: Infection, asphyxia, and preterm birth

Q: _____________  will help creating trust and mutual understanding, enabling frankness between participants, the free exchange of ideas, and immediate feedback
- Disease prevention (Incorrect. Disease prevention activities focus on preventing a disease from developing. e.g. giving a pregnant woman iron supplements to prevent anemia.)
- Health screening activities (Incorrect. Health screening activities focus on routine testing of individuals to see if they are at risk of developing a health problem. e.g. taking the temperature, blood pressure and pulse of every pregnant woman at every antenatal visit.)
- Individual health education activities (Correct! Individual health education activities will help creating trust and mutual understanding, enabling frankness between participants, the free exchange of ideas, and immediate feedback)
A: Individual health education activities

Q: Health promotion is based on the assumption that:
- Everyone's health is their own business (Incorrect. Everyone's health should be everyone's problem)
- Individuals do not have a choice about their own health (Incorrect. Individuals do have a choice about their own health)
- Individuals may be influenced positively by both knowledge base and resource availability (Correct! Individuals or communities may be influenced positively by both knowledge base and resource availability)
- None of the above (Incorrect.)
A: Individuals may be influenced positively by both knowledge base and resource availability

Q: Group discussion is the most commonly used health education method
- True
- False
A: True

Q: Group Discussion is the most commonly used health education method
- True (Correct. Group Discussion is the most commonly used health education method)
- False (Incorrect.)
A: True

Q: Match the best answer to each question
- What are examples of health screening activities | taking the pregnant woman’s temperature and pulse, measuring her blood pressure, or testing her urine for the presence of sugar
- What are examples of disease prevention activities | giving pregnant women iron tablets to prevent anaemia, or giving out insecticide-treated bed nets to prevent malaria.
Also offered: Organising a health campaign to promote the uptake of antenatal care among pregnant women

Q: Health education, health screening, and disease prevention all contribute to health ______ activities
A: Promotion
Feedback ("Promotion"): Correct! Health education, health screening, and disease prevention all contribute to health promotion

Q: Why do you think the muscular walls of the uterus become thicker during pregnancy?
- So the woman is stronger and healthier during pregnancy (Incorrect. The thick uterine lining serves as another purpose during pregnancy)
- To support the growing fetus and the other contents of the uterus (Correct! A thicker layer of the muscle has the strength to support the growing fetus and the other contents of the uterus, which get heavier as pregnancy proceeds)
- To avoid infections of the uterus (Incorrect. The thick uterine lining serves as another purpose during pregnancy)
A: To support the growing fetus and the other contents of the uterus

Q: What is the name of the female reproductive organs that produce eggs or ova?
A: Ovaries / The ovaries / Ovary / The ovary
Feedback ("Ovaries"): Correct! The ovaries are paired female reproductive organs that produce eggs or ova
Feedback ("The ovaries"): Correct! The ovaries are paired female reproductive organs that produce eggs or ova
Feedback ("Ovary"): Correct! The ovaries are paired female reproductive organs that produce eggs or ova
Feedback ("The ovary"): Correct! The ovaries are paired female reproductive organs that produce eggs or ova

Q: The internal female reproductive system includes the __________
- ovaries, fallopian tubes, uterus, cervix and vagina (Correct! The internal female reproductive system includes the ovaries, fallopian tubes, uterus, cervix and vagina.)
- ovaries, fallopian tubes, uterus, vulva and urethra (Incorrect.Try again.)
- fallopian tubes, ovaries, cervix, perineum and vulva (Incorrect. Try again.)
A: ovaries, fallopian tubes, uterus, cervix and vagina

Q: What is another word for the external female genitalia?
A: vulva / the vulva / Vulva / The vulva

Q: The __________ contains the reproductive organs and bladder
- cavity (Incorrect. Try again.)
- fallopian tubes (Incorrect. Try again.)
- pelvic cavity (Correct! The pelvic cavity contains the reproductive organs and bladder)
A: pelvic cavity

Q: The typical ovarian cycle lasts 28 days
- True (Correct! This is the average duration)
- False (Incorrect. It is true. The typical ovarian cycle lasts 28 days.)
A: True

Q: There is a constant level of progesterone throughout the monthly cycle.
- True (Incorrect. It is False. Progesterone is present in significant amounts during the second half of the cycle only.)
- False (Correct. Progesterone is present in significant amounts during the second half of the cycle only.)
A: False

Q: Ovulation in a typical, or "average," cycle usually occurs on day:
A: 14 / Fourteen
Feedback ("14"): Correct! Ovulation occurs on day 14
Feedback ("Fourteen"): Correct! Ovulation occurs on day 14
Feedback ("28"): Incorrect. This is when menstruation occurs.

Q: Match the hormones of the female reproductive system with their function
- Follicle stimulating hormone (FSH) | produced by the pituary gland. It stimulates the development of the maturing ovarian follicle and controls ovum production
- Gonadotropin-releasing hormone (GnRH) | produced by the hypothalamus
- Leutenizing hormone (LH) | produced by the pituary gland. It stimulates the ovaries to produce oestrogen and progesterone
- Progesterone | produced during the second half of the ovarian cycle
- Oestrogen | produced during the first phase of the ovarian cycle

Q: Where is the GnRH hormone produced?
- Adrenal glands (Incorrect. The adrenal glands are endocrine glands that sit on top of the kidneys.)
- Pituitary gland (Incorrect. The pituitary gland secretes FSH and LH hormones.)
- Hypothalamus (Correct! The GnRH hormone is produced by the part of the brain called hypothalamus)
- Ovary (Incorrect. The ovaries secrete oestrogen and progesterone.)
A: Hypothalamus

Q: At which stage in the uterine cycle does the secretory phase occur?
- Days 1-5 (Incorrect. This is when the menstrual phase occurs.)
- Days 6-14 (Incorrect. This is when the proliferative phase occurs.)
- Days 15-28 (Correct! This is when the secretory phase occurs)
A: Days 15-28

Q: Which of the following are effects of increased levels of oestrogen in the proliferative phase of the uterine cycle?
- Hair thinning (Incorrect)
- Thickening of cervical mucus (Incorrect)
- Thinning of the endometrium (Incorrect)
- Thickening of the endometrium (Correct! The endometrium grows thicker and becomes more richly fed by blood vessels in preparation for the possibility of fertilisation or pregnancy)
A: Thickening of the endometrium

Q: Which of the following statements is true about menstruation?
- In a normal 28 day menstrual cycle, you would expect menstruation to last approximately three to five days (Correct! Menstruation or monthly bleeding usually occurs for three to five days)
- Absence of menstruation always indicates that the woman is pregnant (Incorrect. Some women may have more or fewer periods. Many factors can indicate a missed period such as stress, age, contraception, diet. Also, some women may have a menstrual cycle as short as 21 days or as long as 39 days.)
- During menstruation the entire endometrium is shed (Incorrect. Only the part of the endometrium that becomes thick and more richly supplied with blood vessels is shed)
A: In a normal 28 day menstrual cycle, you would expect menstruation to last approximately three to five days

Q: At which stage of the uterine cycle is the
- menstrual phase? | days 1-5
- proliferative phase? | days 6-14
- secretory phase? | days 15-28
Also offered: days 10-14; days 3-7

Q: Which of the following are 2 functions of progesterone?
- Initiation of the secretory phase of the uterine cycle (Correct!)
- It is produced by the hypothalamus in the brain (Incorrect)
- It is produced by the placenta during pregnancy (Incorrect)
- It causes increased production of oestrogen (Correct!)
A: Initiation of the secretory phase of the uterine cycle; It causes increased production of oestrogen

Q: At which stage of the ovarian cycle is the
- follicular phase? | days 1-14
- luteal phase? | days 15-28
Also offered: days 3-5; days 28-32
If wrong: Incorrect. Try again!

Q: At the end of the ovarian cycle, if a woman is not pregnant, the corpus luteum:
- disintegrates (Correct! The corpus luteum disintegrates after ovulation so as to begin the ovarian cycle all over again)
- migrates to the fallopian tubes to await the next menstrual cycle (Incorrect. The corpus luteum spends its entire 'existence' in the ovary.)
- attaches to the uterine lining (Incorrect. The corpus luteum spends its entire 'existence' in the ovary.)
A: disintegrates

Q: What is a blastocyst?
- stage of human development that consists of a hollow ball of cells after 5 days (Correct!)
- stage of human development that forms the early embryo (Incorrect. Try again.)
- stage of human development that forms a hollow ball of cells after three days (Incorrect.Try again.)
- stage of human development of a newborn baby (Incorrect. Try again,)
A: stage of human development that consists of a hollow ball of cells after 5 days

Q: The total number of people in your catchment area is 2,750. Calculate the total number of focused antenatal care (FANC) checkups you need to make in one year.
A: 440
Feedback ("440"): The total number of pregnant women is calculated as 4% of the population, which is 110 in a community of 2,750 people (2,750 x 4/100 = 110) If every pregnant woman receives 4 FANC visits, a total number of 440 visits will be needed in one year (110x4)
  Hint: Try again. First : calculate the total number of pregnant women-which is 4% of the population. Second: Multiply this by 4 (if every woman receives 4 FANC visits).

Q: Why is it important that you promote antenatal care to men also? Check three reasons.
- They may be the community leaders who will be listened to carefully (Correct!)
- Men can encourage and support their wives to take care of themselves during pregnancy and attend antenatal checkups (Correct!)
- So that they can attend antenatal check ups instead of their wives (Incorrect! The pregnant woman should always attend the antenatal check up and bring her husband if possible.)
- They can watch for danger symptoms and get help quickly if problems arise (Correct!)
- None of the above (Incorrect)
A: They may be the community leaders who will be listened to carefully; Men can encourage and support their wives to take care of themselves during pregnancy and attend antenatal checkups; They can watch for danger symptoms and get help quickly if problems arise

Q: [Image]

Label parts a, b, c and d
- a | vagina
- b | cervix
- c | uterus
- d | ovary
Also offered: fallopian tubes

Q: If two ova are released at the same time, the woman could become pregnant with twins
- True (True. If two ova are released at the same time, a woman could become pregnant with twins)
- False (Incorrect. It is true. If two ova are released at the same time, the woman could become pregnant with twins)
A: True

Q: If a pregnant woman drinks alcohol or takes drugs the fetus won't be harmed, because the placenta filters out all harmful substances.
- True (Incorrect. Alcohol and drugs can pass through the placenta and harm the fetus)
- False (Correct! Alcohol and drugs can pass through the placenta and harm the fetus)
A: False

Q: Why does a baby's head have to rotate as it passes through the pelvic canal?
- The fetal head has to rotate to get through the widest part of the pelvic outlet and then get through the widest past of the pelvic inlet. (Incorrect. The pelvic inlet is the space where the baby's head enters the pelvis and the pelvic outlet is where the baby's head emerges from the pelvis.)
- The fetal head has to rotate so that the baby's shoulders and the rest of the body can come first and the baby's head last. (Incorrect. The largest part of the fetus is the skull so the head rotates first.)
- The fetal head has to rotate to get through the widest part of the pelvic inlet and then get through the widest past of the pelvic outlet. (Correct!The fetal head has to rotate to get through the widest part of the pelvic inlet and then get through the widest past of the pelvic outlet.)
A: The fetal head has to rotate to get through the widest part of the pelvic inlet and then get through the widest past of the pelvic outlet.

Q: A normal or broad pelvis is harder for the baby to pass through during delivery whereas a narrow pelvis is easier for the baby to pass through.
- True (Incorrect. A narrow pelvis can obstruct the baby as it moves down the birth canal.)
- False (Correct! It is False. A broad pelvis makes it easier for the baby to pass through and a narrow pelvis can obstruct the baby as it moves down the birth canal.)
A: False

Q: What is the widest measurement of pelvic outlet, in cm
A: 12.5
Feedback ("12.5"): Correct! The widest measurement of the pelvic outlet from top to bottom is 12.5cm

Q: ___________  _____________ is the most common and safest presentation of a baby's head for a normal vaginal delivery.
A: vertex presentation / Vertex Presentation / Vertex presentation
Feedback ("vertex presentation"): Correct! Vertex presentation-where the top of the baby's head is the presenting part-is the most common and safest presentation for a normal vaginal delivery
Feedback ("Vertex Presentation"): Correct!Vertex presentation-where the top of the baby's head is the presenting part-is the most common and safest presentation for a normal vaginal delivery
Feedback ("Vertex presentation"): Correct!Vertex presentation-where the top of the baby's head is the presenting part-is the most common and safest presentation for a normal vaginal delivery

Q: Compared to the male pelvis, females have a broader and flatter pelvis
- True (Correct! Compared to the male pelvis, females have a broader and flatter pelvis)
- False (Incorrect. Compared to the male pelvis, females do have a broader and flatter pelvis)
A: True

Q: [Image]

Choose the correct label for parts a and b
- a | pelvic brim
- b | sacrum
Also offered: frontal suture; fontanel; pelvic inlet; pelvic outlet

Q: The hormone [...] plays an important role in the development of the fetus, by promoting maternal blood flow within the uterus and the placenta.
A: oestrogen
  Hint: It is one of the chief hormones throughout pregnancy
  Hint: It is one of the two chief hormones throughout pregnancy

Q: After about [...] weeks of pregnancy, the fundus can be felt at the height of the woman's belly button.
A: 20
  Hint: more than 16 weeks
  Hint: less than 26 weeks

Q: Why does the workload of the heart have to increase during pregnancy?
- Because more blood is pumped only through to the fetus (Incorrect. Not only the fetus has to receive more blood)
- Because the heart has to work harder after pregnancy - during breastfeeding (Incorrect. The heart has to work harder during pregnancy)
- Because blood is pumped through the placenta, fetus, the uterus and abdomen (Correct! The heart has more work as it has to pump blood through the placenta, fetus, and the larger uterus and abdomen)
A: Because blood is pumped through the placenta, fetus, the uterus and abdomen

Q: The increase in blood volume is caused by which two changes?
- Increase in the number of red blood cells in the circulation (Correct!)
- Increase in oestrogen and progesterone (Incorrect.)
- Increase in the volume of blood plasma (the fluid part of the blood) (Correct!)
- Increase in iron levels (Incorrect.)
A: Increase in the number of red blood cells in the circulation; Increase in the volume of blood plasma (the fluid part of the blood)

Q: The Blood Pressure during pregnancy is usually higher, as the muscular walls of the blood vessels contract slightly.
- True (Incorrect. It is false. The muscular walls of the blood vessels relax slightly and hence the same volume of blood has more space in which to circulate, causing a lower blood pressure.)
- False (Correct! It is false. The muscular walls of the blood vessels relax slightly and hence the same volume of blood has more space in which to circulate, causing a lower blood pressure.)
A: False

Q: Which exercises are generally recommended for pregnant women?
- Running in hot weather (Incorrect. Exercise in hot weather makes a pregnant woman breathless)
- Walking, swimming, yoga (Correct. These are mild exercises that are good in preparing the body for labour)
- Exercise during pregnancy is best avoided (Incorrect. Mild exercise can help the woman's body prepare for labour)
- Doing exercises by lying flat on her back (Incorrect. A woman should not do exercises where she is lying on her back, due to the compression of major blood vessels returning blood to her heart.)
A: Walking, swimming, yoga

Q: A pregnant woman gained 2 kg in the first 20 weeks of pregnancy, then 0.5 kg a week for the next 10 weeks, then 0.1 kg for the last 10 weeks. What is her total weight gain in kg at full term?
A: 8
Feedback ("8"): Correct! She gained a total of 8kg. It is not possible to tell whether this slow weight gain near the end of pregnancy is a sign that the fetus is not developing normally, but it should certainly be investigated at a health facility. Some women have normal pregnancies without gaining much weight, but in others it is a sign of intrauterine growth restriction (IUGR) of the fetus.
  Hint: Try again! Calculate: 2 (kg) + 0.5(kg)x10 (weeks) + 0.1(kg) x 10 (weeks)

Q: If a woman doesn’t have enough [...] in her body, she won’t be able to make enough red blood cells, so her [...] could become serious.
A: iron; anaemia
Feedback: The increase in blood volume exceeds the increase in red blood cells, so they are diluted in the much larger volume of blood plasma, causing physiological anaemia. This is one reason why iron supplementation is so important in pregnancy.

Q: What substance do the breasts begin to produce by the 16th week (during the second trimester)?
A: colostrum / Colostrum
Feedback ("colostrum"): Correct! Colostrum is the precursor of breastmilk. It is a yellowish secretion from the nipples, which thickens as pregnancy progresses.
Feedback ("Colostrum"): Correct! Colostrum is the precursor of breastmilk. It is a yellowish secretion from the nipples, which thickens as pregnancy progresses.

Q: A reduction in blood flow back to the heart may lead to [...] - swelling due to fluid collecting in the legs and feet.
A: oedema
Gap 1 offers: oedema; colostrum; anaemia

Q: A possible symptom of pregnancy is frequent uriniation
- True (Correct! It is true. Women often report needing to urinate more frequently during the first three months and last one or two months of pregnancy.)
- False (Incorrect. It is true. Women often report needing to urinate more frequently during the first three months and last one or two months of pregnancy.)
A: True

Q: Mrs. Y is pregnant and you are seeing her for her first antenatal check up.

You need to take her health history in order to plan her antenatal care.

What are the questions you should ask to asses whether she has any risk factors that could lead to complications?
- How old is she? (Correct!)
- How many children has she had? (Correct!)
- Has she had any miscarriages? (Correct!)
- Has she ever had an abortion? (Correct!)
- Has she had any problems with pas pregnancies or births? (Correct!)
- Was she depressed before birth? (Incorrect. The correct question is whether she was sad or depressed after birth.)
- None of these (Incorrect)
A: How old is she?; How many children has she had?; Has she had any miscarriages?; Has she ever had an abortion?; Has she had any problems with pas pregnancies or births?

Q: Dizziness or fainting may be a sign of anaemia
- True (Correct. It is true. Signs of anaemia include dizziness or fainting)
- False (Incorrect. It is true. Signs of anaemia include dizziness or fainting)
A: True

Q: Having a large baby may be a sign that the mother has [...]
A: diabetes

Q: A woman should be advised to have her baby in a hospital if:
- She bled heavily in a past pregnancy or birth (Correct.)
- she is older than 18 years old (Incorrect. A woman can have her baby at home, hospital or in the health centre, regardless of her age.)
- she experiences a lot of nausea and vomiting during the first three months (Incorrect. it is normal to experience nausea and vomiting during the first three months)
- she has heart problems, liver disease, diabetes, HIV/AIDS. (Correct. If a woman is sick with these problems, she should be advised to get medical help to plan for her needs during pregnancy and decide if she should give birth in a hospital)
- she has had a previous caesarean surgery (Correct. It is safest for a woman who has had a previous caesarean to give birth in a hospital again next time.)
A: She bled heavily in a past pregnancy or birth / she has heart problems, liver disease, diabetes, HIV/AIDS. / she has had a previous caesarean surgery

Q: A pulse rate of 100 when resting is normal for a pregnant woman,
- True (Incorrect. It is false. The normal pulse rate is between 60 and 80 beats a minute. A resting pulse rate of a 100 is a warning sign.)
- False (Correct! It is false. The normal pulse rate is between 60 and 80 beats a minute. A resting pulse rate of a 100 is a warning sign.)
A: False

Q: How many kg per month is a normal weight gain towards the end of pregnancy?
A: 1 / 2

Q: There is no advice you can give to a pregnant woman who has diabetes
- True (Incorrect. It is false. You can advise her to eat small healthy meals frequently, avoid sugar, and give birth in a hospital.)
- False (Correct. It is false. You can advice her to eat small healthy meals frequently, avoid sugar, and give birth in a hospital)
A: False

Q: Which of these are possible signs of pregnancy
- Missing a menstrual period (Correct)
- Nausea and vomiting (Correct)
- Pregnancy test for human chorionic gonadotropin (HCG) (Correct)
- Low back pain (Incorrect. It is not a common sign of pregnancy)
- Bleeding (Incorrect. There shouldn't be any bleeding during pregnancy. If there is, this is a danger sign and she could be having a miscarriage)
- Abdominal enlargement (Correct)
- Frequent urination (Correct)
A: Missing a menstrual period; Nausea and vomiting; Pregnancy test for human chorionic gonadotropin (HCG); Abdominal enlargement; Frequent urination

Q: [...] is a serious condition characterised by high blood pressure (hypertension), swelling of the hands, feet, and even the face, and significant amounts of protein in the urine. It usually develops in the last [...] months of pregnancy.
A: pre-eclampsia / Pre-eclampsia; 3 / three

Q: Identify whether each condition is a risk factor of pregnancy or a symptom of pregnancy
- Previous miscarriage | Risk factor
- Chloasma (mask of pregnancy) | Symptom
- Gave birth previously | Risk factor
- Had an abortion previously | Risk factor
- Frequent urination | Symptom
Also offered: None

Q: Match each of the diagnoses with its associated warning or symptom
- Pre-eclampsia | high blood pressure
- Anaemia | pallor
- Goitre | neck swelling
- Malaria | fever
- Diabetes | larger uterus than expected

Q: What pulse rate is a possible sign of anaemia?
- 80 beats per minute (Incorrect.This is a normal pulse rate)
- 60 beats per minute (Incorrect.This is a normal pulse rate)
- 100 beats per minute or more (Correct! 100 beats or more per minute can be a sign of anaemia)
- 96 beats a minute (Incorrect. This is a higher than normal pulse rate but not necessarily a sign of anaemia)
A: 100 beats per minute or more

Q: [Image]

Blood pressure and pulse rate should be measured when the woman is sitting comfortably
- True (Correct. it is True. When measuring blood pressure and pulse rate, the woman should sit comfortably and relaxed)
- False (Incorrect. it is True. When measuring blood pressure and pulse rate, the woman should sit comfortably and relaxed)
A: True

Q: At an antenatal visit to see Zufan, you record the following measurements:

- Temperature: 37.2°C
- Pulse rate: 96 beats a minute
- Blood pressure: 142/100 mmHg

Should you refer Zufan to a health centre?
- No. The recordings are all normal. (Incorrect. A temperature of 37.2°C is normal. 96 beats per minute is quite high. The blood pressure is above the warning level of 140/90.)
- Maybe. The temperature is not a fever so I might decide not to refer Zufan immediately. (Incorrect. A temperature of 37.2°C is normal but 96 beats per minute is quite high. The blood pressure is above the warning level of 140/90.)
- Yes (Correct! You must refer Zufan immediately. A temperature of 37.2°C is normal. 96 beats per minute is quite high. The blood pressure is above the warning level of 140/90.)
A: Yes

Q: What temperature is this thermometer showing?

[Image]
A: 39.6 / 39.5
Feedback ("39.6"): Correct. This person has a fever.
Feedback ("39.5"): Correct. This person has a fever

Q: Which example shows a high blood pressure (hypertension)?
A: b
Feedback ("b"): Correct. A high blood pressure is more than 140/90. You must refer her to a health centre if it continues to be high.

Q: Which example shows a low blood pressure?
A: d
Feedback ("d"): Correct. A blood pressure of 90/50 or lower is a low blood pressure and cause for concern. You must refer her to the nearest health centre.

Q: Which example shows a normal blood pressure?
A: a / c
Feedback ("a"): Correct. A normal blood pressure stays between 90/60 and below 140/90
Feedback ("c"): Correct. A normal blood pressure stays between 90/60 and below 140/90

Abebech is a pregnant woman, whose duration of gestation based on her last normal menstrual period (LNMP) is six months. When you examine her, you can feel that the fundus is four finger-widths above her bellybutton and you can hear a fetal heartbeat clearly.

Q: What might be the 4 possible reasons for Abebech's uterus to be larger than expected ?
- The date of the LNMP might be incorrect (Correct. Sometimes women do not remember the date of their LNMP correctly or she might miss her menstruation for another reason and then gets pregnant later.)
- She has a poor diet (Incorrect. A poor diet may result in a smaller uterus than expexted.)
- There is too much amniotic fluid surrounding the baby (Correct. Too much water or amniotic fluid might cause the uterus to stretch too much.)
- She might be carrying twins (Correct. If you feel two heads or bottoms when you feel the mother's abdomen - and if you can hear two heartbeats- it means she is pregnant with twins.)
- She may be drinking alcohol or smoking cigarettes (Incorrect. These can cause the baby or uterus to be too small.)
- She may have a high blood pressure (Incorrect. This can keep the baby from getting the nutrition it needs to grow well.)
- She may have diabetes (Correct.Other signs of diabetes are: one of her previous babies was born very big. she is fat. she is thirsty all the time. she has frequent itching and a bad smell coming from her vagina. he wounds heal slowly. she has to urinate more often than other pregnant woman. she has sugar in her urine when you do the dipstick test.)
A: The date of the LNMP might be incorrect; There is too much amniotic fluid surrounding the baby; She might be carrying twins; She may have diabetes

Look at the diagrams a) and b). Then answer the questions.

[Image]

Q: How many months of pregnancy do you think diagram a) shows?
A: 5 / 4.5
Feedback ("5"): Correct. The woman is about 4.5-5 months pregnant
Feedback ("4.5"): Correct. The woman is about 4.5-5 months pregnant
Feedback ("4"): Try again!

Q: How many months of pregnancy do you think diagram b) shows?
A: 6.5 / 7
Feedback ("6.5"): Correct! She is about 6.5-7 months pregnant (three fingers above the belly button)
Feedback ("7"): Correct! She is about 6.5-7 months pregnant (three fingers above the belly button)
Feedback ("6"): Try again!

Q: How would your record the measurement shown in figure a)
A: -2
Feedback ("-2"): Correct. A minus sign is put in front of the number if the top of the uterus is below the bellybutton
Feedback ("2"): Incorrect

Q: How would you record the measurement in figure b) ?
A: +3
Feedback ("+3"): Correct! A plus sign is put in front of the number if the top of the uterus is above the bellybutton
Feedback ("3"): Try again!

Q: What might be 2 limitations that affect the accuracy of the finger method for estimating gestational age?
- There is a big variation in the thickness of our fingers (Correct! Even if the same health worker measures the fundal height of the same woman several times on the same day, the answer might be different each time. This is because the variation in the thickness of our fingers could cause up to 3 weeks difference between the fundal height measurement of the same woman made by two different health workers.)
- Because measuring the fundal height using a soft measure tape is more accurate (Incorrect. This is not the reason why the fundal height measurement using the finger method might not be accurate)
- The distance between the pubic bone and bellybutton is already different in each woman when they are not pregnant (Correct! This variation affects the accuracy of the fundal height measurement.The distance between the pubic bone and bellybutton is 20cm at 20 weeks gestation, but it can be as long as 30cm and as short as 14cm.)
- None of the above (Try again!)
A: There is a big variation in the thickness of our fingers; The distance between the pubic bone and bellybutton is already different in each woman when they are not pregnant

Q: The [...] is the domed region at the top of the uterus.

When you are measuring how high the top of the uterus has reached in the mother's abdomen, you are measuring the [...].
A: fundus; fundal height

Q: At about [...]months, the top of the uterus is usually just above the mother's pubic bone.

At about [...] months, the top of the uterus is usually right at the mother's bellybutton.

At about [...]  to [...]  months, the top of the uterus is almost up to the bottom of the mother's ribs.
A: 3 / three; 5 / five; 8 / eight; 9 / nine

Meron is 20 years old, pregnant with her first child. She appears healthy and has no history of major health problems.

You see her for the first FANC visit when she thinks she is 4 months pregnant, based on her LNMP date. You estimate the gestational age of the fetus using the finger method, and find that the fundal height is two finger-widths below Meron's bellybutton.

Three months latewr, when you see Meron again for a second FANC visit, the fundal height has increased to two finger-widths above Meron's bellybutton.

Q: The gestational age measured using the finger method matches the gestational aged based on the LNMP date at the first visit.
- True (Correct! It does match. At the first visit. the gestational age estimated from the fundal height is two finger-widths below Meron's bellybutton, which matches the gestational age of 4 months based on her LNMP)
- False (Incorrect. It does match. At the first visit. the gestational age estimated from the fundal height is two finger-widths below Meron's bellybutton, which matches the gestational age of 4 months based on her LNMP)
A: True

Q: The gestational age measured using the finger method matches the gestational aged based on the LNMP date at the second visit.
- True (Incorrect. It does not match. At 7 months, the fundal height should be four finger-widths above the bellybutton (and not two finger-widths))
- False (Correct! It does not match. At 7 months, the fundal height should be four finger-widths above the bellybutton (and not two finger-widths))
A: False

Q: What might be the reasons why Meron's uterus may be smaller than expected during the second visit?
- She might have diabetes (Incorrect Diabetes could lead to the baby-and uterus-being bigger than usual)
- She might have a high blood pressure (hyertension) (Correct! A high blood pressure can lead to a smaller baby-and uterus as it may reduce nutrition getting to the baby for normal growth.)
- There is too much amniotic fluid surrounding the fetus (Incorrect. A smaller uterus may be a sign that there is too little amniotic fluid.)
- Her LNMP date may be wrong (Correct! Her LNMP date may be wrong and she is only 6 months pregnant.)
- She might not be eating enough nourising food (Correct! It is necessary to eat enough nourishing food to help the baby grow normally.)
A: She might have a high blood pressure (hyertension); Her LNMP date may be wrong; She might not be eating enough nourising food

Q: The fetal heart rate is normally between [...] and [...] beats a minute
A: 120; 160

Q: If the fetal hearbeat sounds loudest below the mother's bellybutton, the fetal lie is probably breech
- True (Incorrect. It is false. In a breech presentation, the fetal heartbeat sounds loudest above the mother’s bellybutton.)
- False (Correct!In a breech presentation, the fetal heartbeat sounds loudest above the mother’s bellybutton.)
A: False

Eritrea comes for her fourth FANC checkup when is is 8.5 months pregnany. When you feel the lower part of her abdomen, you can feel a round shape that you can 'rock' from side to side without moving the rest of the baby's body. When you gently push the upper part of the abdomen from side to side, you can feel the whole of the baby's body move from side to side. Eritrea tells you she mostly feels strong kicks from the baby near the top of her belly.

Q: What is the probable fetal lie of Eritrea's baby at the fourth FANC visit?
- Breech (Incorrect. Gently pushing the top of the abdomen from side to side moves the whole of Eritrea's baby from side to side. If it was in breech position, only the baby's head would move when you do this.)
- Sideways (Incorrect. If you feel that the ends of the baby are on the mother's sides, the baby is probably lying sideways.)
- Vertical with its head down (Correct! The baby is lying vertically, with its head down- as you feel a round shape at the lower part of her abdomen. Also, Eritrea feels strong kicks near the top of her abdomen, which are probably from the baby's feet.)
A: Vertical with its head down

Q: When you feel Eritrea's abdomen for a large, hard shape (the baby's back), then the baby is facing the mother's [...].

If you feel a lot of small lumps instead of a large, hard shape, it probably means that you are feeling the baby's arms and legs, which tell you that it is facing the mother's [...]
A: back; front

Marcia came for her antenatal check-up at the 8th month of pregnancy. When you felt her abdomen, you found a hard, round mass in the fundus of the uterus, and a soft, irregular, bulky mass towards the pubic bone. Marcia told you that in the past week the baby's kick had decreased, and when you listened to her abdomen with a fetoscope, you could not hear the baby's heartbeat.

Q: What is the probably fetal lie of Marcia's baby at the 8th month of pregnancy?
- Vertical with its head up (Breech) (Correct!The hard, round mass in the fundus of the uterus is most likely to be the baby’s back, and the soft irregular shapes towards the pubic symphysis are its arms and legs. This is a vertical lie.)
- Sideways (Incorrect.If the ends of the babys seem to be in the mother's sides, it would be lying sideways.)
- Vertical with its head down (Incorrect. If you felt hard, round mass towards the pubic bone it would probably mean it was lying vertically, with its head down)
A: Vertical with its head up (Breech)

Q: The [...] part in this case is the presenting part (the part of the baby that is pointing into the cervix of the uterus)
A: bottom

Q: Where would you listen to the fetal heartbeat to confirm your diagnosis of how Marcia's baby is presenting?
- Below her bellybutton (Incorrect. This is where you would check if you thought the baby would be in a vertical position with its head down as its heartbeat would sound loudest there.)
- At the bellybutton (Incorrect. Try again)
- Above her bellybutton (Correct! If the baby is vertical with its head up (breech), its heartbeat would sound loudest there.)
A: Above her bellybutton

Q: You suspect that Marcia's baby may be sick or even dead.
- True (Correct. It is true. You couldn't hear a heartbeat with a fetoscope and the baby's kick had decreased. So your diagnosis would be that the baby may be sick or even dead. Marcia has to be referred to a hospital or health facility straight away.)
- False (Incorrect. It is true. You couldn't hear a heartbeat with a fetoscope and the baby's kick had decreased. So your diagnosis would be that the baby may be sick or even dead. Marcia has to be referred to a hospital or health facility straight away.)
A: False

Q: Abebech is a pregnant woman, whose duration of gestation based on her last normal menstrual period (LNMP) is six months. When you examine her, you can feel that the fundus is four finger-widths above her bellybutton and you can hear a fetal heartbeat clearly. What is your assessment of the gestational age in months of Abebech’s baby using fundal height measurement?
A: 7
Feedback ("7"): Correct. The gestational age based on the fundal height measurement is seven months.

Q: How many centimetres would Abebech’s abdomen measure from her pubic bone to the top of her uterus in order to confirm your fundal height measurement?
A: 28:2
Partly right: 28:27 (10%)
Feedback ("28:2"): Correct. If Abebech is really seven months pregnant, you would expect her abdomen to measure about 28 cm from her pubic bone to the top of the uterus, i.e. approximately one centimetre for each week of pregnancy dated from the LNMP. Remember the measurement may range from 26-30 cm.
Feedback ("28:27"): Try again!

Q: Is the gestational age of Abebech’s baby based on fundal height measurement consistent with the gestational age calculated from her LNMP?
- true (It is false.The gestational age based on fundal height is one month more than expected from the date of the LNMP. Therefore, the uterus is bigger than expected from the date of the LNMP.)
- false (Correct! It is false. The gestational age based on fundal height is one month more than expected from the date of the LNMP. Therefore, the uterus is bigger than expected from the date of the LNMP.)
A: false

Q: Listening to the fetal heartbeat using a stethoscope is called auscultation.
- true (Correct! Listening to the fetal heart beat using a stethoscope is called auscultation.)
- false (It is true. Listening to the fetal heart beat using a stethoscope is called auscultation.)
A: true

Q: When the fetal head is down and the bottom of the fetus is up in the fundus, it is called a vertical lie.
- true (Correct! When the fetal head is down and the bottom of the fetus is up in the fundus, it is called a vertical lie.)
- false (It is true. When the fetal head is down and the bottom of the fetus is up in the fundus, it is called a vertical lie.)
A: true

Q: In a vertex presentation, the presenting part is the baby’s bottom.
- true (It is false. In a vertex presentation, the presenting part is the baby’s head.)
- false (Correct! It is false. In a vertex presentation, the presenting part is the baby’s head.)
A: false

Q: Match each disorder with its correct management
- Haemorrhoids | Eat fruits & vegetables, take a bath
- Insomnia | Drink herbal teas that help her to sleep
- Leg cramps | Flex the foot and gently stroke the leg
- Mild headache | Take 2 paracetamol tablets with water
- Varicosities in the legs | Put the feet up and wear strong stockings
- Sweating a lot | Dress in lightly, bathe frequently, & use a fan
- Mild nausea | Drink mint, cinnamon or ginger tea
- Constipation | Eat fruits and vegetables and drink a lot

Q: Many neonatal deaths can be prevented by which 3 interventions:
- Improving maternal health and nutrition during pregnancy (Correct! Improving the mother's health and nutrition and ensuring timely antenatal visits is critical to health and survival of both the mothers and their newborn)
- Giving the newborn baby nutritious foods (Incorrect! Breastmilk is by far the best food for a baby as soon as he is born.)
- Ensuring clean and safe delivery (Correct! Clean and safe delivery will prevent infections of both the mother and the baby. Should complications arise, referring the mother to the nearest health facility will save both her and the baby.)
- Gently massaging the baby (Incorrect. A massage may be beneficial for the baby later but it certainly will not prevent newborn death.)
- Providing immediate postnatal care after delivery (Correct! Immediate postnatal care will promote breastfeeding and clean cord care - as well as preventing neonatal infections such as pneumonia, diarrhoea, malaria.)
A: Improving maternal health and nutrition during pregnancy; Ensuring clean and safe delivery; Providing immediate postnatal care after delivery

Q: Many maternal deaths can be prevented by referring the mother in a timely manner to quality obstetric care services in a hospital or health facility.

What 3 services can obstetric care provide that can save her life?
- Lifesaving drugs (Correct. Lifesaving drugs can help the mother if she has severe bleeding (postpartum haemorrhage), high blood pressure (pre-eclampsia and eclampsia) and maternal infection (sepsis).)
- Promote healthy nutrition (Incorrect. Promoting healthy and adequate nutrition for the mother is important but is not the primary function of obstetric care services at the hospital or health facility.)
- Perform Cesarean sections (Correct. Cesarean sections can be lifesaving if there are complications during labour.)
- Antibiotics and transfusions (Correct. Antibiotics can treat sepsis or other severe infections (e.g. Pneumonia))
- All of the above (Incorrect. Try again)
A: Lifesaving drugs; Perform Cesarean sections; Antibiotics and transfusions

Q: A child born in a least developed country is almost 14 times more likely to die during the first 28 days of life than one born in an industrialised country
- True (Correct! It is true according the the UNICEF report on the State of the World's Children Report 2009 (http://www.unicef.org/sowc09/index.php))
- False (Incorrect. It is true according the the UNICEF report on the State of the World's Children Report 2009 (http://www.unicef.org/sowc09/index.php))
A: True

Q: This is a pregnant woman's blood pressure record. Which example below matches with a,b,c,or d ?

[Image]
- High blood pressure | b
- Low blood pressure | d
- Normal blood pressure | c

Q: [Image]

Which sign is shown on this pregnant woman?
- Mask of pregnancy (Incorrect.)
- Stretch marks (Incorrect.)
- Linea Nigra (Correct!)
A: Linea Nigra

Q: Why is it important for Community Health Workers to identify and assist all pregnant women in the community?
- Because she could save 1000's of lives (Incorrect.)
- Because all mothers and newborns are vulnerable and need care (Correct!)
- So she can find a better job in another city or country (Incorrect. Try again)
A: Because all mothers and newborns are vulnerable and need care

Q: [Image]

A pregnant woman comes to you complaining that her feet and ankles swell up during the day.

What advice should you give her? There are three right answers.
- Bathe feet 2 or 3 times a day in warm water (Incorrect.)
- Put her feet up for a few minutes at least 2 or 3 times a day (Correct!)
- Avoid eating packaged foods that are very salty (Correct!)
- Drink soda (Incorrect. Try again.)
- Drink more water or fruit juices (Correct!)
A: Put her feet up for a few minutes at least 2 or 3 times a day; Avoid eating packaged foods that are very salty; Drink more water or fruit juices

Q: What is the medical name given for cravings during pregnacny?

[Image]
A: Pica
Feedback ("Pica"): Correct! The medical name for clay soil cravings is called PICA

Q: What should you advise a pregnant woman who is craving to eat clay soil

Encourage her to:
- Drink plenty of water (Incorrect)
- Drink ginger tea (Incorrect)
- Eat foods high in carbohydrates (Incorrect.)
- Eat foods high in iron and calcium (Correct! Encourage her to eat iron-rich foods like chicken, fish, pumpkin, beans, peas, meat and whole grain products and calcium-rich foods like yellow vegetables, milk, curd, yogurt, cheese, and green leafy vegetables)
A: Eat foods high in iron and calcium

Q: Sleepiness and insomnia, headaches, changing feelings and emotions, worry and fear, strange dreams and nightmares, forgetfulness - belong to which category of minor pregnancy disorders?
- Cardiovascular disorders (Incorrect. Try again)
- Skin disorders (Incorrect. Try again.)
- Gastrointestinal disorders (Incorrect. Try again)
- Nervous system disorders (Correct!)
A: Nervous system disorders