I just noticed a little blood OSCE by Michael

 
You have 3 minutes reading time. This OSCE will run for a maximum of 7 minutes.

Scenario:

A 26yo female has presented with a small amount of fresh PV bleeding. She is pregnant. She has had a small amount of abdominal pain. Her abdomen is soft and non-tender. Her observations are all within normal limits and stable.

Instructions for the candidate

You are to take a history, discuss the possible causes of her bleeding and your plan for investigation and treatment.

Domains being examined

  • Medical Expertise
  • Prioritisation And Decision Making
  • Communication
  • Health Advocacy
  • Professionalism
 
The candidate has 3 minutes reading time. This OSCE is expected to run for a maximum of 7 minutes.

For the actor

You have been trying to get pregnant, and have confirmed this pregnancy on a urine test. You estimate your dates to be about 8 weeks. This is your second pregnancy - you had a previous miscarriage at 11 weeks. You have not yet had an ultrasound. You have no other medical conditions.

You have had a small amount of fresh blood, less than a pad. No clots or tissue.

Questions you might ask are:
- Ís there anything I'm doing to cause this?
- How likely is miscarriage?
- Do I need further investigations?

For the examiner

None.

Domains Assessment Objectives

Medical Expertise
Knowledge of causes and differentiation of PV bleeding in the first trimester.

Prioritisation And Decision Making
Appropriate suggested plan for investigation and treatment.

Communication
Clearly articulate likely causes and plan for differentiation.
Respond to emotional cues.

Health Advocacy
Encourage antenatal and ongoing follow up.
Ensure pregnancy preparation, such as vitamin supplementation.

Professionalism
Professional and empathetic approach

Other Assessment Notes

1. History
- relevant personal history
- adequate antenatal history (prior pregnancy / miscarriage, dates, scans, antenatal care)

2. Discuss and describe possible causes
- miscarriage (threatened, inevitable, complete)
- ectopic
- First trimester mostly due to genetic abnormalities

3. Discuss plan for further investigation
- Speculum examination
- Ultrasound
- Quantitative B-HCG

4. Discuss appropriate treatments for most likely causes
- Include anti-D
- Analgesia

Bonus:
- Follow up
- Investigation of recurrent miscarriage


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