MBBS OSCE · Obstetrics & Gynaecology
OSCE — Antepartum Haemorrhage
Eight-minute OSCE station on Antepartum Haemorrhage: focused history, examination priorities, investigations, emergency and definitive management.
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Brief (to candidate)
You will assess a patient with a presentation consistent with Antepartum Haemorrhage.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags. [1]
Clinical context
Antepartum haemorrhage (APH) is bleeding from or into the genital tract from 24+0 weeks of pregnancy and prior to the birth of the baby (RCOG Green-top 63). Discriminate praevia (painless bright-red recurrent bleeding; no digital VE until ultrasound excludes praevia), abruption (painful woody-hard uterus; shock may exceed visible loss — introital blood may not represent the total, e.g. concealed abruption), and vasa praevia (bleeding at membrane rupture with sudden fetal compromise; Zhang pooled survival 98.6% with prenatal diagnosis versus 72.1% without). [1]
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms.
- State focused examination priorities.
- List first-line investigations and any named score/criteria.
- Give immediate resuscitation steps.
- Outline definitive management with doses/routes where standard.
- Name complications and disposition (ward / HDU / theatre / discharge safety-net).
- Mention one special-population modifier (pregnancy, child, elderly, CKD). [1]
Examiner checklist
| Domain | Pass behaviours |
|---|---|
| Definition | Correct working diagnosis language |
| Assessment | Focused, prioritised, red flags sought |
| Investigations | Appropriate first-line + interpretation |
| Emergency care | ABC / time-critical actions first |
| Definitive care | Specific drugs/procedures, not generic phrases |
| Safety | Painless bright-red bleeding after 24 weeks - placenta praevia; ultrasound, NO d |
| Safety | Painful, tense woody uterus with dark bleeding and fetal distress - placental ab |
| Safety | Bleeding at rupture of membranes with sudden fetal compromise (sinusoidal CTG) - |
| Communication | Clear plan and safety-netting |
Model outline
Lead with the working diagnosis and life threats. Resuscitate before definitive tests when unstable. Use guideline-standard therapy with named agents and doses. Document escalation criteria and follow-up. A safe candidate is specific, structured, and never delays critical care for non-urgent imaging. [1]
References3ShowHide
- [1]Royal College of Obstetricians and Gynaecologists Antepartum Haemorrhage: Green-top Guideline No. 63 RCOG, 2011.Source
- [2]Chen D, Gao X, Yang T, et al. Independent risk factors for placental abruption: a systematic review and meta-analysis BMC Pregnancy Childbirth, 2025.PMID 40140972
- [3]WOMAN Trial Collaborators Effect of early tranexamic acid administration on mortality, hysterectomy, and other morbidities in women with post-partum haemorrhage (WOMAN): an international, randomised, double-blind, placebo-controlled trial Lancet, 2017.PMID 28456509