MBBS OSCE · Obstetrics & Gynaecology
OSCE — Miscarriage & Recurrent Pregnancy Loss
Eight-minute OSCE station on Miscarriage & Recurrent Pregnancy Loss: 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 Miscarriage & Recurrent Pregnancy Loss.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags. [1]
Clinical context
Miscarriage is the spontaneous loss of a pregnancy before viability (UK: until 24 weeks). Pooled risk is 15.3 percent of recognised pregnancies.[1][2] The clinical types are distinguished by the cervical os and ultrasound viability: threatened (bleeding, closed os, viable fetus), inevitable (bleeding, open os), incomplete (partial passage, open os, ongoing bleeding), complete (all passed, closed os), missed (fetal demise, retained), and septic (infection — an emergency). Recurrent pregnancy loss (RPL) is 3 or more consecutive first-trimester losses. The commonest cause overall is chromosomal abnormality of the conceptus; the most important treatable cause of recurrent miscarriage is antiphospholipid syndrome (aspirin plus heparin).[1][2]
Candidate tasks
- Clarify onset, severity, associated features, and red-flag symptoms. [1]
- 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).
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 | Heavy bleeding with clots and cramping in early pregnancy - incomplete/inevitabl |
| Safety | Fever, pelvic pain, foul discharge in miscarriage - septic miscarriage; IV antib |
| Safety | Cervical dilatation with bulging membranes in 2nd trimester, painless - cervical |
| 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]
References2ShowHide
- [1]Quenby S, Gallos ID, Dhillon-Smith RK, et al. Miscarriage matters: the epidemiological, physical, psychological, and economic costs of early pregnancy loss Lancet, 2021.PMID 33915094
- [2]Royal College of Obstetricians and Gynaecologists The Investigation and Treatment of Couples with Recurrent First-trimester and Second-trimester Miscarriage Green-top Guideline No. 17, 2011.Source