Tutorial 3 October 2021

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10	Structured conversation. Labour ward scenario.
11	Structured conversation. Maternity Dashboard
12	Role-play. Prepregnancy counselling. Anaemia ↑ MCV

 

 

10.        Structured conversation, Labour ward scenario.

Candidate’s instructions.

You are the registrar on duty and responsible for the labour and gynae wards. You have just had the handover. Your task is to discuss the overall management of the wards with the examiner, to prioritise the patients and decide the allocation of staff to care for them.

This station was written for the first tutorial I ran for the OSCE exam when it was introduced more than 20 years ago. There are phrases and concepts that reveal this distant origin, but I have retained them for nostalgic reasons. I ran the tutorial on a Sunday afternoon when I was on-call and using what was happening on the labour and gynae wards that day.

Labour Ward. Sunday 13.00 hours.

1	Mrs JH	Primigravida. T+8. In labour. 6 cms.
2	Mrs AH	Primigravida at T. In labour. 5 cms.
3	Mrs. BH	Para 2. 30 days post delivery. 2ry. PPH > 1,000 ml. Hb. 9.3.
4	Mrs SB	Primigravida. 32/52 gestation. Admitted 30 minutes ago. Abdominal pain + 200 ml. bleeding. Nephrostomy tube in situ - not draining since this morning. Low placenta on 20 week scan.
5	Mrs KW	Para 1. In labour. Cx. 5 cm. Ceph at spines.
6	Mrs KT	Para 0+1. 38 weeks. SROM. Ceph 2 cm. above spines. Clear liquor.
7	Mrs TB	Para 1. T+4. Clinically big baby. Cx fully dilated for 1 hour. Early decelerations.
8	Mrs RJ	Primigravida. Epidural. RIF pain. Cx fully dilated for 1 hour. Shallow late decelerations. OT position. Distressed ++. BP /105. ++ protein. Urine output 50 ml in past 4 hours.
9	Mrs KC	Transfer from ICU. 13 days after delivery of 32 week twins. Laparotomy on day 7 for pelvic pain and fever. Infected endometriotic cyst removed. IV antibiotics changed to oral.

Gynaecology ward.

8 major post-operative cases who have been seen on the morning ward round and are stable. The husband of a patient who had Wertheim's hysterectomy on the Friday was asking to see a doctor for a report on the operation.

1	Mrs JB	10 week incomplete miscarriage. Hb. 10.8. Moderate fresh bleeding.
2	Ms AS	19 years old. Nulliparous. Just admitted with left iliac fossa pain. Scan shows unilocular 5 cm. ovarian cyst.

Medical staff:

Consultant at home. Registrar - you.

Senior House Officer with 12 months experience.

Registrar in Anaesthesia.

Consultant Anaesthetist on call at home.

Midwifery staff:

Senior Sister.   Trained to take theatre cases. Able to site IV infusions and suture episiotomies and tears.

3 staff midwives. 1 trained to take theatre cases. Two able to site IV infusions.

1 Community midwife looking after Mrs. KW.

2 Pupil Midwives.

 

10.        Structured conversation. Maternity dashboard.

Candidate’s instructions.

This is a viva station about the RCOG’s maternity dashboard. The examiner will ask you 14 questions.

When you have finished a question, you will not be allowed to return to it as later questions may indicate the answer. If you return, no marks will be awarded, even for correct answers.

 

11.        Role-play. Prepregnancy counselling.

Candidate’s instructions.

This is a role-play station. You are a SpR 5 and running the pre-pregnancy counselling clinic. You are about to see Philomena Blott.

GP referral letter.

Health Horizons,

34 Main Road,

Betterworld. BW9HJ.

 

Re Philomena Blott,

DOB: 11 January 1995,

57 Ward Way,

Betterworld. BW107HI.

 

Dear Doctor,

Please see Philomena who is planning her first pregnancy. Her health is good and she has no significant medical or surgical history. She had her first cervical smear recently and that was normal. She had the HPV vaccine at school, so I imagine that this was to be expected. She is a bit overweight and I have advised her about healthy eating in pregnancy.

I arranged some basic blood tests. She is immune to rubella. Her FBC shows her to be a bit anaemic: the Hb was 105 gm/l with an MCV of 105fL. I suspect that she is iron and folate deficient. I have given her a prescription for oral iron and 5mg. folic acid daily. She takes the combined oral contraceptive and I have suggested that she have a repeat FBC before she stops it I have said that if her Hb is normal it would then make sense to switch to a combined iron and vitamin preparation designed for pregnancy that she can get from her chemist.

She works in the Grand Hotel in the village. If you don’t know it, I should mention that it has a very good restaurant, which I can recommend; my favourite is their beef Stroganoff. Delicious! And their house red is excellent and good  value for money.

Her husband is a sales representative for a machine tool company and travels a lot, but he is home most evenings. They seem to get on well and there is no sniff of domestic abuse.

John Williams.