OBGYN OSCE STATIONS COMPILATION

BY MUSANKABALA MJ

@ 2017

1. Manual Vacuum Aspiration (MVA)

Miss KM is 22 y/o referral from Mutendere whose LMP was eight weeks ago. She was
seen by a CO at Mutendere Clinic who made a diagnosis of incomplete abortion. You
repeat the VE and find that the uterus is anterverted, and is eight weeks in size and the
os open. Please perform an MVA.

Aspects being assessed

1. Greets the client, introduces self.
2. Confirms CC and Explains procedure to patient (Gets informed concert).
3. Check MVA syringe and charges it (establishes vacuum)
4. Puts on apron
5. Washes hand/hand scrub and puts on gloves
6. Positions pt in Lithotomy position and cleans perineum
7. (Puts on new gloves) and Inserts Cusco’s speculum
Checks the vagina and cervix for retained POC (Remove with sponge holding forceps)
8. Applies antiseptic solution to the cervix
9. Paracervical block done and puts tenaculum on cervix @ 12’oclock position
10. Identifies appropriate cannula
11. Inserts cannula gently into uterine cavity
12. Attaches prepared syringe to the cannula
13. Evacuates uterus by rotating and moving cannula back and forth within uterine cavity.
Empties Syringe by removing aspirate. Do not remove cannula.
14. Once uterus empty ( ) Withdraws cannula and removes forceps
15. Inspects cervix for bleeding
16. Repeats bimanual examination to check size and firmness of uterus
17. Continues talking to patient during procedure
18. Gives Oxytocin 10IU IM
19. Covers the client and reassures the patient
20. Washes hands
21. Post-abortal care (PAC), Abx, Analgesia.
22. Assesses after 2 hours, If vitals stable, allow home.
23. Review PRN at local clinic.
2. PAP SMEAR
Scenario: Mrs. Judy Mwale, an accountant by profession would like to be screened for
cervical cancer. She is 45 years old ,and has recently heard about the need for
women to be screened for cancer of the cervix

Task: 5 MINUTES

 Perform a cervical smear. You should inform the woman and the examiner
what you are doing as you go along
After 5 minutes you will be asked some questions by the Examiner

ASPECTS BEING ASSESSED POSSIBLE STUDENT

SCORE SCORE
1 Student introduces themselves using full name and 0.5
explains what they plan to do
2 Student performs an appropriate speculum
examination:
3 Ensures that the patient is comfortable 0.5
4 Discusses what the procedure will entail 2
5 Select a Cusco’s speculum and inserts appropriately 2
6 Demonstrates a clear view of the cervix 2
7 Taking a smear with Ayre’s spatula 1
8 Indicates what they would do with the specimen i.e 1
putting on slide, slide placed in alcohol based fixative.
9 Carefully removes speculum 1
10 Disposes of gloves and speculum in appropriate 1
instruments and waste disposal buckets
11 Examiner: Give candidate smear report. Can you
explain the smear report? 1
Smear shows abnormal result 1
The woman does not have cancer 1
The smear indicates a cytological diagnosis only and
needs further tests to establish histological diagnosis
12 Examiner, Ask - What is the most appropriate 2
investigation
Colposcopy or direct vision inspection of the cervix
(VIA)
13 Examiner, please explain to the woman what a 2
colposcopy/VIA involves
Examination of the transformation zone of the cervix
Application of stains (acetic acid and iodine)
Biopsy and treatment where needed
14 How often should a sexually active woman, with
previous normal Pap smear undergo a routine 2
screening?
Every 3 years
End of Exam 20
Total
 3. ACTIVE THIRD STAGE OF LABOUR
Scenario: Mrs Brenda Sialubanje has just delivered a baby boy. The baby is well . A
midwife has requested you to complete the third stage of labour for Mrs Sialubanje. Perform
Active Management of the Third Stage of Labour. 5 minutes.

ASPECTS BEING ASSESSED Possible Student

score score

1 Student introduces him/herself and explains what he/she is about to do 1

2 Student puts on apron, washes hands and puts on gloves 1

3 Students performs Active Management of Third Stage of Labour

 Gives Oxytocin10IU intramuscular within 1 minute of the 3

delivery of the baby

 Clamps the cord near the vulva with artery forceps 1

 Waits for the Uterus to contract (Left hand feels for contraction) 2

 Applies counter traction with the left hand on the uterus above 2
level of symphysis pubis

 Right hand grasps the forceps and cord and at same time applying 2
stead traction to the cord, in downward direction

 When placenta appears on vulva, grasps it with both hands and 1

rolls it, and delivers membranes. Placenta placed in receiver

 Massages uterus and expels and any blood clots 2

Q4 Examiner: What is the next important examination

A Examination of placenta and membranes for completeness 1

Q5 Examiner: Demonstrate the examination

A Student should explain nature of examination, to include the following:

 Holds cord with one hand and allow placenta and membranes to 1
hang down, and inspects for membrane completeness

 Places placenta on surface and checks whether all of the lobes are 2
present

 Inspects the cut end of cord for presence of 2 arteries and one vein 1
4. EXAMINATION OF THE PLACENTA
26 y/o just gave birth to a health 3.2 kg baby and this placenta. Examine the placenta
and do a running commentary during the examination.
i. Wash hands; wear an apron and gloves.
ii. The delivery trolley is a good surface to use.
iii. Lay out the placenta with the foetal surface uppermost – noting shape, size, colour
and smell.
iv. The cord is then examined noting the length (normal @ term=40-60cm), the point of
insertion, Warton jelly and the presence of any knots.
v. Count the vessels in the cut end of the cord (normal=2 arteries + 1 vein). [The
absence of one of the arteries can be associated with renal agenesis].
vi. Observe the foetal surface for irregularities.
vii. By lifting the cord and holding the placenta up, you can then observe the membranes
and inspect for completeness.
viii. The placenta is placed on a flat surface and the membranes are spread out in order to
look for extra vessels, lobes, or holes in the surface.
ix. The amnion is then pulled back towards the cord, thereby separating the membranes
to ensure that they are both present.
x. The placenta is turned over to inspect the maternal side.
xi. The cotyledons are examined to ensure that they are all present, noting any areas of
infarction or blood clots. (normal # = 15-20 cotyledons separated by septa).
xii. Weigh the placenta (normal @ term = 500-600grams).
xiii. Dispose of the placenta as per UTH guidelines. (*Dispose in Sluice room).
xiv. Clean away equipment.
xv. Remove gloves and dispose-off. Remove apron and Wash hands.
5. OBSTETRIC EXAMINATION (BREECH PRESENTATION)
Scenario: MADAME ZOE, 28-years-old, is in her first pregnancy. Her last normal
menstrual period was on 20/04/2013.Her midwife is concerned about the
presentation of the baby. Her blood pressure is 120/80 mmHg and the
urinalysis is normal. Perform a FULL obstetric palpation and answer questions
from the examiner. You are NOT required to examine any other part of the
abdominal system. 5 min then Qs.

ASPECTS BEING ASSESSED POSSIBLE

SCORE
1 Student introduces themselves using full name and explains what they 0.5
plan to do
2 Elicits the patient’s gestation 0.5
3 Places patient in comfortable semi-recumbent position 0.5
4 Exposes abdomen appropriately 0.5
5 Inspects and comments appropriately for positive and negative points 1
to include: abdomen distended, no linea nigra, no stretch marks, no
scars noted, no fetal movements, everted umbilicus
6 Measures the symphysial fundal height correctly (and blinds tape 1
during procedure)
7 Gives an appropriate measurement (between 35-39 cm) 2
8 Palpates the fetus appropriately. To include, assessment of lie, 2
presenting part and position.
9 Auscultates the fetal heart 2
10 Summarises findings: normal SFH, longitudinal lie, breech 2
presentation, normal fetal heart rate.
11 Has student followed sequences /order of examination 1
12 Examiner: At this point ask - What is the diagnosis? 2
(Suppose it is a breech presentation)
13 Examiner, Ask - What options does this woman have for the 2
delivery of her baby?
Elective caesarean section, external cephalic version, vaginal breech
delivery
14 Examiner, Ask – Why is a vaginal breech delivery not the most 1
appropriate course of action?
Identifies vaginal breech as not favoured due to poorer outcomes for
baby(increased perinatal mortality and morbidity)
15 Examiner: Please explain external cephalic version to the patient 1
and how it is performed?
Explanation to include: use of tocolysis, no anaesthetic used,
performed at term, external pressure to encourage baby to perform a
forward or backward roll. Safe for baby but it is monitored.
Uses appropriate communication skills, assessing understanding
using clear language, giving correct information
16 What is the preferred managed plan for a woman with breech if 1
ECV fails?
Elective caesarean section
6. CONTRACEPTION: INSERTION OF JADELLE
Mrs. R Musonda is a 30 year old who has 3 kids. She is not very sure whether she wants
more children and she opts for a long term contraceptive. After counseling
She settles for implants and you have been called to insert jadelle.

Aspects being assessed Possible Students

score score
Greets client and introduces self 1
Explains procedure to patient 1
Asks about allergies to antiseptic solution and local anesthesia 1
Checks to be sure that the arm is clean 1
Determine insertion area by measuring 8cm above elbow fold 1
Determine that instruments are present 1
Wash hands with soap and puts on sterile gloves 1
Apply antiseptic to Incisional area 1
Prepares 1% lignocaine and injects it under the skin 1
Make a shallow 2mm incision just under the skin 1
Insert trocar & plunger though incision with bevel facing up 1
Slowly and smoothly advance trocar and plunger towards the 2
mark
Remove plunger 1
Load first rod into trocar 1
Reinsert plunger and push rod towards tip of trocar 1
Hold plunger firmly and slide trocar till it reaches plunger 2
handle
Redirect trocar about 15 degrees and advance to reinsert 1
second rod
Palpate incision to make sure that both rods are 5 mm clear of 1
incision
Remove trocar from incision 1
Place all instruments into 0.5% chlorine 1
Wash hands 1
Instruct client regarding wound care 2
Total marks 25
 6. CONTRACEPTION: INSERTION OF IUCD
Mrs. J Lungu is a 38 year old who has 4 kids. She is not very sure whether she wants
more children and she opts for a long term contraceptive. After counseling
She settles for an intra-uterine device and you have been called to insert Mirena.

i. Confirm that the patient understands the method and alternatives and has signed a
consent form.
ii. Examine the patient to establish the size and position of the uterus to detect cervicitis
or other genital contraindications and to exclude pregnancy.
iii. Obtain cervical cultures, perform a pregnancy test and give antibiotic prophylaxis if
indicated.
iv. Use aseptic technique during insertion.
v. Administer oral analgesics if needed.
vi. Cleanse the cervix and vagina with an antiseptic solution.
vii. Administer paracervical block if needed.
viii. Grasp the upper lip of the cervix with a tenaculum and apply gentle traction to align
the cervical canal with the uterine cavity.
ix. Carefully sound the uterus to measure its depth and to check the patency of the cervix.
If you encounter cervical stenosis, use dilatation, not force, to overcome resistance.
x. The uterus should sound to a depth of 6 to 9 cm.
xi. Insertion of MIRENA® into a uterine cavity less than 6.0 cm by sounding may
increase the incidence of expulsion, bleeding, pain, perforation, and possibly,
pregnancy.
xii. Open the sterile package.
xiii. Place sterile gloves on your hands.
xiv. Pick up the inserter containing MIRENA®.
xv. Carefully release the threads from behind the slider, so that they hang freely.
xvi. Make sure that the slider is in the furthest position away from you (positioned at the
top of the handle nearest the IUS).
xvii. While looking at the insertion tube, check that the arms of the system are horizontal.
If not, align them on a sterile surface or with sterile gloved fingers.
xviii. Pull on both threads to draw the MIRENA® system into the insertion tube
xix. Fix the threads tightly in the cleft at end of the handle
xx. Set the flange to the depth measured by the sound.
xxi. Hold the slider firmly in the furthermost position (at the top of the handle).
xxii. Grasp the cervix with the tenaculum and apply gentle traction to align the cervical
canal with the uterine cavity. Gently insert the inserter into the cervical canal and
advance the insertion tube into the uterus until the flange is situated at a distance of
about 1.5–2 cm from the external cervical os to give sufficient space for the arms to
open.
xxiii. While holding the inserter steady release the arms of MIRENA® by pulling the slider
back until the top of the slider reaches the mark (raised horizontal line on the handle).
xxiv. Push the inserter gently into the uterine cavity until the flange touches the cervix.
MIRENA® should now be in the fundal position.
xxv. Holding the inserter firmly in position release MIRENA® by pulling the slider down
all the way. The threads will be released automatically.
xxvi. Remove the inserter from the uterus. Cut the threads to leave about 2-3 cm visible
outside the cervix.

Note:
 If you suspect that the system is not in the correct position, check
placement (with ultrasound, for example).
 Remove the system if it is not positioned completely within the uterus. Do
not reinsert a removed system.
 Remove MIRENA® by applying gentle traction on the threads with
forceps.
 The arms of the system will fold upward as it is withdrawn from the
uterus.
 The system should not remain in the uterus after 5 years.
7. BLOOD PRESSURE MEASUREMENT
Situation: Mrs. Rani, a 26 year-old primi gravid, has come today for her 2nd AN visit at 24
weeks of pregnancy. You have already conducted the history and have found nothing
abnormal. Now you will demonstrate measuring BP as part of physical examination.
STEPS
1 Wash hands and tell the woman what you are going to do.
2 Check that bulb is properly attached to the tubing.
3 Check for any crack and leakage in the bulb and cuff.
4 Check that mercury column knob is in open mode.
5 Ask the person to sit on a chair or lie down on flat surface.
6 Place the apparatus on a horizontal surface at the person’s heart level.
7 The mervury column should be at the observer’s eye level.
8 Tie the cuff so that it covers middle 2/3 of arm or 1 inch above the elbow placing both the
tubes in front.
9 Raise the pressure of the cuff to 30 mm Hg above the level at which pulse is no longer
felt.
10 Release pressure slowly and listen with stethoscope keeping it on brachial artery at the
elbow.
11 Note the reading where the sound is heard (systolic pressure).
12 Follow the sound and take note of # the reading where the sound disappears (diastolic).
13 Deflate and remove the cuff; closes the mercury column knob.
14 Take two more measurements at at least 5min intervals and calculate average.
15 Inform the woman the findings and washes hands.
16 Records the readings.
8. DELIVERY OF BABY
You have been assisting Ms. Musonad with her labor for 12 hours. It has been an
uncomplicated labor and she has progressed well. Now she is fully dilated and the head has
descended to the perineum. She is pushing well and the birth is imminent. Demonstrate how
you would perform the 2nd stage of labour.
1. Puts on personal protective barriers (Wears Goggles, Mask, Cap, Shoe cover, Plastic
Apron). Places the plastic sheet under the woman’s buttocks.
2. Performs hand hygiene and puts on sterile gloves.
3. Palpates the supra pubic region to ensure that the woman’s bladder is not full
encourages her to pass urine if needed.
4. Cleans the woman’s perineum & places clean drape on abdomen.
5. Encourages woman for breathing and small pushes with contractions.
6. Controls the birth of the head with the fingers of one hand to maintain flexion, allows
natural stretching of the perineal tissue, prevents tears, and supports the perineum
with other hand using the clean pad.
7. Wipes the mucus (and membranes, if necessary) from the baby’s mouth and nose.
8. Feels around the baby’s neck for the cord and responds appropriately if the cord is
present.
9. Allows the baby’s head to turn spontaneously and with the hands on either side of the
baby’s head, delivers the anterior shoulder.
10. When the axillary crease is seen, guides the head upward as the posterior shoulder is
born over the perineum.
11. Supports the rest of the baby’s body with one hand as it slides out and places the baby
on the mother’s abdomen over the clean towels.
12. Notes the time of birth and sex of the baby and tells the mother.
13. Clamps and cuts cord. Thoroughly dries the baby and covers with a clean, dry cloth,
and assesses APGAR score at 1 min, 5min and 10min.
9. POST ABORTION CARE
Situation : You are in C03 and Ms. Sakala who had heavy bleeding and followed by complete
abortion during her 8 weeks of pregnancy is being admitted today. Demonstrate post abortion
care.

1) Provide her emotional support by

 Explaining the possible cause of early abortion,
 Listening to her if she wants to talk
 Reassure her

2) Advise for home care

 Drink plenty of fluids and eat nutritious food
 Rest ofter
 Avoid heavy work for a week
 Bathe regularly
 Use clean pads
 Avoid sexual intercourse for at least 2 weeks after the bleeding

3) Counsel the women on family planning choices to avoid unwanted pregnancy / if she
wants to delay her next pregnanacy.
 10. NEONATAL RESUSCITATION
Steps:
1. Preparation: Prepare the birth companion to assist if baby does not cry. The area where a baby is
born should be clean, warm and well-lighted.
2. Gathering equipment: Gloves, suction device, cloths, head covering, timer, ventilation bag and
mask, stethoscope
3. Wash hands and put on sterile gloves
4. Keep the Baby warm: Note the time. Dry the baby, place on a warm dry blanket and cover the
head.
5. Position the head: Neck slightly extended to keep the airway open
6. Clear the airway: Clear the mouth and then the nose with a clean suction device. Stop suctioning
when secretions are cleared.
7. Stimulate breathing: Gently rub the back once or twice.
IF THE BABY IS NOT BREATHING, INITIATE VENTILATION:
8. Place the baby on a clean, warm, and dry area with good light (radiant warmer)
9. Select the correct mask: The mask should cover the chin, mouth and nose, but not the eyes
10. Position the mask on the face: Position the rim of the mask to rest on the tip of the chin, and
then place the mask over the mouth and nose.
11. Hold the mask on the face with the thumb and index finger on top of the mask. Use the middle
finger to hold the chin up toward the mask. Use the 4th and 5th fingers along the jaw to lift it
forward and help keep the airway open
12. Form a tight seal by pressing lightly on top of the mask and gently holding the chin up toward
the mask. Squeeze the bag to produce a gentle movement of the chest
13. Give 40 breaths per minute: count “one..two..three..one..two..three”. Let your “one” coincide
with your squeezing the bag. Ventilate for one minute.
14. Evaluate and call for help if the baby is not breathing after one minute of ventilation. Ask
your assistant to continue ventilating
15. Check the heart rate and decide if the heart rate is normal or slow: Listen with a stethoscope
or evaluate by feeling the umblical cord.
A heart rate of 100/ min or more is normal
IF THE HEART RATE IS NOT DETECTABLE OR LESS THAN 60 BEATS PER
MINUTE, START CHEST COMPRESSIONS
16. Identify the compression area: (Below the nipple line on the sternum)
17. Hands encircle the torso and the fingers support the spine while the thumbs depress the sternum
18. Compress the chest quickly and firmly, reducing the antero-posterior diameter of the chest by
about one third.
19. Ask the assistant to give 1 breath after every 3 compressions and continue for 30 seconds
20. If heart rate increases and baby breathing normally, stop resuscitation, cover the baby with
warm, dry cloth
21. Monitor baby with the mother. Monitor vital signs including breathing, heart rate, temperature,
and colour
22. Talk to the mother about the baby and the plan of care. Encourage her to breastfeed
23. Document
11. HISTORY TAKING: ECTOPIC PREGNANCY
YOU HAVE 10 MINUTES FOR THIS STATION

Scenario: Mrs Martha Daka, 28-years-old, is in her first pregnancy at 7 weeks gestation. She
has had some vaginal bleeding.

 Take a focused history of the presenting complaint [5 MIN]

 Explain the possible causes of her bleeding to her and what investigations if any
you would wish to perform.
[This station tests the candidate’s ability to ask questions about bleeding in pregnancy, awareness of the differential diagnosis of ectopic
pregnancy, be able to manage patient anxiety and know that ultrasound is the most appropriate investigation].

ASPECTS BEING ASSESSED POSSIBLE STUDENT

SCORE SCORE
Student introduces themselves using full name and explains nature of 1
consultation (to find out more about the vaginal bleeding)
Elicits date of last menstrual period 1
Elicits details of the bleeding; amount, start of bleeding, frequency, colour of 1
blood loss, presence of clots or tissue (full mark for any 3, for 2 or less half a
mark)
Asks if any precipitating factors for the bleeding e.g. trauma/ intercourse? 1
Elicits severity of abdominal and shoulder pain (both full mark, one give half a 1
mark)
Asks about other symptoms e.g. fainting, nausea, vomiting, headaches 1
(for 2 or more full mark, less give half a mark)
Asks about contraception prior to the pregnancy 1
Asks about regularity of menstrual cycle before pregnancy 1
Elicits details of recent cervical smear tests 1
Manages patient anxiety and distress appropriately showing empathy and 1
appropriate communication skills
Examiner: At this point ask - What is the differential diagnosis? 2
Miscarriage, ectopic pregnancy, Cervical polyp/ectropion/cancer
(full mark for any 3, for 2 or less half a mark)
Examiner, Ask - What is the most appropriate investigation 2
Student states transvaginal ultrasound (full mark), ultrasound (half a mark)
Examiner, Ask - What structures may be visible on a transvaginal USS in this 2
patient?
States gestation sac, yolk sac, foetal pole, heart beat or empty uterus (full mark
for 3, half mark for 2 or less)

LAST 5 MINUTES OF THE EXAM

Ask the candidate the following questions
Hand the candidate the ultrasound report showing a missed abortion
What is the diagnosis?
A missed abortion 2
What are the treatment options for this lady now? For each one, explain how
it is performed and how successful they are (whether highly successful or
low)
Surgical: General anaesthetic, dilatation of the cervix and suction evacuation of 1
the uterus, high success rates
Medical: combination of mifepristone and misoprostol. Outpatient based 1
management, high success rates
END
12. HISTORY TAKING: ANTEPARTUM HAEMORRHAGE
Scenario: Mrs Mutale M, a 30-year-old pregnant woman has had an episode of vaginal
bleeding. Take a history of the presenting complaint and any other
information you think is appropriate from the current pregnancy or previous
pregnancies. You are NOT expected to take a full obstetric history.

ASPECTS BEING ASSESSED Possible Student

score score
Student introduces themselves using full name and explains nature 0.5
of consultation
Assesses gestation and parity (both to score 1, otherwise 0.5) 1
Elicits details of bleed including: volume of bleeding, nature of loss 2
(i.e. clots), colour (fresh red or brown) (full marks for 2 or more)
Asks about associated pain 0.5
Asks about associated events i.e. intercourse 1
Asks about previous bleeding to include: previous APH in this 1
pregnancy, in previous pregnancy or early pregnancy vaginal
bleeding
Asks about date of previous smear, its result and any previous 0.5
abnormal smears/treatments
Asks about associated risk factors to include: hypertension, pre- 2
eclampsia, smoking, medical problems in current pregnancy (one
for adequate, 2 or more for good)
Elicits details of possible low lying placenta on earlier scans 0.5
Asks about blood group, especially rhesus status (both to score 0.5
good)
EXAMINER, ASK THE FOLLOWING QUESTIONS AND GIVE
SCORE
Q What is the name given to the presenting complaint?
A Antepartum haemorrhage 0.5
Q What is the differential diagnosis for Antepartum Haemorrhage
A To include: placental abruption, placenta praevia, local bleeding 3
(vaginal or cervical), vasa praevia
(full marks for 2 or more)
Q What assessment would be the most useful to differentiate
between these causes
A ultrasound 0.5
Q What is the likely clinical diagnosis in view of the history?
A Placenta praevia 0.5
Q What investigation is not appropriate if placenta praevia is
suspected?
A Digital vaginal examination/speculum 2
Q What is the definition of placenta praevia?
A A placenta located in the lower segment of the uterus/ (full marks) 1
Low lying placenta (half a mark)
Q How can placenta praevia be classified
A Answer to include: major and minor or grades I-4 (full marks for 2
both)
Q How does the grade of placenta praevia affect decisions for
delivery
A Grades 3 and 4 (or major praevia) or 2b requires caesarean 1
section for delivery,
13. HISTORY TAKING: REPRODUCTIVE HEALTH
Scenario: Mrs Zulu is 8 weeks pregnant and has just been diagnosed with a heart condition
incompatible with pregnancy. Patient refuses to undergo a TOP. How would you manage
her? Task: Take a background history and advise appropriately.
No score students
1 Student greets patient and introduces oneself 1
2 Student maintains good eye contact 1
3 Asks if she is married 1
4 Asks if pregnancy was planned 1
5 Asks if she has any living children 2
6 Asks about sex of children 1
7 Asks if she is religious 1
8 Asks if she is aware that she has a serious cardiac condition. 2
9 Expresses empathy on losing a baby but stresses that her life is 2
in danger
10 Asks if she is accompanied 1
11 Asks if she has changed her mind 1

Q&A
12 What are the basic principles of medical ethics?
ans Autonomy, beneficence, non-maleficence & justice 2
13 What value of ethics is involved in this case?
ans Autonomy, Beneficence 1
14 If you did not convince her, what should happen?
ans Call a more senior doctor 1
15 If senior doctor fails, what next?
ans Call parents, husband or next of kin 1
16 If parents convince her, what should happen?
ans Obtain informed consent. 1

Total
14. COMMUNICATION SKILLS: PREVIOUS CAESAREAN SECTION
Scenario: Mrs Ann Bwalya is a 37 years old woman at 38 weeks gestation and would like to
discuss the mode of delivery in her current pregnancy. She delivered her first child 3
years ago, via an emergency caesarean section at 38 weeks for foetal distress.

Task: 5 MINUTES

 Discuss with the patient the options for delivery of this pregnancy and future
fertility i.e. BTL.

[This station tests the candidate’s ability to discuss the options for delivery for a previous caesarean
section].

NB: Pt. might ask the following questions:

 She is keen to try vaginal delivery and want to know the chances of success
 But she also wants to know risks associated with LSCS
 If she is offered a vaginal delivery she will accept
 She may ask specifically if this birth will be a hospital one
 She may ask if the baby will be monitored continuously
 She may ask if IOL would be an option in your case

ASPECTS BEING ASSESSED POSSIBLE STUDENT

SCORE SCORE
Student introduces themselves 1
Gathers information regarding previous obstetric history and circumstances 2
regarding the previous LSCS
Student clarifies that there were no other complications in the previous 2
pregnancy
Student ascertains gestation age of the current pregnancy 1
Elicits severity of abdominal and shoulder pain (both full mark, one give half a 1
mark)
The student talks about the choices regarding mode of delivery i.e elective 3
caesarean section or vaginal birth
The student talks about VBAC especially scar dehiscence 4
The student talks about VBAC being attempted in a hospital setting 3
The student talks about the role of IOL in this case 1
The student asks the patient to ask questions/comments 1
The student thanks the patient 1

End of Exam 20
TOTAL
15. COMMUNICATION SKILLS: PPROM

Scenario: Mrs Jane Mwanza 28 years old woman at 36 weeks gestation with spontaneous
rupture of membranes. She has had two (2) spontaneous vaginal deliveries
previously.

Task: 5 MINUTES

 Discuss with patient how you will manage her

ASPECTS BEING ASSESSED POSSIBLE STUDENT PARTIAL NO

SCORE SCORE SCORE SCORE
1 Student introduces himself/herself 1
2 Notes that the pregnancy is preterm and need to 2
ascertain presenting part
3 Talks about conservative management and fetal 3
monitoring in the next 24 hours
4 The role of steroids if any ,at this gestation age 3
5 Talks about choice of mode of delivery viz-a-viz 5
presenting part
6 Mentions the risk of chorioamnionitis should the 2
patient go beyond 24 hours without being
delivered
7 The role of caesarean section when the presenting 2
part is breech
8 The role of the paediatrician at delivery 2
End of Exam 20
TOTAL
16. COMMUNICATION SKILLS: P.E
Scenario: You are the attending doctor in the antenatal clinic. The patient is presented to you
with the following history:
Mrs Jane Tembo is a 39 year old lady in her first pregnancy at 38 weeks gestation
with a breach presentation. She was seen by the midwife and her blood pressure was
160/110 mmHg with 2+ of protein in urine and pre tibial pitting oedema. She has no
symptoms.

Task: 5 MINUTES

 Discuss with the patient what you intend to do

[The station tests the student’s ability to make a relevant diagnosis from the information given. The student is expected to
admit the patient, make a diagnosis indicating the degree, control the blood pressure, carry out appropriate investigations and
make a definitive decision to deliver this patient by caesarean section as she is already term and has three obstetric
complications i.e moderate PE and elderly primigravida, and a breach presentation.]

Name: Mrs Jane Tembo

Age: 39
Occupation: Not working
Diagnosis: Raised Bp of 160/105 mmHg with 2+ proteinuria

ASPECTS BEING ASSESSED Possible Student

score score
Student introduces themselves using full name and explains 1
nature of consultation
The student notes that the patient is an elderly primigravida 3
The student notes that the condition is moderate P.E 3
The student is expected to indicate that the patient needs 2
admission
The student is expected to mention the investigations to be 4
done
FBC, clotting profile, LFTs, renal function, 24r urine protein,
scan to confirm gestation age
The student is expected to mention treatment with anti- 2
hypertensive drugs e.g nifedipine, hydrallazine, labetolol
The student is expected to mention caesarean section as the 3
delivery of choice in this case
20
Total