Labour ward 1

When the exam changed to include an OSCE, I invited my teaching group to the hospital for OSCE training.

It was a Sunday afternoon and I was on call.

The following was what faced us on the labour and gynaecology wards.

This station has a preparatory station.

You are given 15 minutes to get ready; then you face an examiner.

You will be asked to prioritse the patients and delegate staff to deal with them.

Give yourself 15 minutes.

Prepare your answer.

Write down the key points you will make to the examiner.

Then send me an e-mail detailing what you have come up with.

I'll e-mail what I think the answer should be.

Labour Ward Scenario 1.

Sunday 13.00 hours.

Labour Ward.

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.

Husband of patient who has had Wertheim's hysterectomy 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.

Gynae ward staff:

Sister.

One fully-trained nurse.

Two ward aides.