MBBS OSCE · Obstetrics & Gynaecology
OSCE — Placenta Praevia
Eight-minute OSCE station on Placenta Praevia: 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 Placenta Praevia.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Placenta praevia = placenta implanted wholly or partly in the lower uterine segment, over or near the internal cervical os. Incidence about 0.3 to 0.5 percent of pregnancies at term (higher earlier because most low placentas migrate). Classic: painless, causeless, recurrent bright-red vaginal bleeding after 20 to 24 weeks; uterus soft and non-tender (unlike abruption). Transvaginal ultrasound is the gold standard; NEVER do a digital vaginal examination until praevia is excluded. Caesarean for praevia where the placenta overlaps the os, at 36 to 37 weeks. Previous caesarean + praevia = high placenta accreta spectrum risk.
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).
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 vaginal bleeding after 20 weeks = PRAEVIA until ultrasound p |
| Safety | NEVER do a digital vaginal examination in suspected praevia (unless in theatre w |
| Safety | Previous caesarean scar + praevia = placenta accreta spectrum risk; plan multidi |
| 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.