MBBS OSCE · Obstetrics & Gynaecology
OSCE — Placental Abruption
Eight-minute OSCE station on Placental Abruption: 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 Placental Abruption.
You have 8 minutes to take a focused history, outline examination, investigations, and management including red flags.
Clinical context
Placental abruption (abruptio placentae) = premature separation of a normally-situated placenta from the uterine wall before delivery of the fetus. Incidence about 1 in 100 pregnancies; severe (fetal death) about 1 in 1000. Classic triad: painful vaginal bleeding + hard, woody, tender hypertonic uterus + fetal distress. Two patterns: revealed (about 80%, blood tracks via cervix, visible, less dangerous) and concealed (about 20%, blood trapped behind placenta, shock disproportionate to visible loss, more dangerous). Pathology: decidual vasculopathy (pre-eclampsia) leads to spiral artery rupture, retroplacental clot, extension of separation, and in severe cases Couvelaire uterus (blood infiltr
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 | Severe constant abdominal pain + hard woody tender uterus = ABRUPTION — obstetri |
| Safety | Shock disproportionate to visible blood loss = CONCEALED abruption — assess clin |
| Safety | Fibrinogen under 2 g/L = severe DIC — correct with cryoprecipitate before any op |
| 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.