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Home / First-trimester bleeding and ectopic pregnancy
Reproductive health — complete topic guide

First-trimester bleeding and ectopic pregnancy

Turn this presentation into an 11-minute OSCE performance: focused assessment, prioritized differential, targeted examination and investigations, immediate management, communication, disposition and safety-netting.

What you must demonstrate

  • Pregnancy-focused history
  • Sensitive sexual and reproductive history
  • Recognize time-critical obstetric emergencies
  • Shared decision-making
  • Trauma-informed communication
Do not miss: Hemodynamic instability · Ongoing major blood loss · Coagulopathy/anticoagulant effect · Need for urgent source control · Unsafe discharge

11-minute performance map

0:00–0:45

1. Opening and immediate safety

Introduce yourself, confirm identity, explain the task, obtain consent and identify instability before routine questioning.

0:45–4:30

2. Focused assessment

Clarify onset, progression, severity, associated features, discriminating positives/negatives and the most relevant background risks.

4:30–6:30

3. Targeted examination

Perform only the examination maneuvers needed to assess severity, confirm localization and discriminate the leading diagnoses.

6:30–7:30

4. Synthesize

Give a one-sentence summary, leading diagnosis and two to four prioritized alternatives including the dangerous diagnosis you cannot miss.

7:30–8:40

5. Investigations

Choose tests that answer a specific diagnostic or safety question; state urgent tests first.

8:40–10:15

6. Immediate management

Treat instability, begin syndrome-specific care, consult early when needed and define disposition.

10:15–11:00

7. Communication and safety net

Explain the plan, check understanding, address concerns and state exact deterioration/return criteria.

Focused history prompts

Define the presentation

  • Onset, chronology, triggers and progression.
  • Severity and effect on function.
  • Associated symptoms that support the leading diagnosis.
  • Relevant negatives that reduce dangerous alternatives.

Risk context

  • Relevant past medical/surgical/obstetric/psychiatric history.
  • Medications, allergies and adherence.
  • Family, social, substance, travel/exposure or safeguarding factors as applicable.
  • Patient ideas, concerns, expectations and goals.

Dangerous alternatives to prioritize

  1. Hemodynamic instability
  2. Ongoing major blood loss
  3. Coagulopathy/anticoagulant effect
  4. Need for urgent source control
  5. Unsafe discharge

Targeted investigations

Pregnancy testing and gestational age when relevant

CBC, blood group/Rh and type/screen for significant bleeding

Urinalysis/STI testing or targeted microbiology when indicated

Pelvic ultrasound and obstetric/gynecologic imaging according to urgency

Immediate management and disposition

  1. Prioritize maternal hemodynamic stability and time-critical obstetric/gynecologic emergencies.
  2. Use pregnancy-safe investigations/treatments when relevant.
  3. Obtain early obstetric/gynecologic consultation for ectopic pregnancy, torsion, severe preeclampsia, hemorrhage or sepsis.
  4. Use shared decision-making and trauma-informed communication.
High-yield closing sentence: “I would reassess after the initial intervention, escalate if there is deterioration, explain the plan in plain language, confirm understanding and give specific safety-net instructions.”

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