[VIDEO SKILL OSCE - ANTENATAL CARE]

Summary

In this detailed prenatal consultation, a doctor meets with a pregnant woman to assess her condition as she enters the active phase of labor. The consultation includes discussions about her pregnancy history, symptoms, and physical examinations, including checking vital signs, fetal positioning, and cervix dilation. The doctor performs a series of routine checks to ensure the mother and baby are progressing well, offering reassurance and guidance as labor approaches. The woman is advised to prepare for childbirth, with a focus on monitoring her status as she moves closer to delivery.

Takeaways

• 😀 The patient is a 22-year-old woman in her first pregnancy, experiencing intermittent uterine contractions since yesterday evening.
• 😀 The patient’s last menstrual period (LMP) was August 2, 2022, and her estimated due date is around April 9, 2025.
• 😀 The patient's medical history is clear with no prior health conditions like hypertension or diabetes.
• 😀 A thorough physical examination was performed, including checks on vital signs (heart rate, blood pressure, respiration rate, temperature), and physical measurements (height and weight).
• 😀 The patient’s heart rate was 90 beats per minute, respiration rate was 18 breaths per minute, and blood pressure was normal at 120/80 mmHg.
• 😀 The Leopold’s maneuvers were conducted to assess the fetal position, confirming the fetus is in a breech position (bumper first) initially, and then head down.
• 😀 The fundal height was measured at 30 cm, indicating appropriate fetal growth for gestational age.
• 😀 The patient’s cervix was checked during a vaginal examination, revealing a dilation of 4 cm and 25% cervical effacement, indicating active labor.
• 😀 The amniotic sac was intact, and the baby’s head was identified as the presenting part with the small fontanelle (anterior fontanel) positioned downward.
• 😀 The patient was advised to continue observing the labor progress and prepare for the upcoming birth, with instructions to bring necessary items such as food, drinks, and baby supplies.

Q & A

What symptoms did the patient report during the consultation?

The patient reported experiencing tightness or cramps, which began yesterday afternoon, continued through the night, and persisted into the morning. Each episode lasted for about 30 seconds.

How long has the patient been married, and is this her first pregnancy?

The patient has been married and this is her first pregnancy.

What is the patient's estimated due date, and how was it calculated?

The patient's estimated due date is April 9, 2025, calculated by adding 7 days to the first day of her last menstrual period, which was August 2, 2022.

What are the patient's vital signs, and do they indicate any concerns?

The patient's vital signs are normal: Pulse rate is 90 bpm, respiratory rate is 18 breaths per minute, blood pressure is 120/80 mmHg, and temperature is 36.5°C. These indicate no immediate health concerns.

What did the Leopold's maneuver reveal about the baby's position?

Leopold's maneuver indicated that the baby's head is positioned at the top of the uterus (hard), and the breech is soft. The baby’s back is positioned on the right side of the abdomen, and the head has entered the pelvis.

What is the significance of the patient's cervical dilation during the examination?

The patient is 4 cm dilated, which indicates she is in the active phase of labor, meaning the body is preparing for delivery.

What is the status of the patient's amniotic sac, and why is it important?

The amniotic sac is intact, meaning it has not ruptured. This is significant because it suggests that labor is progressing without the immediate risk of water breaking prematurely.

How did the doctor check the baby’s heart rate during the examination?

The doctor performed a fetal heart rate check using a stethoscope or a similar instrument, which is a standard procedure to ensure the baby’s well-being.

What did the cervical examination reveal about the patient's cervix?

The cervical examination revealed that the cervix is 4 cm dilated and 25% effaced, indicating that the patient is in the active phase of labor, with the cervix starting to thin and open for delivery.

What advice did the doctor give the patient regarding preparation for delivery?

The doctor advised the patient to bring food, drinks, and baby supplies to the hospital, as well as to have family members ready for the impending labor process.