ALARM INTERNATIONAL PROGRAM

OSCE STATION 1
HISTORY AND PHYSICAL
A 16 year old Gravida one, Para now one mother arrives at
emergency. She had undergone a Cesarean section seven days
earlier in this hospital. She does not know why she was operated on.
She reports that, for the past 48 hours, she has been feeling
lethargic, anorexic, feverish, and having stomach pains, foul and
brownish vaginal discharge, painful urination, and lower back pains.

OSCE STATION 1

ALARM INTERNATIONAL PROGRAM

On examination, the patient has a blood-pressure of 110/60 mm. Hg,

a heart rate of 110 per-minute, a 32 rpm respiration rate and an oral
temperature of 39.2C. She has pale-colored mucous membranes,
good pulmonary ventilation, a painful uterine fundus two fingers
below the umbilicus, a hardened, painful and hyperemic operation
site, and foul lochia.
The nurse obtained the patients clinical history, which revealed that
the reason for the Cesarean section was a cephalopelvic
disproportion and acute fetal distress, under general anesthetic, with
abundant loss of blood (no blood transfusion); prior to the C-section,
forceps were used unsuccessfully. The patients clinical history also
OSCE STATION 1

ALARM INTERNATIONAL PROGRAM

indicated that the patient had suffered a premature rupture of

membranes one day earlier, that she had been in labour for 20 hours,
and that she had pushed for two hours, before the attempted forceps.

OSCE STATION # 1
HISTORY AND PHYSICAL
A 16 year old Gravida one, Para now one mother arrives at emergency. She had undergone a
Cesarean section seven days earlier in this hospital. She does not know why she was operated
on. She reports that, for the past 48 hours, she has been feeling lethargic, anorexic, feverish, and

OSCE STATION 1

ALARM INTERNATIONAL PROGRAM

having stomach pains, foul and brownish vaginal discharge, painful urination, and lower back
pains.
On examination, the patient has a blood-pressure of 110/60 mm. Hg, a heart rate of 110 perminute, a 32 rpm respiration rate and an oral temperature of 39.2C. She has pale-colored
mucous membranes, good pulmonary ventilation, a painful uterine fundus two fingers below the
umbilicus, a hardened, painful and hyperemic operation site, and foul lochia.
The nurse obtained the patients clinical history, which revealed that the reason for the Cesarean
section was a cephalopelvic disproportion and acute fetal distress, under general anesthetic, with
abundant loss of blood (no blood transfusion); prior to the C-section, forceps were used
unsuccessfully. The patients clinical history also indicated that the patient had suffered a
premature rupture of membranes one day earlier, that she had been in labour for 20 hours, and
that she had pushed for two hours, before the attempted forceps.

Ask the candidate

Which would be your two first diagnoses?

Endometritis
OSCE STATION 1

_____

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Infection of the operation site

_____

Which predisposing factors of the infection did the patient present?

Prolonged labour
_____

Premature rupture of the membranes

_____

Cesarean-section
_____
Which other pathologies should be considered?

Urinary infection

Pulmonary infection

_____
_____

What are the predisposing factors for these two pathologies?

Insertion of a urinary catheter

General anesthetic

_____
_____

Which cultures should be taken?

Blood

Urine

_____
_____

OSCE STATION 1

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Operation site exudates

What would your initial antibiotic treatment consist of?

cefoxitin 2g IV 6 hourly

gentamicin 60-100 mgs IV 8 hourly and

clindamycin 900 mgs IV 8 hourly

_____
_____
_____

If after 48 hours with either of the two antibiotic scenarios, cefoxitin or

gentamycin and clindamycin, the fever persists, what would be your next step?
Add 5 million units penicillin IV 6 hourly to the gentamicin and clindamycin
Ask what the scientific basis is for adding penicillin
Entrococcus overlay

_____

After 48 hours of penicillin, clindamycin and gentamicin, the patient still has fever,
what pathology should be discarded as a first option?
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Pelvic abscess

_____

If pelvic abscess is ruled out both clinically and by pelvic ultra-sound, what
pathology should be used?
Septic pelvic thrombophlebitis

_____

The following therapy is recommended:

Intravenous heparin

_____

How soon after beginning the intravenous heparin does the fever begin to drop?
24-72 hours
TOTAL: ____ / 19

OSCE STATION 1

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