Vaginal Bleeding History Taking | OSCE Tips

Vaginal Bleeding taking history taking is a crucial skill that is frequently tested in OSCEs. This tutorial offers a methodical way to collect a vaginal bleeding history during an OSCE.

Presenting complaint (PC): 

What brought you here today? 

Can you tell me more about your vaginal bleeding?

History presenting complaint (HPC):

You can adapt SOCRATES to explore skin problems too: Site, Onset, Character, Radiation, Associations, Time course, Exacerbating/Relieving factors and Severity.

Site: are you bleeding from your vagina or somewhere else?

Onset: when did the bleeding start? suddenly or gradually?

Character: is it heavy or light bleeding? bright or dark ?

Radiation: n/a

Associate symptoms:

• Abdominal pain?

• Cramps?

• Dishcarge?

Timing: are the symptoms getting worse or better? how often are you bleeding?

Exacerbating/Relieving factors: does anything make it better or worse? is it worse after sexual intercourse?

Severity: from a scale from 1 to 10. with 10 being the worse, how severe is the bleeding?

Ideas, Concerns & Expectations (ICE): 

Now is a good idea to ask Ideas, Concerns & Expectations (ICE): do you have an idea what might be causing your symptoms? is there anything that particularly concern you? what were expecting to achieve in this consultation?

Past medical history (PMH): 

Ask about any previous episodes of vaginal bleeding issues or treatment or investigations?

Drug history (DH):

Are you taking any medication (prescribed or over-the-counter (OTC)? If so, any side effects.

Any recent use of medications that might have caused the bleeding? (HRT, contraceptive pill, IUD).

Allergies:

Are you allergic to any medications?

Family history (FMH): 

Is there any family members who have similar symptoms? 

Social History (SH): 

Ask about living condition, occupation and social support.

Do you smoker? alcohol? recreational drug use?

System review: 

Review each body system to check for any other symptoms that might be causing the bleeding.

Possible differential diagnosis:

1. STI ( gonorrhea, chlamydia, or herpes)

2. UTI

3. Polycystic ovary syndrome (PCOS)

4. Fibroids

5. Intrauterine device (IUD) complications

6. Ectopic pregnancy

Summaries your findings.

Investigation: 

• Pregnancy test

• STI test

• Bloods: full blood count (FBC), C-reactive protein (CRP) + Erythrocyte Sedimentation Rate (ESR), coagulation profile, thyroid function test (TFT).

• Transvaginal ultrasound

• Urinalysis: check for protenuria.

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