Aimee Drayton
Age: 28 years old female
Full Case
Patient’s Data
Patient’s name: Aimee Drayton
Age: 28 years old female
Past medical history:
- Nil
Drug history
- Nil
Recent consultation/ notes
- Nil
Patient booked urgent appointment by receptionist to discuss issues
Patient's Story (Role player’s brief)
You are Aimee Drayton, 28 years old.
You booked this appointment because you’ve noticed some bleeding from your vagina over the last couple of days, and it’s made you quite anxious.
If the doctor asks for more detail, explain:
“You found out you were pregnant about 5 days ago after taking a home pregnancy test. Your last menstrual period was 11 weeks ago, so you estimate that you are around 11 weeks pregnant.
For the past 2 days, you’ve had some light bleeding. It’s not heavy like a period, and there’s no pain, but it’s worrying you.
You repeated a pregnancy test this morning, and it still came back positive.
You feel physically well otherwise — no fever, no abdominal pain, and no dizziness.”
You’re just concerned something might be wrong and want to make sure everything is okay.
Social history:
You live with your husband, who is very supportive. You smoke around 5 cigarettes a day and have been doing so for the past 2 years. You do not drink alcohol. You have a 2-year-old son at home, so this is not your first pregnancy.
You are currently not working and are on universal credit.
Ideas: You’re wondering if this could be a miscarriage.
Concerns: You’re not sure if this is something that needs a trip to the emergency department, but you are worried.
Expectations: You want the GP to tell you what to do.
SAY NO TO ANY OTHER QUESTIONS ASKED.
If the doctor speaks to you nicely, accept his/her proposal to stop smoking.
If the doctor offers same day admission—tell him/her it may not be possible as no one is able to take care of your son and husband is away in France for a job.
If the doctor suggests a good alternative or explains why going to the hospital is important, you can say that you’ll ask your mum to help look after your son.
Marking Scheme
Data Gathering and Diagnosis
- Clarify the onset of bleeding: when it started and how it began.
- Assess the volume of bleeding – is it light, moderate, or heavy?
- Ask if the bleeding is accompanied by clots.
- Ask if there is any other discharge PV.
- Confirm the date of her last menstrual period (LMP).
- Check whether she has repeated the pregnancy test since the bleeding started.
- Explore for associated abdominal pain (consider miscarriage or ectopic pregnancy).
- Specifically ask about shoulder tip pain (suggestive of ectopic pregnancy).
- Screen for symptoms of anaemia: dizziness, light-headedness, shortness of breath, or palpitations.
- Ask if she is booked for antenatal care and whether any scans have been done.
- Ask about any recent trauma to the abdomen.
- Ask about urinary symptoms: frequency, urgency, pain or stinging.
- Ask about nausea or vomiting.
- Determine whether the pregnancy was planned and if she was using any contraceptive methods, particularly an intrauterine device (IUCD or Mirena), due to the associated ectopic risk.
- Explore lifestyle factors: smoking, alcohol use, and her family or home situation.
- Give a diagnosis of Bleeding in pregnancy – likely Threatened miscarriage.
Example of explanation to patient
Aimee, thank you for explaining everything so clearly. I can completely understand why you’re feeling anxious — bleeding at this stage of pregnancy is understandably worrying.
I want to start by reassuring you that bleeding in early pregnancy is common, and in many cases, it doesn’t mean something is wrong. What you’ve described; light bleeding, no pain, and a positive pregnancy test, could be something we call a “threatened miscarriage.” This means that there is some bleeding, but the pregnancy can still continue normally, and many women go on to have healthy babies.
That said, there are other causes of bleeding in early pregnancy that we do need to rule out, especially something called an ectopic pregnancy; where the pregnancy develops outside the womb. This can sometimes be serious, so to be safe, I’d like you to be seen today at the Early Pregnancy Assessment Unit (EPAU). They can do a scan and blood tests to check exactly what’s happening and make sure everything is okay.
I completely understand that your husband is away and you’re home alone with your child, it’s a lot to juggle, especially with your current worries. Would it help if I wrote a note or spoke to the unit myself to explain your circumstances and see if we can arrange a time that works around your childcare?
Alternatively, is there anyone at all, a family member, friend, or even a trusted neighbour, who could stay with your son for a short while? This visit to the unit is really important, just to make sure you’re safe and the pregnancy is progressing as it should.
Also, just to mention, I saw from your notes that you smoke. If you’re open to it, we can offer some gentle support to help cut down or quit, as this can help reduce risks in pregnancy — but only if that feels right for you at this time.
Management
Management
- Offer urgent referral to the Early Pregnancy Assessment Unit (EPAU) for same-day review. They will arrange a pelvic ultrasound scan and carry out blood tests (e.g., β-hCG levels).
- Provide smoking cessation advice and offer an immediate referral to support services if applicable.
- Advise her to register for antenatal care and to start taking folic acid (400 micrograms daily) until 12 weeks of gestation or after the dating scan.
- Discuss and offer pregnancy vaccinations: COVID-19 and influenza vaccines – recommended at any stage of pregnancy. Pertussis (whooping cough) vaccine – from 16 weeks. RSV (Respiratory Syncytial Virus) vaccine – from 28 weeks.
- Provide clear safety netting advice: If bleeding becomes heavier, if she develops abdominal pain or shoulder tip pain, or if she feels dizzy, faint, or unwell — she should seek urgent medical attention via 999 or A&E.
Learning point from this station:
Bleeding in Pregnancy – general guide management in Primary care
- Refer the patient to the Early Pregnancy Assessment Unit (EPAU) for same-day assessment if she has any of the following:
- Pregnancy is greater than 6 weeks gestation.
- Uncertain gestational age (patient is unsure of her last menstrual period, making it difficult to determine how far along she is).
- Associated pain.
2. Refer the patient to the Emergency Department if:
- She shows signs of haemodynamic instability, such as dizziness, light-headedness, palpitations, or fainting.
- There is significant concern about the severity of bleeding or pain.
3. Offer face to face to see same day in the GP surgery
- Offer a face-to-face consultation if the patient is less than 6 weeks pregnant, has no pain, no heavy bleeding, and is haemodynamically stable.
- During the assessment, consider performing a speculum examination to: Assess the cervical os for signs of miscarriage. Identify other possible sources of bleeding, such as a cervical ectropion, cervical polyp, or genital tract laceration. Quantify the amount of bleeding and check for visible products of conception.
- Examine for signs of an ectopic pregnancy by: Performing an abdominal examination to check for signs of an acute abdomen, such as rebound tenderness or guarding, which could suggest a ruptured ectopic pregnancy.
- If there is no abdominal pain or tenderness, perform a gentle pelvic examination, but avoid palpating for an adnexal or pelvic mass, as this may increase the risk of rupture if an ectopic pregnancy is present.
4 .Refer urgently to the Early Pregnancy Assessment Unit (EPAU) for same-day review if the patient has:
- Abdominal pain and tenderness.
- Pelvic tenderness.
- Cervical motion tenderness.