Case Information
- Case ID: PREG-012
- Patient Name: Emily Carter
- Age: 30
- Gender: Female
- Indigenous Status: Non-Indigenous
- Year: 2025
- ICPC-2 Codes: W78 – Pregnancy Confirmed
Competency Outcomes
| Competency Domain | Competency Element |
|---|---|
| 1. Communication and Consultation Skills | Establishing rapport, providing clear education about pregnancy care, and addressing patient concerns |
| 2. Clinical Information Gathering and Interpretation | Taking a structured history to assess maternal and fetal risk factors |
| 3. Diagnosis, Decision-Making and Reasoning | Confirming pregnancy, estimating gestational age, and identifying early pregnancy complications |
| 4. Clinical Management and Therapeutic Reasoning | Developing an antenatal care plan, including referrals, screening tests, and lifestyle advice |
| 5. Preventive and Population Health | Providing education on folic acid, vaccinations, and lifestyle modifications |
| 6. Professionalism | Ensuring a patient-centred approach and addressing the psychosocial impact of pregnancy |
| 7. General Practice Systems and Regulatory Requirements | Coordinating appropriate referrals for shared or specialist care |
| 9. Managing Uncertainty | Identifying when additional investigations (e.g., early ultrasound) are needed |
| 10. Identifying and Managing the Patient with Significant Illness | Recognising high-risk pregnancies requiring specialist input |
Case Features
- 30-year-old female, first pregnancy, presents with a positive home pregnancy test.
- Unsure about gestational age, last menstrual period (LMP) was irregular due to previous long cycles.
- No significant past medical history but has a family history of gestational diabetes (mother).
- Non-smoker, occasional alcohol use but stopped after positive test.
- BMI: 28 kg/m² (overweight category).
- Wants to discuss next steps, dietary advice, and early pregnancy screening.
Candidate Information
Instructions
The candidate is expected to review the following patient record and scenario. The examiner will ask a series of questions based on this information. The candidate has 15 minutes to complete this case.
The approximate time allocation for each question:
- Question 1: 3 minutes
- Question 2: 3 minutes
- Question 3: 3 minutes
- Question 4: 3 minutes
- Question 5: 3 minutes
Patient Record Summary
Patient Details
- Name: Emily Carter
- Age: 30
- Gender: Female
- Indigenous Status: Non-Indigenous
Allergies and Adverse Reactions
- No known drug allergies
Medications
- Nil regular medications
Past History
- No previous pregnancies
- No history of diabetes, hypertension, or thyroid disease
Social History
- Works as a teacher
- Lives with her partner, stable relationship
- Non-smoker, occasional alcohol use (ceased after pregnancy confirmed)
- BMI: 28 kg/m² (overweight category)
Family History
- Mother had gestational diabetes
- No family history of congenital conditions
Vaccination and Preventive Activities
- Influenza vaccine: Up to date
- COVID-19 booster: Received
- No recent pertussis or rubella immunity check
Scenario
Emily Carter, a 30-year-old teacher, presents with a positive home pregnancy test. She is unsure of her gestational age due to previous irregular cycles.
She has no chronic medical conditions but has a family history of gestational diabetes. She has a BMI of 28 kg/m² and is concerned about diet, exercise, and pregnancy screening tests.
She wants to know the next steps and discuss how to ensure a healthy pregnancy.
On examination:
- Blood pressure: 120/78 mmHg
- Abdominal exam: Soft, non-tender, no palpable mass
- Urine dipstick: Positive for hCG, no proteinuria or glucose
Likely Diagnosis: Early pregnancy, requiring dating ultrasound and antenatal screening
Examiner Only Information
Questions
Q1. What are the next steps in confirming and assessing this pregnancy?
- Prompt: What investigations are required at this stage?
- Prompt: When would you arrange an early ultrasound?
Q2. What routine antenatal screening tests should be offered?
- Prompt: What blood tests are recommended in early pregnancy?
- Prompt: What genetic screening options are available?
Q3. What lifestyle and dietary advice would you provide?
- Prompt: What recommendations should be given regarding diet, exercise, and supplements?
- Prompt: How would you address weight management in pregnancy?
Q4. How would you assess and manage Emily’s risk for gestational diabetes?
- Prompt: What factors increase her risk for gestational diabetes?
- Prompt: When should glucose testing be performed?
Q5. What are the options for antenatal care and referrals?
Prompt: When should referral to an obstetrician be considered?
Prompt: What models of care are available in Australia (e.g., GP shared care, midwifery-led care, obstetric-led care)?
THE COMPETENT CANDIDATE
The competent candidate should be able to:
Q1. What are the next steps in confirming and assessing this pregnancy?
The competent candidate should:
- Confirm pregnancy and establish gestational age:
- Order a serum beta-hCG test to confirm pregnancy.
- Arrange a dating ultrasound (if LMP is uncertain, cycles are irregular, or pregnancy complications are suspected).
- Take a comprehensive antenatal history:
- Menstrual history: LMP, cycle regularity, contraceptive use.
- Obstetric history: Gravidity, parity, complications in previous pregnancies.
- Medical history: Pre-existing conditions (e.g., hypertension, diabetes, thyroid disease).
- Family history: Genetic conditions, gestational diabetes, pre-eclampsia.
- Lifestyle factors: Smoking, alcohol, diet, folic acid supplementation.
- Perform a physical examination:
- Measure blood pressure, BMI, and check for pallor/oedema.
- Perform abdominal palpation (although early gestation may not reveal findings).
- Discuss early pregnancy care:
- Start folic acid (400-500 mcg daily) and iodine supplementation.
- Advise avoiding alcohol, smoking, and excessive caffeine.
- Provide pregnancy safety information, including foodborne illness prevention.
SUMMARY OF A COMPETENT ANSWER
- Confirms pregnancy with beta-hCG and arranges a dating scan if needed.
- Takes a thorough antenatal history, including obstetric, medical, and lifestyle factors.
- Performs a basic physical examination, including blood pressure and BMI.
- Provides essential early pregnancy advice (nutrition, folic acid, lifestyle).
PITFALLS
- Failing to confirm gestational age when LMP is uncertain.
- Neglecting lifestyle and risk factor assessment (e.g., alcohol, smoking).
- Not discussing the importance of folic acid and iodine supplementation.
- Missing early red flags (e.g., risk factors for miscarriage or ectopic pregnancy).
REFERENCES
- RACGP Guidelines for Antenatal Care
- Australian Pregnancy Care Guidelines
- Therapeutic Guidelines on Pregnancy Management
MARKING
Each competency area is on the following scale from 0 to 3.
☐ Competency NOT demonstrated
☐ Competency NOT CLEARLY demonstrated
☐ Competency SATISFACTORILY demonstrated
☐ Competency FULLY demonstrated
1. Communication and Consultation Skills
1.1 Communicates clearly and empathetically with the patient.
1.3 Engages the patient in discussing pregnancy concerns and expectations.
2. Clinical Information Gathering and Interpretation
2.1 Takes a structured and hypothesis-driven antenatal history.
2.3 Determines gestational age and need for further investigations.
3. Diagnosis, Decision-Making and Reasoning
3.1 Identifies key clinical concerns and determines appropriate investigations.
3.5 Uses clinical reasoning to guide early pregnancy management.
Competency at Fellowship Level
☐ CLEARLY BELOW STANDARD
☐ BELOW EXPECTED STANDARD
☐ BORDERLINE
☐ AT EXPECTED STANDARD
☐ ABOVE STANDARD