Vignette cases and construction of vignette score
| Vignette action | Vignette score |
|---|---|
| Case A. Section 1. A 26-year-old woman who is 7 months pregnant comes in complaining of headaches, blurred vision and epigastric pain and her face looks swollen. In this facility, what would you usually do to establish a diagnosis? | |
| Measure the woman’s blood pressure* | +1 point if mentioned |
| Check her urine for protein* | +1 point if mentioned |
| Check her reflexes* | +1 point if mentioned |
| Check fetal heart rate* | +1 point if mentioned |
| Refer to other health facility*, or | +1 point if at least one out of two mentioned |
| Call specialist or respondent is a specialist (ie, a doctor) | |
| Section maximum: 5 points | |
| Case A. Section 2. On examination, she had a blood pressure of 170/120 mm Hg, 3+ protein in her urine and brisk reflexes. How would she be managed at this facility? | |
| Giving antihypertensive drug, eg, hydralazine, labetalol or nifedipine* | +1 point if mentioned |
| Give magnesium sulfate or, if not available, diazepam* | +1 point if mentioned |
| Have somebody stay with her all the time in case she starts having seizures* | +1 point if mentioned |
| Plan for delivery within the next 24 hours, or | +1 point if at least one out of two mentioned |
| Refer to other health facility* | |
| Section maximum: 4 points | |
| Case B. Section 1. A 35-year-old woman who is 8 months pregnant comes to this facility because she has started to bleed heavily vaginally. She has no contractions and does not complain of any pain. In this facility, what would you usually do to establish a diagnosis? | |
| Check the woman′s vital signs* | +1 point if mentioned |
| Check fetal heart rate | +1 point if mentioned |
| Perform abdominal examination | +1 point if mentioned |
| Do not perform vaginal examination* | +1 point if mentioned |
| Refer to a facility where caesarean delivery can be performed*, or | +1 point if at least one out of two mentioned |
| Call specialist or respondent is a specialist (ie, a doctor) | |
| Section maximum: 5 points | |
| Case B. Section 2. The woman has a feeble pulse at 120/min, her systolic blood pressure is 85 and she is pale, sweating and breathing rapidly at 30 breaths per minute. Fetal heart sound is normal. There is no pain on abdominal examination. She is still bleeding bright red blood vaginally. You suspect placenta praevia and, therefore, do not perform a vaginal examination. How would such a patient be managed now? | |
| Elevate legs to increase return of blood to the heart* | +1 point if mentioned |
| Give intravenous fluids rapidly* | +1 point if mentioned |
| Give oxygen by mask or nasal cannula, or | +1 point if at least one out of two mentioned |
| If oxygen unavailable, refer to a facility where caesarean delivery can be performed | |
| Perform ultrasound to confirm diagnosis, or | +1 point if at least one out of two mentioned |
| If ultrasound unavailable, refer to a facility where caesarean delivery can be performed | |
| Give blood transfusion, or | +1 point if at least one out of two mentioned |
| If blood transfusion unavailable, refer to a facility where caesarean delivery can be performed | |
| Prepare for caesarean delivery, or | +1 point if at least one out of two mentioned |
| Refer to a facility where caesarean delivery can be performed* | |
| Section maximum: 6 points | |
| Cases A and Case B | Total maximum: 20 points |
*Vignette actions mentioned in WHO Pregnancy, Childbirth, Postpartum and Newborn care.21