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Physician Assistant (PA)
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PANCE Blueprint
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Reproductive System (Male and Female)
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Complicated Pregnancy

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Reproductive System (Male and Female) | Physician Assistant (PA) School Study Aid

Complicated Pregnancy
18 Picmonics to Learn | 39 mins
Spontaneous Abortion Overview
Assessment
Bleeding < 20 weeks Gestation
Interventions
Identify Type
Bed Rest
Monitor for Hemorrhage
Save Pads and Linens
RhoGAM
Dilation and Curettage (DandC)
Cerclage
Emotional Support
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2 mins
Spontaneous Abortion Types
Missed Abortion
No Fetal Heartbeat, No Cervical Dilation, No Bleeding
Threatened Abortion
No Cervical Dilation and Minimal Bleeding
Inevitable Abortion
Bleeding and Cervical Dilation with No Loss of Products of Conception
Incomplete Abortion
Bleeding and Cervical Dilation with Loss of Some Products of Conception
Complete Abortion
Bleeding with No Cervical Dilation, with Loss of All Products of Conception
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2 mins
Abruptio Placentae
Mechanism
Premature Separation of Placenta
Assessment
Tearing Pain
Bleeding (Often Concealed)
Rigid Uterus
Contractions
Interventions
Corticosteroids as Needed
Emergent Delivery
Considerations
Increased Risks for Neonate
Rh (Rhesus) Incompatibilities
Increased Risk for Shock
Monitor Fetal Heart Rate
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3 mins
Cesarean Section - Indications
Maternal Indications
Active Genital Herpes Infection
Cervical Cancer
Eclampsia (Preeclampsia)
History of Uterine Surgery
History of C-section (Vertical)
Fetal Indications
Malpresentation
Fetal Distress
Cord Compression/Prolapse
Other Indications
Failed Vaginal Delivery
Cephalopelvic Disproportion
Abruptio Placentae or Placenta Previa
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2 mins
Prolapsed Umbilical Cord
Mechanism
Cord Prolapses
Signs and Symptoms
Visualization of Cord
Prolonged or Variable Decelerations
Considerations
Hips Elevated
Insert 2 fingers in Vagina
Saline Towel on Cord
Oxygen
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2 mins
Ectopic Pregnancy
Signs and Symptoms
Lower Abdominal Pain
Delayed Menses
Abnormal Vaginal Bleeding
Shock
Referred Shoulder Pain
Cullen Sign
Considerations
Methotrexate
Surgery
RhoGAM
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2 mins
Gestational Diabetes
Signs and Symptoms
Usually Asymptomatic
Fetal Macrosomia
Polyhydramnios
Diagnosis
Glucose Intolerance After 24 Weeks Gestation
3-hr 100g Glucose Tolerance Test
Treatment
Diet and Exercise
Close Glucose Monitoring
Insulin
Ultrasound (or Nonstress Test (NST))
Delivery
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2 mins
Gestational Hypertension
New-Onset Hypertension
> 20 Weeks Gestation
Risk Factors
Nulliparity
Obesity
African American Females
> 35 years Old
Multiple Gestations
Family History of Gestational HTN (or Preeclampsia)
Complications
IUGR
Prematurity
Abruptio Placentae
Management
Fetal Monitoring
Alpha-Methyldopa
Beta-Blockers (Labetalol)
Calcium Channel Blockers
Hydralazine
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4 mins
Preeclampsia Assessment
After 20 Weeks of Pregnancy
Mild
Hypertension > 140/90
Proteinuria or End-Organ Dysfunction
Severe
Hypertension > 160/110
Progressive Renal Insufficiency
Vision Changes
HELLP Syndrome
Pulmonary Edema
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2 mins
Preeclampsia Interventions
Side Lying Position and Bedrest
Antihypertensives
Magnesium Sulfate
Labor Induction
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1 min
Severe Preeclampsia
Mechanism of Action
Vasospasm and Decreased Organ Perfusion
Intravascular Coagulation
Increased Permeability and Capillary Leakage
Signs and Symptoms
Hypertension
Proteinuria or End-Organ Dysfunction
HELLP Syndrome
Hepatic Dysfunction and Hemolysis
Elevated Liver Enzymes
Low Platelet Counts
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3 mins
Eclampsia
Mechanism of Action
Increased Central Nervous System Irritability
Signs and Symptoms
Hyperreflexia
Positive Ankle Clonus
Headaches
Visual Disturbances
Epigastric or RUQ Pain
Seizures
Coma
Considerations
Don't Leave Bedside
Magnesium Sulfate
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2 mins
Incompetent Cervix
Mechanism
Premature Cervical Dilation
Assessment
Recurring Miscarriage
Short Cervix
Considerations
Cervical Cerclage
Rest
Labor
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1 min
Placenta Previa
Mechanism
Placenta Covers Cervical Os
Assessment
Painless
Bright Red Vaginal Bleeding
Interventions
Stable Fetus
Bed Rest
Observation
Unstable Fetus
C-section Delivery
Considerations
Risk for Shock
Magnesium Sulfate
Tocolysis
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3 mins
Postpartum Hemorrhage
Mechanism
Uterine Atony
Lacerations
Retained Placenta
Signs and Symptoms
Bleeding
Hypotension
Boggy Uterus
Considerations
Oxytocin
Bimanual Compression of Uterus
Surgery
Blood Transfusion
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2 mins
Premature Rupture of Membranes (PROM)
Pathophysiology
Rupture > 1 Hour Before Labor
Risk Factors
Infection
PROM History
Incompetent Cervix
Diagnosis
Fern Test
Nitrazine Paper Test
Ultrasound
Treatment
Consider Tocolytics
Consider Antibiotics
< 34 Weeks Gestation
Corticosteroids
> 34 Weeks Gestation
Induction of Labor
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2 mins
RhoGam [Rho(D) Immune Globulin]
Indications
Antepartum Prevention at 28 weeks
Suppress Antibody Production
Mechanism of Action
Lysis of Fetal RBC in Maternal Bloodstream
Side Effects
Myalgia and Lethargy
Considerations
Negative Coombs Test
Standard Dose 300 mcg
Microdose 50 mcg
Blood Product
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2 mins
Fetal Macrosomia
Pathophysiology
Increased Birth Weight
> 4500 g
Causes
Maternal Obesity
Gestational Diabetes
Diagnosis
Weigh Newborn at Birth
Ultrasound
Hadlock's Formula
Complications
Birth Canal Trauma
Neonatal Hypoglycemia
Shoulder Dystocia
Treatment
Planned Cesarean Section
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2 mins

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