Obstetrics Exam Review: Prenatal Care, Pregnancy Complications & Labor for Physician Assistants

Sharpen your obstetric clinical knowledge with this podcast-style summary from A Comprehensive Review for the Certification and Recertification Examinations for Physician Assistants by Claire Babcock O'Connell and Thea Cogan-Drew. This review covers everything from prenatal care to high-risk pregnancy, labor, and postpartum complications—an essential resource for physician assistants preparing for certification exams and clinical success.

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Routine Prenatal Care

• Initial Prenatal Visit: Review of obstetric history, subjective symptoms (amenorrhea, nausea), and objective signs (Chadwick sign, uterine growth). Estimate due date using Nägele's Rule.
• Subsequent Visits: Monitor weight, blood pressure, fetal movement, fundal height, and heart tones. Address common complaints like backache and varicosities.

Prenatal Diagnostic & Screening Tests

• First Trimester: Serum testing (PAPP-A, free β-hCG), nuchal translucency, and chorionic villus sampling (CVS).
• Second Trimester: Maternal serum screening, targeted ultrasound for fetal anomalies.
• Third Trimester: Nonstress test (NST) and biophysical profile (BPP) to assess fetal well-being.

High-Risk Pregnancy & Complications

• Teenage Pregnancy & Multiples: Higher risk for preterm birth, preeclampsia, anemia, congenital anomalies.
• Ectopic Pregnancy: Abnormal implantation, often in fallopian tube; treated with methotrexate or surgery.
• Spontaneous Abortion: Types: threatened, inevitable, incomplete, complete, septic. Management varies from expectant to surgical.
• Gestational Trophoblastic Disease: Hydatidiform mole presents with high hCG and "snowstorm" ultrasound.
• Gestational Diabetes: Screen with glucose tolerance test, manage with diet, exercise, insulin if needed.
• Hypertensive Disorders:
  • Preeclampsia/Eclampsia: Managed with antihypertensives, magnesium sulfate, and timely delivery.
  • HELLP Syndrome: Hemolysis, Elevated Liver enzymes, Low Platelets—urgent management required.
• Preterm Labor & PPROM: Early labor or membrane rupture; managed with tocolytics, corticosteroids.
• Placental Disorders:
  • Abruptio Placentae: Painful bleeding due to placental separation.
  • Placenta Previa: Painless bleeding, placenta covers cervical os.

Labor, Delivery & Postpartum Care

• Stages of Labor:
  • Cervical dilation and effacement
  • Fetal delivery
  • Placenta delivery
  • Immediate postpartum assessment
• Monitoring & Management: Evaluate cervical changes, contractions, and fetal status. Manage dystocia with augmentation or surgical intervention (cesarean).
• Postpartum Changes & Complications:
  • Normal: Uterine involution, lochia, emotional changes.
  • Complications: Hemorrhage (manage with uterotonics, surgery), endometritis (antibiotics), postpartum depression.

Glossary of Key Terms

• Amniocentesis: Sampling amniotic fluid for genetic testing.
• Biophysical Profile (BPP): Ultrasound/NST assessment of fetal well-being.
• Eclampsia: Seizures in a woman with preeclampsia.
• Rh Incompatibility: Maternal-fetal blood type issue managed with RhoGam.
• HELLP Syndrome: Severe preeclampsia variant (Hemolysis, Elevated Liver enzymes, Low Platelets).
• Preterm Labor: Labor between 20 and 37 weeks gestation.
• PPROM: Preterm premature rupture of membranes.

Conclusion: Exam Success in Obstetrics

Mastering prenatal care, high-risk pregnancy, labor, and postpartum management is vital for the physician assistant exam and clinical care. Focus on distinguishing key complications, proper screening, and first-line interventions. Familiarity with obstetric emergencies and terminology will boost both test performance and patient safety.

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