168 Painless vs Painful: Pregnancy Bleeding Patterns, Cervical Insufficiency & Rh Traps for the PANCE
Physician Assistant Exam ReviewShow Notes
Third-trimester bleeding comes down to one contrast: painless and soft means previa, painful and rigid means abruption. This episode adds cervical insufficiency and Rh incompatibility, and boils each to the pattern, the one exam you never perform, and the one drug you never forget.
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A new mom is bleeding heavily minutes after delivery. Six weeks later, another can't breastfeed. Two days after a C-section, a third has a fever and a tender uterus. Each is a classic PANCE setup with a wrong answer that sounds reasonable.
A breastfeeding mom asks for contraception at her two-week postpartum visit. A patient with gestational diabetes returns six weeks after delivery. A new mother on postpartum day six has a severe headache and blood pressure of 164/112.
Fifteen PANCE-style questions, mixed systems, the way the exam mixes them. Pause after each one, say your answer out loud, then check yourself. Keep count.
A white count of 20,000 the day after delivery. A temperature of 38 in the first 24 hours. Cramping every time she breastfeeds. Each one looks like trouble, and each one is normal.
The water breaks at 30 weeks. The baby's head is in the fundus at 37. The ultrasound shows one placenta and two babies. Each one changes the delivery plan, and one number decides it every time.