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% Document Info
\author{StudentMidwifeLisa}
\pdfinfo{
  /Title (mechanisms-of-labour-and-birth.pdf)
  /Creator (Cheatography)
  /Author (StudentMidwifeLisa)
  /Subject (Mechanisms of Labour and birth Cheat Sheet)
}

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    {\parbox{\dimexpr\textwidth-2\fboxsep\relax}{\noindent
        \hspace*{-6pt}\includegraphics[width=5.8cm]{/web/www.cheatography.com/public/images/cheatography_logo.pdf}}
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\begin{tabulary}{11cm}{L}
    \vspace{-2pt}\large{\bf{\textcolor{DarkBackground}{\textrm{Mechanisms of Labour and birth Cheat Sheet}}}} \\
    \normalsize{by \textcolor{DarkBackground}{StudentMidwifeLisa} via \textcolor{DarkBackground}{\uline{cheatography.com/126195/cs/24353/}}}
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  \mymulticolumn{2}{p{5.377cm}}{\bf\textcolor{white}{Cheatographer}}  \\
  \vspace{-2pt}StudentMidwifeLisa \\
  \uline{cheatography.com/studentmidwifelisa} \\
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  \mymulticolumn{1}{p{5.377cm}}{\bf\textcolor{white}{Cheat Sheet}}  \\
   \vspace{-2pt}Published 20th September, 2020.\\
   Updated 20th September, 2020.\\
   Page {\thepage} of \pageref{LastPage}.
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  Measure your website readability!\\
  www.readability-score.com
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\begin{multicols*}{4}

\begin{tabularx}{3.833cm}{X}
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\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{Mechanism basics}}  \tn
% Row 0
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\mymulticolumn{1}{x{3.833cm}}{The baby engages in the widest diameter of the pelvic inlet = Transverse (13cm)} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{Enters the circular cavity (12cm) and rotates} \tn 
% Row Count 3 (+ 1)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{Exits via the widest diameter the antero-posterior (AP) of the pelvic outlet (13cm)} \tn 
% Row Count 5 (+ 2)
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\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
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\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{Mechanisms of Labour}}  \tn
% Row 0
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\mymulticolumn{1}{x{3.833cm}}{The birth canal is formed by the bony pelvis and soft tissues} \tn 
% Row Count 2 (+ 2)
% Row 1
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\mymulticolumn{1}{x{3.833cm}}{To negotiate the birth canal, the fetus must take advantage of the widest diameter of each part of the pelvis} \tn 
% Row Count 5 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{The baby needs to twist and turn as it makes its way through the birth canal and adapt to the shape of the mothers pelvis} \tn 
% Row Count 8 (+ 3)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{The pelvic inlet is widest in the transverse diameter and the pelvic outlet is widest in the anteroposterior} \tn 
% Row Count 11 (+ 3)
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\par\addvspace{1.3em}

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\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{The 'normal' mechanism requires that the fetal:}}  \tn
% Row 0
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\mymulticolumn{1}{x{3.833cm}}{Lie is longitudinal} \tn 
% Row Count 1 (+ 1)
% Row 1
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\mymulticolumn{1}{x{3.833cm}}{Attitude is fully flexed} \tn 
% Row Count 2 (+ 1)
% Row 2
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\mymulticolumn{1}{x{3.833cm}}{Presentation is cephalic} \tn 
% Row Count 3 (+ 1)
% Row 3
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\mymulticolumn{1}{x{3.833cm}}{Position is right or left occipitoanterior} \tn 
% Row Count 4 (+ 1)
% Row 4
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\mymulticolumn{1}{x{3.833cm}}{Presenting part or Denominator is the occiput} \tn 
% Row Count 5 (+ 1)
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\begin{tabularx}{3.833cm}{X}
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\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{According to Rankin}}  \tn
% Row 0
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\mymulticolumn{1}{x{3.833cm}}{The fetus descends} \tn 
% Row Count 1 (+ 1)
% Row 1
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\mymulticolumn{1}{x{3.833cm}}{The presenting part of the fetus meets resistance of the pelvic floor} \tn 
% Row Count 3 (+ 2)
% Row 2
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\mymulticolumn{1}{x{3.833cm}}{The presenting part rotates forwards to lie anteriorly under the symphysis pubis} \tn 
% Row Count 5 (+ 2)
% Row 3
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\mymulticolumn{1}{x{3.833cm}}{The emerging part of the fetus pivots around the pubic bone} \tn 
% Row Count 7 (+ 2)
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\begin{tabularx}{3.833cm}{X}
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\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{Causes of descent}}  \tn
% Row 0
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\mymulticolumn{1}{x{3.833cm}}{Descent occurs due to: uterine contractions, amniotic fluid pressure, abdominal muscle contractions} \tn 
% Row Count 3 (+ 3)
% Row 1
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\mymulticolumn{1}{x{3.833cm}}{Descent is encouraged by: Increased abdominal muscle tone, Braxton hicks, fundal based uterine contractions, increased frequency and strength of contractions} \tn 
% Row Count 7 (+ 4)
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\begin{tabularx}{3.833cm}{X}
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\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{Mechanisms of labour movements}}  \tn
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\mymulticolumn{1}{x{3.833cm}}{- Descent} \tn 
% Row Count 1 (+ 1)
% Row 1
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\mymulticolumn{1}{x{3.833cm}}{- Flexion} \tn 
% Row Count 2 (+ 1)
% Row 2
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\mymulticolumn{1}{x{3.833cm}}{- Internal rotation of the head} \tn 
% Row Count 3 (+ 1)
% Row 3
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\mymulticolumn{1}{x{3.833cm}}{- Crowning and extension of the head} \tn 
% Row Count 4 (+ 1)
% Row 4
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\mymulticolumn{1}{x{3.833cm}}{- Restitution} \tn 
% Row Count 5 (+ 1)
% Row 5
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\mymulticolumn{1}{x{3.833cm}}{- Internal rotation of the shoulders and external rotation of the head} \tn 
% Row Count 7 (+ 2)
% Row 6
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\mymulticolumn{1}{x{3.833cm}}{- Lateral flexion} \tn 
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\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{Descent - the fetus descends into the pelvis}}  \tn
% Row 0
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\mymulticolumn{1}{x{3.833cm}}{As the head descends, it moves towards the pelvic brim in either the left or right occipitotransverse position} \tn 
% Row Count 3 (+ 3)
% Row 1
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\mymulticolumn{1}{x{3.833cm}}{The baby descends through the pelvic inlet towards the pelvic floor} \tn 
% Row Count 5 (+ 2)
% Row 2
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\mymulticolumn{1}{x{3.833cm}}{As the fetus descends through the pelvis, it changes position to accommodate the widest part of the woman's pelvis} \tn 
% Row Count 8 (+ 3)
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\begin{tabularx}{3.833cm}{X}
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\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{Flexion}}  \tn
% Row 0
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\mymulticolumn{1}{x{3.833cm}}{Contractions push down on the spine causing the fetal head to come in contact with the pelvic floor which leads to flexion of the fetal head.} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{The increased flexion leads to the presentation of the smallest diameter of the fetal head (sub-occipito bregmatic), which assists passage through the pelvis.} \tn 
% Row Count 7 (+ 4)
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\begin{tabularx}{3.833cm}{X}
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\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{Internal rotation of the head}}  \tn
% Row 0
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\mymulticolumn{1}{x{3.833cm}}{Internal rotation of the head aligns the head with the anteroposterior diameter of the pelvic outlet and moves the occiput forwards to lie under the symphysis pubis} \tn 
% Row Count 4 (+ 4)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{This is caused by pressure from uterine contractions, the shape of the pelvic floor, the pressure of the ischial spines} \tn 
% Row Count 7 (+ 3)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{It causes a slight twisting of the neck and now the head is no longer in line with the shoulders} \tn 
% Row Count 9 (+ 2)
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\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
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\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{Crowning and extension of the head}}  \tn
% Row 0
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\mymulticolumn{1}{x{3.833cm}}{The occiput now moves from beneath the pubic arch and pushes against the vaginal entrance} \tn 
% Row Count 2 (+ 2)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{The head is born by extension and pivots on the suboccipital region around the pubic bone} \tn 
% Row Count 4 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{The sinciput, face and chin sweep the perineum} \tn 
% Row Count 5 (+ 1)
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\begin{tabularx}{3.833cm}{X}
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\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{Restitution}}  \tn
% Row 0
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\mymulticolumn{1}{x{3.833cm}}{Restitution occurs after the birth of the head} \tn 
% Row Count 1 (+ 1)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{The head returns to its original position in correct alignment with the shoulders} \tn 
% Row Count 3 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\begin{tabularx}{3.833cm}{X}
\SetRowColor{DarkBackground}
\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{Internal rotation of the shoulders}}  \tn
% Row 0
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{This occurs when the shoulders turn to fit the widest diameter of the pelvic outlet (anteroposterior)} \tn 
% Row Count 3 (+ 3)
% Row 1
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{The anterior shoulder reaches the pelvic floor and rotates forwards to lie under the symphysis pubis} \tn 
% Row Count 5 (+ 2)
% Row 2
\SetRowColor{LightBackground}
\mymulticolumn{1}{x{3.833cm}}{This causes external rotation of the head so the occiput lies laterally towards the woman's thigh} \tn 
% Row Count 7 (+ 2)
% Row 3
\SetRowColor{white}
\mymulticolumn{1}{x{3.833cm}}{The anterior shoulder is usually born first under the pubic arch} \tn 
% Row Count 9 (+ 2)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\par\addvspace{1.3em}

\begin{tabularx}{3.833cm}{X}
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\mymulticolumn{1}{x{3.833cm}}{\bf\textcolor{white}{Lateral flexion}}  \tn
% Row 0
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\mymulticolumn{1}{x{3.833cm}}{The spine undergoes lateral flexion to accommodate the curved birth canal and the rest of the body is born in that position} \tn 
% Row Count 3 (+ 3)
\hhline{>{\arrayrulecolor{DarkBackground}}-}
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\par\addvspace{1.3em}


% That's all folks
\end{multicols*}

\end{document}