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Factors that determine the rate and outcome of labour: "3 Ps"

• Powers : strength of the uterine contractions.

• Passages : size of the pelvic inlet and outlet.

• Passengers : fetus - is it big or small, does it have anomalies, is it alive or dead?

Shoulder dystocia ; Management : "HELPER"
H - Help! (call for Help)
E - Episiotomy
L - Legs up (McRoberts position)
P - Pressure subrapubically (not on fundus)
E - Enter vagina for shoulder rotation
R - Reach for posterior shoulder and deliver posterior shoulder/Return head into vagina (Zavanelli maneuver) for C-section/Rupture clavicle or pubic symphysis

Labor - Onset of Labor : "Raymond Michael Sells Dope"
• Regular and painful uterine contractions
• Membranes ruptured
• Show
• Dilatation and effacement of cervix

Labour; Causes of Preterm labour : "DISEASE"
D - Dehydration
I - Infection
S - Sex
E - Exercise (strenuous) A - Activities
S - Stress
E - Environmental factor (job, etc)

Post-partum examination simplified checklist : "BUBBLES"
B - Breast
U - Uterus
B - Bowel
B - Bladder
L - Lochia
E - Episotomy
S - Surgical site (for Cesarean section)

Post-partum pyrexia causes : "1B-5W"
• Breast - engorgement, mastitis • Wind - atelectasis, pneumonia • Water - UTI • Wound - Cesarean section site • Walking - DVT, thrombophlebitis • Womb - endometritis

Postpartum collapse causes : "HEPARINS"
H - Hemorrhage
E - Eclampsia
P - Pulmonary embolism
A - Amniotic fluid embolism
R - Regional anaethetic complications
I - Infarction (MI)
N - Neurogenic shock
S - Septic shock

Postpartum hemorrhage Risk factors : "PARTUM"
P - Prolonged labour/Polyhydramnios/Previous caesarean
A - APH
R - Recent history of bleeding
T - Twins (Multiple pregnancy)
U - Uterine fibroids
M - Multiparity

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