MANAGEMENT OF NORMAL

LABOUR AND DELIVERY

Dr Nabeel Bondagji
Consultant Perinatologist
KAUH&KFSH
 LECTURE OVERVIEW
• Definitions
• Anatomy of the fetal head and maternal
pelvis
• Management of 1st, 2nd and 3rd stages of
normal labour
– monitoring of maternal well being
– monitoring of fetal well-being
– monitoring progress of labour
NORMAL LABOUR: Definitions

Onset of regular involuntary coordinated,

painful uterine contractions associated with
cervical effacement and dilatation
• Delivery is the expulsion of the product of
the conception after fetal viability.
 TRUE LABOURVX FALES
LABOUR

• Regular contractions • Irregular

• Increase in frequency • Remain the same
and intensity
• Cervix dilate • Unchanged
• No relive with • relive
sedation
• Abd and back pain • Lower abd
 STAGES OF LABOUR 4
• First stage cervical dilatation and
effacement
• Second stage is the expulsion of the fetus
• Third stage is the delivery of the placenta
• Fourth stage is the early recovery
FRIEDMAN’S CURVE
 Management of Normal Labour

• Monitor maternal well-being

• Monitor fetal well-being
• Monitor the progress of labour
 HOW DOES THE HEAD
NEGOTIATE THE PELVIS?

(1) change it’s shape and size (moulding)

(2) change it’s position (flexion and rotation)
 ANATOMY OF THE FETAL
HEAD
• Largest and least compressible part of the fetus
– therefore the most important obstetrically
• Comprises of
– (1) base of skull (ossified, non compressible, protecting brain
stem)
– (2) cranium
• (a) bones: occipital, 2 parietal, 2 frontal and 2 temporal
interconnected with membrane; therefore compressible
• (b) sutures (where the bones meet): saggital, lambdoid, coronal
• © fontanelles (where the sutures meet): ant and post
• The compressibility of the fetal skull means the bones can overlap
(moulding) in order for the skull to change shape negotiating the
maternal pelvis