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MANAGEMENT OF NORMAL LABOUR AND DELIVERY
Dr Nabeel Bondagji
Consultant Perinatologist
KAUH&KFSH
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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
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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.
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TRUE LABOURVX FALES LABOUR
• Regular contractions• Increase in frequency
and intensity• Cervix dilate• No relive with
sedation• Abd and back pain
• Irregular• Remain the same
• Unchanged• relive
• Lower abd
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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
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FRIEDMAN’S CURVE
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Management of Normal Labour
• Monitor maternal well-being
• Monitor fetal well-being
• Monitor the progress of labour
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MECHANICS OF LBOUR, OR,
HOW DOES THE HEAD NEGOTIATE THE PELVIS?
(1) change it’s shape and size (moulding)
(2) change it’s position (flexion and rotation)
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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
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