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 Increase in frequency and intensity Cervix dilate No relive with sedation Abd and back pain Irregular Remain the same Unchanged relive 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

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)

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