This document discusses the management of normal labor and delivery. It defines labor as regular painful uterine contractions associated with cervical changes. The stages of labor are outlined as first stage being cervical dilation, second stage being fetal expulsion, and third stage being placental delivery. Fetal head shape and size changes during labor through moulding and position changes to negotiate the maternal pelvis. Monitoring of maternal well-being, fetal well-being, and labor progress is important for managing normal labor.

1. MANAGEMENT OF NORMAL
LABOUR AND DELIVERY
Dr Nabeel Bondagji
Consultant Perinatologist
KAUH&KFSH

2. 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

3. 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.

4. 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

5. 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

6. FRIEDMAN’S CURVE

7. Management of Normal Labour
• Monitor maternal well-being
• Monitor fetal well-being
• Monitor the progress of labour

8. HOW DOES THE HEAD
NEGOTIATE THE PELVIS?
(1) change it’s shape and size (moulding)
(2) change it’s position (flexion and rotation)

9. 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