FETAL SKULL

INTRODUCTION
 The fetal head is the most important
part of the fetus because it contains
the brain,which is a vital organ.
About 95% of babies present by the
head. The midwife must know
which are of the fetal head causes
least problem during labour and
delivery.
 CONTD…..
 If the midwife is familiar with the
landmarks on the fetal head, she will
be able to diagnose abnormal
presentation and positions as well as
conduct delivery with minimal
injury.
 DEFINITION

 Fetal skull is made

upof compressible,
thin pliable tabular
(flat) bones forming
the vault.this is
anchored to the rigid
and incompressible
bones at the base of
skull.
 AREAS OF FETAL SKULL
 It is divided into 3 parts :-
 Vertex
 Brow
 face
 VERTEX
 It is a quadrangular
area bounded
anteriorly by the
bregma and coronal
sutures behind by the
lambda and lambdoid
sutures and laterally
by lines passing
through the parietal
eminences.
 BROW
 It is an area
bounded on one
side by the anterior
fontanelle and
coronal sutures and
on the other side by
the root of the nose
and supra-orbital
ridges of either.
 FACE
 It is an area bounded on one side by root
of the nose and supra-orbital ridges and
on the other by the junction of the floor
of the mouth with neck.
 Sinciput
 It is the area lying in front of the anterior
fontanelle & corresponds to the area of
brow .
 SUTURES

 Flat bones of the vault are united together

by non-ossified membranes attached to the
margins of the bones these are called
sutures.
 MOULDING
The cranial bones are connected by
membranes and this allows
considerable shifting or sliding of each
bone to accommodate to the maternal
pelvis.this process is called moulding.
 CONTD…..
 Moulding is assessed on vaginal examination
at two sites: parietal-parietal and parietal-
occipital. In normal labour, moulding results
in a reduction of 0.5 to 1 cm of the biparietal
and suboccipitobregmatic diameters without
any brain damage. Molding disappears after
birth. Moulding is a protective mechanism
and prevents the fetal brain from
compression as long as it is not excessive or
too rapid.
 GRADING OF MOULDING
 Grade 1 or + moulding –
obliteration of the suture line.
 Grade 2 or ++ moulding – reducible
overlap.
 Grade 3 or +++ moulding –
irreducible overlap.
 CLINICAL SIGNIFICANCE
OF MOULDING
 Some amount of moulding is beneficial
and this is one of the factors which
decide the success of a trial of labour.
 Severe moulding can lead to
intracranial haemorrhage.
 The site of moulding gives information
about the position of the head.
 FONTANELLES
 Fontanelles are the membrane filled
spaces at the meeting point of the
sutures. They Are important in
diagnosing the position of the fetal head
on vaginal examination
 TYPES OF FONTANNELES
 The anterior fontanelle or bregma is the
meeting point of the sagittal, coronal and
frontal sutures. It is diamond shaped and
measures 3*2 cm. It ossifies by one and a
half years.
 The posterior fontanelle or lambda is at
the junction of the sagittal suture and the two
lambdoid sutures. It is much smaller than the
anterior fontanelle and is triangular shaped
and measures about 1.2 x 1.2cm. It closes at
6 to 8 weeks.
 IMPORTANCE OF
FONTANNELES
 Palpation of the posterior fontanelle during
vaginal examination denotes the position of
the head. If the posterior fontanelle is felt in
the left anterior quadrant, the position is left
occipitianterior and if in the right anterior
quadrant,right occipitianterior. Similarly, if
the posterior fontanelle is felt in either of the
posterior quadrant, it will be right or left
occipitoposterior
CONTD…
 Palpation of the anterior fontanelle will denote the
degree of flexion of the head. If the head is well
flexed as in occipitoanterior, the anterior fontanelle
is not usually palpable
 If the anterior fontanelle is easily palpable, the
head is Usually deflexed, as in occipitoposteior.
 After birth, trhe fontanelles are usefull to assess the
condition of the baby. For example: if there is
dehydration they are depressed and in cases of
Raised intracranial tension they may be tense
and bulging.
CONTD…..
 As the fontanelles remains membranous
for some time after birth, it helps to
accommodate the marked growth of the
brain.
 BONYLANDMARKS
 Occiput is the area occupied by the occipital
bone and is behind and below the posterior
fontanelle.
 Vertex is the area bounded by the two
fontanelles and the parietal bones.
CONTD…
 Glabella is the raised area between
the orbital ridges.
 Nasion is the root of the nose.
 Parietal bases are the two
eminences on the side of each
parietal bone.
DIAMETERS OF THE FETAL
SKULL
 ANTEROPOSTERIOR DIAMETERS:
The different anteroposterior diameters
depending upon the presentation and
position.
CONTD…
 Suboccipitobregmatic diameter (9.5 cm)
extends from the nape of the neck to the
centre of the anterior fontanelle or bregma. It
is the diameter that presents when the head is
well Flexed and in occipitoanterior position.
The presentation is Vertex
CONTD…
 Occipitofrontal diameter (11.5cm)
extends from the occipital eminence
to the root of the nose(Glabella) and
presents when the head is deflexed
as in occipitoposterior.
 Suboccipitofrontal (10cm) extends
from the nape of the neck to the
anterior end of the anterior
fontanelle or centre of the sinciput.
CONTD…..
 Mento-vertical (14cm) extends from the
mid point to the chin to the highest
point on the sagital suture and is the
diameter in brow presentation.
 Submentobragmatic (9.5 cm )extends
from the junction of the neck and the
lower jaw to the centre of the anterior
fontanelle and is the diameter in face
presentation.
Cont….
 Submento-ventical (11.5cm)-extends from
junction of floor of the mouth and neck to
the highest point on the sagittal suture and
is the diameter in brow presentation
 TRANSVERSE DIAMETER
 Biparietal diameter (9.5cm) is the
largest transverse diameter in all
cephalic presentation. The head is
said to be engaged when the
biparietal diameter has passed
through the pelvic brim. It extends
between the two parietal bones.
Contd….
 Bitemporal diameter (8cm) is the shortest
transverse diameter and is distance between
the antero-inferior ends of the coronal
suture.
 Supersubparietal (8.5cm) extends from a
point below one parietal eminence to another
placed above the opposite parietal eminence.
 Bimastoid diameter- (7.5cm) It is the
distance between the tips of the mastoid
processes.
CONCLUSION
 The head is the most important part of
the fetus because it is the most common
presenting part, it is the largest and least
compressible, and once born, generally
ensures smooth delivery of the rest of
the body. During intrauterine life the
calcification occurs more completely in
bones of the base and the face, and at
birth these are firmly united and are not
easily compressible.
SUMMARIZATION
RECAPTULIZATION
 BIBLIOGRAPHY
 Annamma Jacob, A comprehensive
Textbook Of Midwifery. Second Edition
2008.Jaypee Publisher.Page No.196-197
 Babu Molly, Gusain Shobha. Clinical Case
Record For Midwives. First Edition 2007.
Kumar Publishing House. New Delhi. Page
No.18-24
 Dr.G.K.Sandhu. Obstetric And
Midwifery.First Edition 2013.Lotus
Publisher.Page No.28.
CONTD…
 Dutta D.C. Text Book Of Obstetrics. Edition
Sixth 2004. New Central Book Agency 2009
Page No.83-86
 Myles Margret F.Text Book For Midwives .
Edition Eight. Elsvier Medical Publisher,
New Delhi 2009 Page No. 157-164
 Chakravarthi Sudip, Daftary N Shirish. Text
book of Mannual of Obstetrics. Edition First
2002 Published by Elsevier India Private
Limited. Page No. 51-56
CONTD…
 WEBSITES-
 www.ncbi.nim.nih.gov.
 www.scribd.com/doc.
 www.pubmed.com.