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 ome
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.

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 parietaloccipital. 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
1 or + moulding
obliteration of the
suture line.
Grade 2 or ++ moulding reducible
overlap.
Grade 3 or +++ moulding
irreducible overlap.
Grade

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 y shaped. 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
occipitoposterior.After birth, the fontanelles
are usefull to assess the condition of the
baby. For example: if there is dehydration
tey 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 (9.4 cm)

extends from the undersurface of the
occipital bone where it meets 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.

CONTD
Occipitofrontal

diameter (11cm)
extends from the external occipital
protuberance to the glabella and
presents when the head is deflexed
as in occipitoposterior.
Suboccipitofrontal (10.5) is another
presenting
diameter
in
occipitoposterior.

CONTD..

Verticomental (13.5) extends from the

vertex to the chin and is the longest
anterioposterior diameter of the head
and the diameter in which brow
presents.
Submentobragmatic (9.4 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.

TRANSVERSE DIAMETER
Biparietal

diameter (9.4cm) 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
between the two parietals.
Supersubparietal (8.5cm) extends from
a point below one parietal eminence to
another placed above the opposite
parietal eminence. In the
Case of
asynclitic engagement, this diameter
which is smaller than the biparietal,
presents at the pelvic brim.

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.