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FETAL SKULL
By: Maj Saminder Malik
MSc (N) Obs & Gyn
INTRODUCTION
Contains delicate brain to prevent any pressure as head passes
through birth canal
Large in comparison to fetal body and maternal pelvis
Require adaptation between fetal skull & maternal true pelvis
Most difficult part to deliver
Somewhat compressible and made of pliable tubular bones
forming vault
Fetal skull
BONES OF SKULL
Total 05 bones in skull
1. Occipital bone (1): at the back of head, at the center of it has
occipital protuberance
2. Parietal Bones (2):at the either side of head, ossification center
of each is Parietal eminence
3. frontal Bones (2): forms the forehead, center of each is known
as frontal eminence. Frontal bones fuses into single by 8 yrs. of
age
Fetal skull
SUTURES OF THE SKULL
1. LAMBDOID: shape like Greek letter Lambda, separates
occipital bone from two Parietal bones
2. SAGITTAL: longitudinal suture, lies between two parietal bones
3. CORONAL: separates frontal bones from parietal bones
4. FRONTAL: lies between two frontal bones
Fetal skull
AREAS OF SKULL
1. VAULT: large dome shaped wall above an imaginary line drawn
between the orbital ridges and the nape of neck
2. BASE: comprised of bones which are firmly united to protect the vital
centers in the medulla
3. BROW: extends from anterior fontanels and coronal sutures to the
orbital ridges
4. FACE: bounded on one side by the root of nose and supraorbital
ridges & other side by the junction of the floor of mouth with neck.
(composed of 4small bones, firmly united & compressible)
FONTANELLES
1. ANTERIOR (BREGMA):
2. POSTERIOR( LAMBDA)
ANTERIOR FONTANEL (BREGMA)
anteriorly frontal suture, posteriorly sagittal suture and laterally
coronal suture
Diamond shaped
Measures 3-4cm long & 1.5 – 2cm wide
Closes by 18months (1.5yrs)
Pulsations can be felt through it
Help in molding of head, assessing position of head during labor,
depressed during dehydration, bulging during increased ICP,
collection of CSF from lateral angles
POSTERIOR FONTANEL (LAMBDA)
Formed by anteriorly sagittal suture and laterally lambdoid suture
Triangular in shape
Measures 1.2 ˣ 1.2
Floor is membranous
Closes by 6weeks (1.5 months)
Helps in assessing position and degree of flexion of head of
head
Fetal skull
LANDMARKS
1. BREGMA: anterior fontanel
2. LAMBDA: posterior fontanel
3. VERTEX: bounded anteriorly by Bregma, posteriorly by Lambda
and laterally by parietal eminence. Quadrangular in area,
considered as a presenting part in labor.
4. BROW: bounded superiorly by bregma & coronal sutures and
inferiorly by root of nose & supraorbital ridges.
5. GLABELLA: point between two eyebrows
6. FACE: bounded superiorly by root of nose and supraorbital ridges
and inferiorly by the junction of floor of mouth with neck
7. SINCIPUT: area in front of bregma, lined by frontal bone
8. OCCIPUT: between foramen magnum & lambda, lined to occipital
bone
9. MENTUM: chin
DIAMETERS OF SKULL
1. ANTEROPOSTERIOR/ LONGITUDINAL
2. TRANSVERSE
Fetal skull
AP /LONGITUDINAL DIAMETERS
AP Diameter Extension Clinical
Importance
SUBOCCIPITOBREGMATIC From below the occipital protuberance to
center of bregma, 9.5cm
Complete flexion
vertex
SUBOCCIPIATOFRONTAL From below the occipital protuberance to
center of frontal suture, 10cm
Partial flexion
vertex
OCCIPITOFRONTAL From occipital protuberance to the glabella,
11.5cm
Deflexion
vertex
MENTOVERTICAL From midpoint of chin to highest point on
vertex, 14cm
Partial extension
brow
SUBMENTOBREGMATIC From junction of floor of mouth & neck to
center of bregma, 11.5cm
Complete
extension, face
SUBMENTOVERTICAL From junction of floor of mouth & neck to
highest point of vertex, 9.5 cm
Partial extension
face
Fetal skull
TRANSVERSE DIAMETERS
Transverse Diameter Extension
BIPARIETAL Between two parietal eminences, 8.5cm
BITEMPORAL Between two coronal sutures, 8cm
BIMASTOID Between tips of mastoid process, 7.5cm
CLINICAL CONDITIONS
MOLDING OF HEAD
CAPUT SUCCEDANEUM
CEPHALHEMATOMA
Fetal skull
MOLDING OF HEAD
Occurs with descent of fetal head into pelvis to reduce head
circumference
Obliteration of sutures
Overlapping of the bones of vault (frontal bones slip under parietal
bones, parietal bones override each other, parietal bones slip under
occipital bones)
Reduces the fetal skull diameters by 0.5 -1cm or even more
Degree:
0 (suture lines separate)
+1 (suture lines meet)
+2 (suture lines overlap but can be reduced by gentle digital
pressure
+3 (suture lines overlap irreducible)
Fetal skull
CAPUT SUCCEDANEUM
Diffuse scalp edema resulting from venous congestion due to
prolonged pressure on fetal head by the pelvic bones
Soft & boggy to touch
Disappears after birth
Mostly localized in nature
Usually few mm thick but may be large
Medico-legal implication: baby was living, difficult labor
CEPHALHEMATOMA
Swelling due to bleeding between skull bone & periosteum
Bleeding occurs due to friction between overriding bones and
periosteum during molding
Likely to occur during difficult vaginal labor
Low prothrombin levels can be contributory
Not present at birth but appears after 2-3 days
Swelling is limited by periosteum, so doesn't cross the suture line
Head appears more red & bruised
Swelling can increase & may take 6weeks to disappear
Fetal skull

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Fetal skull

  • 1. FETAL SKULL By: Maj Saminder Malik MSc (N) Obs & Gyn
  • 2. INTRODUCTION Contains delicate brain to prevent any pressure as head passes through birth canal Large in comparison to fetal body and maternal pelvis Require adaptation between fetal skull & maternal true pelvis Most difficult part to deliver Somewhat compressible and made of pliable tubular bones forming vault
  • 4. BONES OF SKULL Total 05 bones in skull 1. Occipital bone (1): at the back of head, at the center of it has occipital protuberance 2. Parietal Bones (2):at the either side of head, ossification center of each is Parietal eminence 3. frontal Bones (2): forms the forehead, center of each is known as frontal eminence. Frontal bones fuses into single by 8 yrs. of age
  • 6. SUTURES OF THE SKULL 1. LAMBDOID: shape like Greek letter Lambda, separates occipital bone from two Parietal bones 2. SAGITTAL: longitudinal suture, lies between two parietal bones 3. CORONAL: separates frontal bones from parietal bones 4. FRONTAL: lies between two frontal bones
  • 8. AREAS OF SKULL 1. VAULT: large dome shaped wall above an imaginary line drawn between the orbital ridges and the nape of neck 2. BASE: comprised of bones which are firmly united to protect the vital centers in the medulla 3. BROW: extends from anterior fontanels and coronal sutures to the orbital ridges 4. FACE: bounded on one side by the root of nose and supraorbital ridges & other side by the junction of the floor of mouth with neck. (composed of 4small bones, firmly united & compressible)
  • 10. ANTERIOR FONTANEL (BREGMA) anteriorly frontal suture, posteriorly sagittal suture and laterally coronal suture Diamond shaped Measures 3-4cm long & 1.5 – 2cm wide Closes by 18months (1.5yrs) Pulsations can be felt through it Help in molding of head, assessing position of head during labor, depressed during dehydration, bulging during increased ICP, collection of CSF from lateral angles
  • 11. POSTERIOR FONTANEL (LAMBDA) Formed by anteriorly sagittal suture and laterally lambdoid suture Triangular in shape Measures 1.2 ˣ 1.2 Floor is membranous Closes by 6weeks (1.5 months) Helps in assessing position and degree of flexion of head of head
  • 13. LANDMARKS 1. BREGMA: anterior fontanel 2. LAMBDA: posterior fontanel 3. VERTEX: bounded anteriorly by Bregma, posteriorly by Lambda and laterally by parietal eminence. Quadrangular in area, considered as a presenting part in labor. 4. BROW: bounded superiorly by bregma & coronal sutures and inferiorly by root of nose & supraorbital ridges. 5. GLABELLA: point between two eyebrows 6. FACE: bounded superiorly by root of nose and supraorbital ridges and inferiorly by the junction of floor of mouth with neck 7. SINCIPUT: area in front of bregma, lined by frontal bone 8. OCCIPUT: between foramen magnum & lambda, lined to occipital bone 9. MENTUM: chin
  • 14. DIAMETERS OF SKULL 1. ANTEROPOSTERIOR/ LONGITUDINAL 2. TRANSVERSE
  • 16. AP /LONGITUDINAL DIAMETERS AP Diameter Extension Clinical Importance SUBOCCIPITOBREGMATIC From below the occipital protuberance to center of bregma, 9.5cm Complete flexion vertex SUBOCCIPIATOFRONTAL From below the occipital protuberance to center of frontal suture, 10cm Partial flexion vertex OCCIPITOFRONTAL From occipital protuberance to the glabella, 11.5cm Deflexion vertex MENTOVERTICAL From midpoint of chin to highest point on vertex, 14cm Partial extension brow SUBMENTOBREGMATIC From junction of floor of mouth & neck to center of bregma, 11.5cm Complete extension, face SUBMENTOVERTICAL From junction of floor of mouth & neck to highest point of vertex, 9.5 cm Partial extension face
  • 18. TRANSVERSE DIAMETERS Transverse Diameter Extension BIPARIETAL Between two parietal eminences, 8.5cm BITEMPORAL Between two coronal sutures, 8cm BIMASTOID Between tips of mastoid process, 7.5cm
  • 19. CLINICAL CONDITIONS MOLDING OF HEAD CAPUT SUCCEDANEUM CEPHALHEMATOMA
  • 21. MOLDING OF HEAD Occurs with descent of fetal head into pelvis to reduce head circumference Obliteration of sutures Overlapping of the bones of vault (frontal bones slip under parietal bones, parietal bones override each other, parietal bones slip under occipital bones) Reduces the fetal skull diameters by 0.5 -1cm or even more Degree: 0 (suture lines separate) +1 (suture lines meet) +2 (suture lines overlap but can be reduced by gentle digital pressure +3 (suture lines overlap irreducible)
  • 23. CAPUT SUCCEDANEUM Diffuse scalp edema resulting from venous congestion due to prolonged pressure on fetal head by the pelvic bones Soft & boggy to touch Disappears after birth Mostly localized in nature Usually few mm thick but may be large Medico-legal implication: baby was living, difficult labor
  • 24. CEPHALHEMATOMA Swelling due to bleeding between skull bone & periosteum Bleeding occurs due to friction between overriding bones and periosteum during molding Likely to occur during difficult vaginal labor Low prothrombin levels can be contributory Not present at birth but appears after 2-3 days Swelling is limited by periosteum, so doesn't cross the suture line Head appears more red & bruised Swelling can increase & may take 6weeks to disappear