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THE FETUS:
FETAL SKULL AND ITS
SIGNIFICANCE IN LABOUR
ROZIAH ARABI
Module Coordinator
FFFM5024 MODULE 2: INTRAPARTUM
ADVANCED DIPLOMA IN MIDWIFERY 2014/2015
LEARNING OUTCOMES
At the end of this topic, students will be able to:
1. Describe the regions of the fetal skull
2. Describe the bones that make up the vault of
the fetal skull
3. Describe the sutures and fontanelles
4. Describe the various diameters of the fetal
skull and their significance in labour
General description of the fetal skull
Ossified from
membranous tissue as
early as 8th weeks in-utero
Protects the most vital
organ of the body
Composed of:
1. The base
2. The face
3. The vault
1. The base
Composed of hard bones firmly united that protects the vital
centres in the brain during labour
2. The face
A part of the skull below the supra-orbital ridges (glabella) to
the junction of chin and neck
Compose to 14 rigid bones (ossified from cartilage)
3. The vault
Region above an imaginary line drawn from the orbital
region to the nape of the neck
Formed by 7 pieces of bones which are incompletely
ossified at birth
Separated by sutures and fontanelles allows the scull to
mould and compress during birth
The bones
Vault are made up of :
2 frontal bones
2 parietal bones
2 temporal bones
1 occipital bone
The two frontal bones
These bones form the forehead
They are roughly square in shape
They cover the frontal lobes of the brain
The two parietal bones
These bones lie behind the frontal bones
On either side of the skull
Roughly square in shape with a bony
eminence at the centre known as the parietal
eminence (the centre of ossification)
The largest of all bones
Cover the parietal lobes
of the brain
THE OCCIPITAL BONE
Is a single piece of bone lying below
the parietal bone at the back of the
head
Is triangular shape with a small
eminence at its centre known as the
Occipital Protuberance
It covers the occipital lobe of the
brain and cerebellum
The lower part forms the margin
of the foramen magnum &
articulates
with the 1st cervical vertebrae
The two temporal bones
Form part of the side walls
Lie below the parietal bones in front of the
ears
The sutures
Sutures are membranous junction between 2 bones
Important because they allow the bones to overlap
Thus reducing the size of the fetal skull and facilitating
delivery
The sutures are:
1. Frontal suture
Runs between the frontal
bones
2. Sagittal suture
Lies between the 2
pieces of parietal bones
3. Coronal suture
Like a crown running
across the head
Lies between the frontal
and the parietal bones
4. Lambdoidal sututre
Runs obliquely between
the parietal and the
occipital bone
The fontanelles
Fontanelles are membraneous spaces where
2 or more sutures meet
~ membraneous junction of sutures
Out of 6 fontanelles in the fetal skull, only 2
are important
1. Anterior fontanelle (in front of the vault)
2. Posterior fontanelle (at the back of the vault)
The fontanelles
The anterior fontanelle The posterior fontanelle
Known as the Bregma Known as Lambda
large diamond shaped space
Lies at the junction of the
At the junction of 4 sutures; the
frontal, coronal and sagittal sagittal and labdoidal
About 3-4 cm in length Small and triangular in shape
1.5-2 cm in breadth If this fontanelle is felt during
Pulsation of cerebral vessels VE, means that the fetus is in
can be felt through it the OA position
If this fontanelle is felt during Close when the child is 6
VE, means that the fetus is
either in OP position or face to weeks
pubes
Close when the child
is 18 months old
These fontanelles are important structures of
fetal skull as they denote the position of the
fetal head
The regions of the fetal skull
KEYWORDS:
Diameter Length
SOB = suboccipitobregmatic 9.5 cm
OF = occipitofrontal 11.5 cm
MV = mentovertical 13.5 cm
1. Biparietal
Biparietal diameter extends
between the two pairetal
eminence
It measures 9.5 cm
2. Bitemporal
Bitemporal diameter runs
between the two extremities of
the coronal suture
It measures 8.5 cm
The engaging diameters varies in
length, the shorter diameter are
more favourable for delivery of the
fetal head
Presentation & Denominator
Presentation is the fetus part that presented at the
brim of pelvis or at the lower segment of the uterus
1. Vertex presentation –
denominator is occiput
2. Brow presentation –
denominator is sinciput
3. Face presentation –
denominator is mentum
4. Breech presentation –
denominator is sacrum
5. Shoulder presentation –
denominator is acromium
process
Vertex presentation
1. Well flexed head
When the head is well flexed, the sub-occipito-
bregmatic and the biparietal are the 2 diameters of
the presenting circular area and the circumference is
29 cm
2. Deflexed head
When the head is deflexed, it is erect as in the
military attitude. The engaging diameters are:
i. Occipito-frontal – 11.5cm
ii. Biparietal 9.5cm (transversely)
iii. Bitemporal 8.5cm (transversely)
Brow presentation
When partial extension occurs, the engaging
diameter is mento-vertical, which is 13.5cm
The circumference is 38cm
So the engaging diameter is longer, and the
circumference is also larger
Shape of
Attitude of head circumference
circumference
1. Well flexed 29 cm Round
2. Deflexed 34.5 cm Ovoid
3. Partial Eextension 38 cm Round
SIGNIFICANCE OF THE FETAL SKULL IN
LABOUR