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Fetal skull is large in relation to the fetal body, and in comparison with the maternal pelvis. It, needs adaptation between skull and pelvis during, labour process. It is the most difficult part to be, born whether at the first or last., , 2
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Fetal skull to some extent compressible, and made, mainly of thin pliable tabular (flat) bones forming, the vault this is anchored to the rigid and, incompressible bones at the base of the skull., , 3
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BASE, FACE, VAULT, , 4
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Bones, Sutures, Fontanels, , 7
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Frontal Boss, Parietal Eminence, , Occipital protuberance, 10
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SUTURES, , 11
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CLINICAL IMPORTANCE OF SUTURE, , 13
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Anterior fontanelle or bregma, It is otherwise named as Bregma, It is a kite or diamond shaped area of unossified membrane formed by the, junction of 3 sutures such as Anteriorly:- frontal suture, Posteriorly:- sagittal, suture, Laterally, on both side:-coronal suture., It is felt on fetal head surface as a soft shallow depression., It ossifies by 18 months after birth., The length is 3-4c.m & width is 1.5 – 2 c.m, Clinical importance:1.Degree of flexion can be assessed from its position. If on vaginal examination it is felt, easily, it indicates the head is not well flexed., 2. It helps in the moulding of head., 3. From its position, internal rotation of the head can be assessed., 4.ICP can be roughly assessed from its condition after birth. Depression in, dehydration and bulging in raised ICP., 5. CSF can be collected from its lateral angles from the lateral ventricles., , 14
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Posterior fontanelle or lambda: It is the triangular depressed area at the junction of the three suture., The suture are:Anteriorly:-sagittal suture, Posteriorly:- lambdoid sutures, It gets closed at 6 Weeks ossifies, It is otherwise known as Lambda, Clinical importance:1.From its relation of the maternal pelvis, position of vertex is determined., 2.Internal rotation can be assessed from its location., 3.Degree of flexion can be assessed from its position. On vaginal examination if it is felt, easily and anterior fontanelle is not felt, this indicates good flexion of the fetal head., 15
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Occiput:- is the occipital bone/external occipital protuberance., Sinciput:- is the forehead region of fetal head. It extends from, Glabella to Bregma & in between two frontal boss, Mentum:- is the tip of the chin., Vertex:-, , is the diamond shaped area covered between, , bregma to lambda & in between two parietal eminence., , Parietal eminences:- are the ossification centre of parietal bone, on either side., , 18
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Glabella :- Centre point of Orbital ridges., Sub occiput:- it is the junction fetal neck and Occiput, below to Occipital protuberance., Sub mentum:- it is the junction between neck and chin., Bi parietal:- is the transverse distance between two, parietal eminences., Bi temporal :- is the distance between two lower end of, coronal suture, Occipital protuberance:- It is the Ossification centre of, Occipital bone., 19
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2.Suboccipito frontal:-, , Diameter of skull, , It extends from the nape of the neck to root of, , F, , Length:-10cm, , O, , S, , nose., , Attitude:- Incomplete flexion., , Presentation:-Vertex., , 21
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The engaging diameter of the fetal skull, , Diameter of skull, , depends on the degree of the flexion of the, presenting part., A.The antero-posterior diameter which may be, engaged are:B.1.Sub-occipito bregmatic:It extends from the nape of the neck to the, , S, , O, , B, , centre of anterior fontanelle., Length:-9.5cm, Attitude:-complete flexion, Presentation:-Vertex., Clinical importance:Smallest diameter., 20
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3.Occipito-frontal:-, , Diameter of skull, , Extends from the occipital eminence to the, root of the nose (Glabella)., , Attitude:-Marked deflexion, , O, F, , Length:-11.5cm, , Presentation:-vertex, , Clinical importance:This engaging diameter may give rise to, prolonged labour., , 22
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4.Mento-vertical:-, , Diameter of skull, , It extends from the mid-point of the chin to, the center of the sagittal suture., Length:-14cm, Attitude :- Partial extension., Presentation:- Brow, , M, V, , Clinical importance:In this engaging diameter, baby has to, be delivered by caesarean section., 23
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5.Sub-mento vertical:-, , Diameter of skull, , It extends from the junction of the floor of, the mouth and neck to the center of the, sagittal suture,, Length:-11.5cm, Attitude: -Incomplete extension., Presentation:-Face, , S, M, V, , Clinical importance:In this engaging diameter, baby has to, be delivered by caesarean section., , 24
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6.Sub-mento bregmatic:-, , Diameter of skull, , It extends from the junction of the floor of, the mouth and Neck to the centre of, bregma., Length:-9.5cm, Attitude:-Complete extension, Presentation:-Face, , S, M, B, , Clinical importance:In this engaging diameter, baby has to, be delivered by caesarean section, , 25
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B. The transverse diameter are:-, , 1. Bi parietal diameter:It extend between 2 parietal eminences., , Length:-9.5cm, , B, P, , Attitude:-irrespective of position of head, this diameter always engages., , 26
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2. Bi temporal diameter:-, , Diameter of skull, , Distance between the anterior-inferior, ends of the coronal suture., , Lines extends between two coronal, suture point or between two temporal, , S, M, B, B, , T, , bone, Length:- 8.5 cm, 27
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FETAL SKULL CHANGES IN LABOUR, , 28
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Mechanism, , 29
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GRADING, , 30
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CAPUT SUCCEDANEUM, It is localized area of edema on fetal, scalp on vertex presentation due to, pressure effect of dilating cervical, ring and vaginal introitus., Characteristics:1.It is physiological, present at birth, and disappears within 24 hours., 2.It is soft, diffuse and pits on, pressure., 3.No underlying skull bone fracture., , 31
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MECHANISM, Pressure effect of dilated cervical ring and vaginal, introitus on descending head, Interference normal venous return and lymphatic, drainage, Stagnation of fluid, Appearance of swelling in the scalp, 32
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CEPHALO HEMATOMA, It is a collection of blood between periosteum and skull bone which is limited, by the periosteal attachments at the suture lines., Characteristics:Appears after 12 hours of birth., Limited by suture lines., Tends to grow larger., Disappears within 6-8 weeks., It is circumscribed, soft and non pitting., May be associated with skull bone fracture., Treatment:- No treatment required. The blood is absorbed and the swelling, subside., , 33
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DIFFERENCES, CAPUT SUCCEDANEUM, , CEPHAL HAEMATOMA, , 1. Present at birth on normal vaginal, delivery., , 1. Appears within a few days after birth on, normal or forceps delivery., , 2. May lie on sutures, not well defined., , 2. Well defined by suture, gradually, developing hard edge., , 3. Soft, pits on pressure., , 3. soft, elastic but does not pits on pressure., , 4. Skin ecchymotic., , 4. No skin change., , 5. Size largest at birth , gradually subsides, within a day., , 5. Become largest after birth and then, disappears within 6-8 weeks to few months., , 6. No underlying skull bone fracture., , 6. May underlying skull bone fracture., , 7. No treatment required., , 7. No treatment required., , 34
