FETAL SKULL

Fetal skull is to some extent compressible and made mainly on thin pliable
tabular bones forming the vault.

Areas of Skull
Skull is divided into several zones, These are
1) Vertex : It is a quadrangular area bounded by the bregma and coronal
sutures behind by the lambda and lambadoid sutures and laterally by
line passing through the parietal eminences
2) Brow : It is an area bounded on one side by the anterior tondanelle and
coronal sutures and on the other side by root of the nose and supra
orbital ridges of either side
3) Face : It is an area bounded on one side by root of the nose and
supraorbital and on the other by the junction of the floor the mouth
with neck
4) Sinciput is the are lying in front of the anterior fontanelle and
corresponds to the area of brow and the occiput is limited to the
occipital bone.

Sutures :
 The sagittal or longitudinal sutures lies between two parietal bones.
 The coronal sutures run between parietal and frontal bones on either
side
 The frontal suture dies between two frontal bones
  The lambdoid sutures separate the occipital bone and the two parietal
bones
 The coronal sutures run between parietal and frontal bones on either
side
 The frontal suture lies between two frontal bones
 The lambdoid sutures separate the occipital bones and the two parietal
bones

Importance :
1) It permits gliding movement of one bone over the other during
moulding of head, a phenomenon of significance while the head passess
through the pelvis during labour
2) Digital palpation of sagitalal suture during internal examination in
labour gives an idea of the manner of enlargement of the head
Fontanelles :
Wide gap in the suture line is called fontanelle
1. Anterior fontanelle or bregma
2. Posterior fontanelle or lambda

1) Anterior fontanelle :
 It is formed by joining of the four sutures in the midplace
 The shape is like a diamond
 Its anteroposterior transverse diameters measures approximately 3cm
each
 The floor is formed by a membrane and it becomes ossified 18 months
after birth. It becomes pathological if it is fails to ossify even after 24
months

Importance :
 It palpation through internal examination denotes the degree of flexion
of the head.
 It facilitates moulding of the head
 Palpation of the floor reflects intracranial status – depressed in
dehydration , elevated in raised interacranial tension
 Collection of blood and exchange transfusion on rare occasion , can be
performed through it via the superior longitudinal sinus.

2) Posterior Fontanelle :
It is formed by junction of three suture lines
sagital suture anteriorly and lambdoid suture on either side
It is triangular in shape and measures about 1.2 X 1.2 cm
Its floor is membranous but becomes bony at term

Diameters of Skulls
The engaging diameter of the fetal skull depends on the degree of flexion
present.
The anteroposterior diameter of the head which may engage are,

S. Diameter Measurement altitude of Presentation

N. in cm the head
1) Subocciito bregmatic 9.5cm complex vertex
flexion
2) Suboccipito frontal 10 cm incomplete Vertex
flexion
3) Occipito frontal 11.5 cm marked vertex
deflexion
4) Mento vertical 14 cm partial brow
 extension
5) submento vertical 11.5 cm incomplete face
extension
6) submento bregmatic 9.5 cm complete face
extension

The transverse diameters which are concerned in the mechanism of labour

are ,
Biparietal diameter – 9.5 cm, It extends between two parietal eminences.
Super subparietal – 8.5 cm, it extends from a point placed below 1 parietal
eminences to a point placed above the other, parietal eminences of the
opposite side
Bitemporal diameter : 8 cm. It is the distance between the anterioinferior
ends of the coronal suture.
Bimastoid diameter : 7.5 cm. It is the distance between the tips of the
mastoid process.