Fetal Skull and Maternal Pelvis

Fetal Skull

Fetal skull – Cranium + Face

Cranium – the bony cavity which covers
brain from all sides.

• Fetal skull is made mainly of thin pliable

flat bones forming the vault.
• Flat bones of the vault are united
together by non-ossified membranes
attached to the margins of the bones.
These are called sutures and fontanelles.

• AREAS OF SKULL: The skull is arbitrarily

divided into several zones of obstetrical
importance.

1. Vertex : It is a quadrangular area

bounded by :-
• Anteriorly by the bregma and
coronal sutures.
• Posteriorly By the lambda and
lambdoid sutures.
• laterally by lines passing through the
parietal Eminences.
 2. Brow : It is an area bounded on
• Anteriorly - by the root of the nose
/Glabella and supraorbital ridges.
• Posteriorly by the anterior fontanel
and coronal sutures.
3. Face : It is an area bounded on
• Ant. - by the junction of the floor of
the mouth with neck / Mentom.
• Post. – by root of the nose and
supraorbital ridges / Glabella.

4. Occiput – Surrounded by
• Ant. – Lembda and Lambdoidal suture.
• Post. – Nape of Neck (Junction of skull
&vertebrae) .

*Bones of Fetal Skull – there are 28 bones

• Cranial bones –
1.Frontal – 1
2.Parietal – 2
3.Occipital – 1
4.Temporal – 2
5.Ethmoid – 1
6. Sphenoid – 1
• Facial Bones –
1. Zygomatic – 2
2. Maxilla – 2
3. Nasal – 2
4. Vomer – 1
5. Palatine – 2
6. Mandible – 1
7. Lacrimal – 2
8. Inferior nasal concha – 2
• Auditory Ossicles –
1. Malleus – 2
2. Incus – 2
3. Stapes – 2

• Sutures of fetal skull – Total 8

A. Frontal suture – total : 1

• Lies between Two frontal bone

B. Sagittal – total : 1
• The sagittal or longitudinal suture
lies between two parietal bones.

C. Coronal sutures – Total 2

• run between Parietal and frontal

bones on Either side.

D. Lambdoid sutures – total 2

• separate The occipital bone and

the two Parietal bones.

E. Squamous Suture – total 2

 • B/w Parietal bone and Temporal
Bone.
Importance :-
• It permits gliding Movement of one
bone over the Other during
molding of the head.
• Digital palpation of sagittal Suture
during internal examination.

• Fontanels -
Wide gap in the suture line is
called fontanel.
Total fontanels – 6
# Ant. (Bregma) – 1

Formed by joining of 4 suture in the

midplane.
Shape – Diamond.
Size – 4×2.5 cm.
Bounderies –
Ant. – Frontal suture & frontal bone
Post. – Sagittal suture & parietal
bone
Lateral – Coronal suture

Importance :-
• Palpation through internal examination
denotes the degree of flexion of the
head.
• It facilitates molding of the head.
• It allows brain growth.
• Palpation of the floor reflects
intracranial status—depressed in
dehydration, elevated in raised
intracranial Tension.
• Collection of blood and exchange
transfusion, on rare occasion, can be
performed through it via the superior
Sinus Longitudinal sinus.
• Cerebrospinal fluid can be drawn,
although rarely, through the angle of the
anterior fontanel from the lateral
Ventricle.

• Closure - @12 to 18 month

# Posterior / lembda –
Shape – Equvilateral Triangle.
Size – 1.2 cm ×1.2 cm

Formed by 3 suture line.

Bounderies –
Ant. – Sagittel Suture
Post. – Occipital Bone
Lateral – Parietal Bone

• Its floor is membranous but becomes

bony at term.
• It denotes the position of the head in
relation to maternal pelvis.

Closure - @ 6 to 8 wks. Within 3 months

# Sphenoidal Fontanel – 2
# Mastoidal Fontanel – 2

∆ Diameters of skull -
• Anterio-posterior Diameter-
1. Suboccipito Bregmatic – 9.5 cm
 Extend from nape of neck to center of
Bregma.

Seen in vertex presentation.

2. Suboccipito-frontal – 10.5 cm
Extend from nape of neck to The center of
sinciput.
Seen in vertex presentation.

3. Occipito -Frontal – 11.5cm

Extend from occiput eminence to root of

nose (Glabella).
Seen in vertex presentation.
 4. Mento vertical – 14 cm

Extend from midpoint on the chin to the

highest point on segittal suture.
Scene in brow presentation.

5. Submento-Bregmatic – 9.5cm

Extend from floor of mouth to Centre of

bregma.
Seen in face presentation.
6. Submento-vertical – 11.5cm

Extend from floor off mouth to highest

point on segittal suture.
Seen in face presentation.
• Transverase Diameter –

1. Bi mastoid – 7.5 cm
Distance between The tips of mastoid
processes.

2. Bi temporal – 8cm

Distance between interio-inferio

end of the coronal suture.

3. Suprasub Parietal – 8.5 cm

It extends from a point placed

Below one parietal eminence To a
point placed above other parietal
eminence of the opposite side.
 4. Bi Parietal – 9 to 9.5cm

It extends between 2 parietal Eminence.

#MOLDING:
It is the alteration of the shape of
the Fore-coming head while passing
through the resistant Birth passage during
labor.

Maternal Pelvis

#Bones in Pelvis –
 it consist of 4 bones.
• Innominate bones – 2
• Sacrum – 1
• Coccyx – 1

#Note – each innominate bone also consist

of –
१. Ilium
२. Ischium
३. Pubis

#Joints in pelvis – 4 joint

• Sacro iliac joint – 2
• Sacro-coccygeal – 1
• Symphysis pubis – 1
# The pelvis is anatomically divided into –
True & False
• Boundary Line being the brim of the
pelvis.

#Bony landmarks on Pelvic Brim –

From Anterior to Posterior… .
1. Symphysis pubis,
2. Pubic crest,
3. Pubic tubercle,
4. Pectineal line,
5. Iliopubic eminence,
6. Iliopectineal line,
7. Sacroiliac articulation,
8. Anterior border of The ala of sacrum.
9. Sacral promontory.
 1. False Pelvis –
• Bounderies –
Ant. – Ant. Abdominal wall
Post. – Lumber vertebrae
Lateral – iliac fossa
Inferior – linea terminalis

Importance :-
Support the enlarged uterus during
pregnancy.

2. True Pelvis –
This part of the pelvis is chiefly of
concern to the obstetricians, as it forms the
canal through which the fetus has to pass.
 Bounderies –
Ant. : Pubic Symphysis
Post. : Sacral Vertebrae (S1 - S5)
Lateral : Ischium & Pelvic Muscle
Superior : Linea terminalis.

#Parts -:
A. Inlet
B. Cavity
C. Outlet

A. Inlet :-
A/K/A Pelvic Brim.
 • Circumferance formed by Landmarks.
• Shape –
Almost Round

∆ Bounderies –
Ant. – Upper border of SP.
Post. – Upper border of S1 Vertebrae.
Lateral – Ilio pectineal line.

∆ Inclination –
In the erect posture, the pelvis is
tilted forward. As such, the plane of the
inlet makes an Angle of about 55° with the
horizontal and is called angle of inclination.
∆ Sacral angle: It is the angle formed by the
true conjugate with the first two pieces of
the sacrum Normally, it is greater than 90°.

∆ Pelvis In front – Shallow , Formed by SP

nd measures 4cm.
∆ Pelvis In posterior – Deep , formed by
Sacrum and Coccyx , Measures 11.5cm
# Diameters Of Pelvic Inlet :-
1. Anterio-Posterior –
A/K/A true Conjugate, Anatomical
Conjugate, Conjugate Vera.
• The distance from Sacral promontory to
midpoint on upper border (inner
margin) of SP.
• It measures 11 cm.

• DC – 1.2 cm = AC

2. Obstetric Conjugate –
• It is the distance between the
midpoint of the sacral
promontory to prominent Bony
projection (Mid point) on the
inner surface of the symphysis
pubis.

• It measures – 10.5 cm(10 – 10.5)

• DC – 1.5 to 2cm = OC
3. Diagonal Conjugate (DC) –
• It is the distance between
the lower border of
symphysis pubis to the
midpoint On the sacral
promontory.

• It measures 12 cm.

• It can be measured during

examination.
4. Oblique diameter –
• Distance from one
sacrsacroiliac joint to the
 opposite side iliopubic
Eminence.

• It measures - 12 cm

• Rt. OD – Rt. Sacroiliac joint to

left iliopubic eminence.

5. Transverse Diameter –
• The max. Distance between
both iliopectoneal line.

• It measures – 13 cm
2. Pelvic Cavity -
• Cavity is the segment
of the pelvis bounded
above by The inlet and
below by plane of
least pelvic
dimensions.

#Bounderies –
Ant. – SP
Post. - S1 to s5
Lateral – Ischium&
lower part of ilium.
Superior – plane of
inlet.
Inf. – Plane of outlet.
 • Shape – Round

• Plane-
The plane extends
from the midpoint of posterior surface of
symphysis pubis to the junction of S2 & S3
sacral vertebrae.
• It is called plane of greatest pelvic
dimensions

# Diameters –
1. Ant. – Posterior –
The distance from S2 to S3 to the
mid point on post. Surface of SP.
 • It measures – 12 cm

2. Transverse (12 cm or 4 ¾"): It

cannot be precisely measured as
the points lie over the soft tissues
covering the sacrosciatic notches.

3. Pelvic Outlet –

∆ Obstetric Outlet –

#Bounderies –
Ant. – lower border of SP.
Post. – Sacro-coccygeal junction
 LLateral – Ischial Spine

• Shape: It is anteroposteriorly oval.

• Plane:
The plane is otherwise known as
plane of least pelvic dimensions or narrow
pelvic plane. The plane extends from the
lower border of the SP to the tip of ischial
spines and posteriorly to meet the tip of the
fifth sacral vertebra.

#Diameters –
1. Ant. – Posterior –
 The distance from Sacro-coccygeal
junction to the inf. Border of SP.

• It measures – 11 cm.

2. Transeverse –
A/K/A Bispinous / interspinous.
• The distance between both Ischial
spine.

• It measures – 10.5cm to 11 cm.

• Most narrow diameter of whole

pelvis.

3. Post. Sagittal –
 Tip of sacrum to mid point of
Bispinous diameter.

• It measures – 5cm.

∆ Anatomical Outlet –
• Bony outlet.
Shape – Diamond

# Bounderies –
Ant. – Lower border of SP
Post. – Tip of Coccyx.
Lateral- Ischial tuberosity, sacro tuberous
ligament.
# Diameters –
1. Ant. – Posterior –
• Lower border of SP to Tip of coccyx.

• It measures – 13 cm (During 2nd

stage of labour).

• Note - Normal position = 13 – 2.5

cm.

2. Transeverse –
• Bituberous /Intertuberous.

• The distance between both

ischial tuberosities.

• It measures – 11 to 11.5 cm.

• Subpubic angle:
It is formed by the
approximation of the two descending
pubic rami. In normal female pelvis, it
measures 85°.

• Pubic Arch:
Arch formed by the descending
rami of both the sides is of obstetric
importance. Normally, it measures 6 cm
in between the pubic rami at a level of 2
cm below the apex of the subpubic arch.
Clinically, it is assessed by placing 3
fingers side by side.
 • The narrower the pubic arch, the more
is the fetal head displaced backward and
the less the room Available for it.
Normally, the subpubic arch is rounded
and less space is wasted under the
symphysis Pubis.
• When a round disk of 9.3 cm diameter
(diameter of well flexed fetal head) is
placed under the Arch, the distance
between the symphysis pubis and the
circumference of the disk is measured.
• This Measurement is the waste space of
Morris and should not exceed 1 cm in a
normal pelvis.

# Curve of Carus:
Anatomical pelvic axis is formed by
joining the axes of inlet, cavity and outlet.
# Importance of least Pelvic Dimension –
• Max. Arrest occur here.
• Ischial spine present here.
• External cervical os is located here.
• Zero station is located here.
• Internal rotation occurs here.
• Pudendal nerve blockage done here.

# Ligaments -
1. Sacroiliac – 2
2. Sacro coccygeal ligament – 1
3. Inter pubic ligament – 1
4. Sacro tuberous ligament – 2
5. Sacro spinous ligament – 2
# Types of Pelvis –
# Mid pelvis – From S3 to S5.

# Annomalies Of Pelvis –
• Naegele's Pelvis –
One Ala of sacrum is missing.
 • Robert's Pelvis – Whenboth Ala of
sacrum Absent.

• Osteomalsic Pelvis –
Softning of pelvis due to deficiency of
Calcium.

• Rhacatuc Pelvis –
Due to deficiency of Vit. D.
इति सिद्धम ्