Fetal Skull

Adaptation between the skull and the pelvis is necessary
to allow the head to pass through the pelvis during labour

without complication.
The fetal head is large in relation to the fetal body
compared with adult.
• The skull bones encases and protect the brain.
• Fetal skull is compressible, and made
mainly of thin pliable tabular(flat) bones
forming the vault.
• The fetal skull has three major parts :
• Vault of the cranium (Roof)
• Face
• Base
• It is the quadrangular area bounded anteriorly by the bregma
and coronal sutures behind by the lambda and the lambdoid
sutures and laterally by the line passing through the parietal
A. Vertex:- eminences.
• It is an area bounded on one side by the anterior fontanelle and

the coronal sutures and on the other side by the root of the nose
and supra-orbital ridges of the either side.
B. Brow:-
• It is an area bounded on one side by the root of the nose and the
supra-orbital ridges and on the other by the junction of the floor
of mouth with neck.
C. Face:-
FRONTAL BONE-2 PARIETAL BONE-2
TEMPORAL BONE -2 OCCIPITAL BONE -1
 Space between the bones margins are united
together by non-ossified membrane is called
sutures.
 Wide gap in the suture line is called fontanelle.
CLINICAL IMPORTANCE OF SUTURE:-
These suture permit gliding movement of one bone over other during
moulding of the head in the vertex presentation , as a result the
diameter of the head get smaller so passage of head through the birth
canal become easier.
Position of fontanelle and sagittal suture can identify attitude and

position of vertex.
From the digital palpation of the sagittal suture during labour, degree of
internal rotation and degree of moulding of the head can be noticed.
In deep transverse arrest, this sagittal suture lies transversely at the level
of the ischial spines.
Anterior fontanelle or bregma:-
It is a diamond shaped area of unossified membrane formed by the
junction of 4 suture.
The suture are:-
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.
Clinical importance:-
1. Degree of flexion : Felt on vaginal examination-head is not well
flexed.
2. moulding of head.
3. internal rotation of the head.
4. ICP can be roughly assessed from its condition after birth.
Depression in dehydration and bulging in raised ICP.
Posterior fontanelle or lambda:-
It is the triangular depressed area at the junction
of the three suture.
The suture are:-
Anteriorly:-sagittal suture
Posteriorly:-2 lambdoid sutures at both side.
It ossifies as term.
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. felt easily On vaginal examination :
• Occiput- is the occipital bone/external occipital protuberance.
• Sinciput- is the forehead region of fetal head.
• Parietal eminences- are the eminences of parietal on either
side.
• Mentum- it is the chin.
• Vertical point- it is the center of saggital suture.
• Frontal point- is the root of nose.
• Sub occiput- is the junction fetal neck and occiput.
• 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
TRANSVERSE DIAMETER:-
• Bi parietal Diameter-
Measure about 9.5cm.
It extends between two parietal eminences.
• Bi-temporal diameter-
Measure about 8cm.
It is the distance between anterio-inferior ends
of the
coronal suture.
• Sub-occipitobregmatic- 9.5cm:from below the
occipital protuberance to the center of the
anterior fontanelle.
• Sub-occipitofrontal- 10cm;from below the
occipital protuberance to the center of the
frontal suture.
• Occipitofrontal-11.5cm. The diameter from the
occipital protuberance to the glabella.
• Mentovertical-13.5cm:from the midpoint chin
to the highest point on the vertex.
Submentovertical-11.5cm: from junction of chin to
highest point on the vertex.
• Submentobregmatic-9.5cm: from junction of chin
to the center of bregma.
DIFFERENCES
CAPUT SUCCEDANEUM CEPHAL HAEMATOMA
1. Present at birth on normal vaginal 1. Appears within a few days after birth
delivery. 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 5. Become largest after birth and then
subsides within a day. 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.

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Adaptation between the skull and the pelvis is necessary

to allow the head to pass through the pelvis during labour

• It is an area bounded on one side by the anterior fontanelle and

Position of fontanelle and sagittal suture can identify attitude and

3. Soft, pits on pressure. 3. soft, elastic but does not pits on

4. Skin ecchymotic. 4. No skin change.

6. No underlying skull bone fracture. 6. May underlying skull bone fracture.

7. No treatment required. 7. No treatment required.

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