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    Dr. Khilud Salim Al-Salami Assistant Professor Dept. of Obst. & Gyn. College of Medicine University of Basra

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    Raqia Ali
    This document discusses the anatomy of the female pelvis and fetal skull. It begins by listing the objectives which are to describe the types of female pelvis, anatomy of the bony pelvis, fetal skull bones and diameters, and concepts of molding, caput succedaneum, and cephalhematoma. It then defines and compares the types of pelvis. It details the anatomy of the bony pelvis including landmarks. It outlines the diameters used to measure the pelvis and fetal skull. Key landmarks of the fetal skull are defined. The sutures and fontanels are described. The engaging diameters of the fetal skull are listed and explained in relation to fetal position and clinical implications. Mechanisms and grading

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    Dr. Khilud Salim Al-Salami Assistant Professor Dept. of Obst. & Gyn. College of Medicine University of Basra

    Uploaded by

    Raqia Ali
    13 views38 pages
    This document discusses the anatomy of the female pelvis and fetal skull. It begins by listing the objectives which are to describe the types of female pelvis, anatomy of the bony pelvis, fetal skull bones and diameters, and concepts of molding, caput succedaneum, and cephalhematoma. It then defines and compares the types of pelvis. It details the anatomy of the bony pelvis including landmarks. It outlines the diameters used to measure the pelvis and fetal skull. Key landmarks of the fetal skull are defined. The sutures and fontanels are described. The engaging diameters of the fetal skull are listed and explained in relation to fetal position and clinical implications. Mechanisms and grading

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    This document discusses the anatomy of the female pelvis and fetal skull. It begins by listing the objectives which are to describe the types of female pelvis, anatomy of the bony pelvis, fetal skull bones and diameters, and concepts of molding, caput succedaneum, and cephalhematoma. It then defines and compares the types of pelvis. It details the anatomy of the bony pelvis including landmarks. It outlines the diameters used to measure the pelvis and fetal skull. Key landmarks of the fetal skull are defined. The sutures and fontanels are described. The engaging diameters of the fetal skull are listed and explained in relation to fetal position and clinical implications. Mechanisms and grading

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    13 views38 pages

    Dr. Khilud Salim Al-Salami Assistant Professor Dept. of Obst. & Gyn. College of Medicine University of Basra

    Uploaded by

    Raqia Ali
    This document discusses the anatomy of the female pelvis and fetal skull. It begins by listing the objectives which are to describe the types of female pelvis, anatomy of the bony pelvis, fetal skull bones and diameters, and concepts of molding, caput succedaneum, and cephalhematoma. It then defines and compares the types of pelvis. It details the anatomy of the bony pelvis including landmarks. It outlines the diameters used to measure the pelvis and fetal skull. Key landmarks of the fetal skull are defined. The sutures and fontanels are described. The engaging diameters of the fetal skull are listed and explained in relation to fetal position and clinical implications. Mechanisms and grading

    Copyright:

    © All Rights Reserved
    Download as PPT, PDF, TXT or read online from Scribd
    Download as ppt, pdf, or txt
    of 38

    Dr.

    Khilud Salim Al-salami


    Assistant professor
    Dept. of Obst. & Gyn.
    College of Medicine
    University of Basra
    The objectives of this
    lecture
     a- Types of female bony pelvis .
     b- Anatomy of the bony pelvis ,it,s planes &
    diameters .
     c- Fetal skull bones & it,s longitudinal &
    vertical diameters & it,s effect on
    mechanism of labor.
     d-understanding the meaning of
    moulding ,caput succedaneum & cephal
    hematoma.
    Types of bony pelvis

     1- Gynaecoid pelvis

     2- Android pelvis

     3- Anthropoid pelvis

     4- Platypelloid pelvis
    BONY PELVIS

    •Hip bone (Ilium, ischium and


    pubis)
    •Sacrum
    •Coccyx
    Joined anteriorly by pubic
    symphysis
    Posteriorly by sacro -iliac
    joint
    Greater Pelvis (pelvis major)
    Lesser Pelvis (pelvis minor)

    Also known as True Pelvis.


    It is composed of inlet (brim), cavity, and outlet.
    Cavity:- formed by the hip bone (pubic bones, ischium,
    ilium) and sacrum and consist of pelvic viscera – the
    urinary bladder, rectum, uterus and ovaries.
    Outlet: diamond-shaped made up of the pubic bones,
    ischium, ischial tuberosities, sacrotuberous ligament, and
    5th segment of sacrum.
    The Pelvic Inlet (Brim):-
    Boundaries:-
     Sacral promontory,
     Ala of the sacrum,
     sacroiliac joints,
     iliopectineal lines,
     iliopubic eminencies,
     upper border of the
    superior pubic rami,
     pubic tubercles,
     pubic crests and
     upper border of
    symphysis pubis.
    Measurement of pelvis

    Pelvic inlet/ brim:-


    A-P diameter:-it is the distance between
    mid point of sacral promontory to the mid
    point of upper border of pubic symphysis.

    Transverse diameter:- distance between


    the iliopectineal lines.

    Oblique diameter:- distance between one


    sacro –iliac joint to opposite ilio-pubic
    eminence.
    Landmark of Fetal skull
     Occiput:- is the occipital bone/external occipital protuberance.
     Sinciput:- is the forehead region of fetal head.
     Parietal eminences:- are the eminences of parietal bone on
    either side.
     Mentum:- is the chin.
     Vertical point:- is the center of sagittal suture.
     Frontal point:- is the root of nose.
     Sub occiput:- it 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
    coronal suture
    SUTURES :
    CLINICAL IMPORTANCE OF SUTURE:-
    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 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.
    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. On vaginal
    examination if it is felt easily and anterior fontanelle is not felt, this
    indicates good flexion of the fetal head.
    Diameter of skull

    The engaging diameter of the fetal


    skull depends on the degree of the
    flexion of the presenting part.

    A. The antero-posterior diameter


    which may be engaged are:-

    1.Sub-occipito bregmatic:-

    It extends from the nape of the neck


    to the centre of anterior fontanelle.
    Length:-9.5cm
    Attitude:-complete flexion
    Presentation:-Vertex.

    Clinical importance:-
    Smallest diameter.
    2.Suboccipito
    frontal:-

    It extends from
    the nape of the
    neck to root of
    nose.
    Length:-10cm
    Attitude:-
    Incomplete
    flexion.
    Presentation:-
    Vertex.
    3.Occipito-frontal:-
    Extends from the
    occipital eminence to
    the root of the nose
    (Glabella).
    Length:-11.5cm
    Attitude:-Marked
    deflexion
    Presentation:-vertex

    Clinical importance:-
    This engaging
    diameter may give
    rise to prolonged
    labour.
    4.Mento-vertical:-
    It extends from the mid-
    point of the chin to the
    center of the sagittal
    suture.
    Length:-14cm
    Attitude :- Partial
    extension.
    Presentation:- Brow

    Clinical importance:-
    In this engaging
    diameter, baby has to be
    delivered by caesarean
    section.
    5.Sub-mento vertical:-
    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

    Clinical importance:-
    In this engaging
    diameter, baby has to be
    delivered by caesarean
    section.
    6.Sub-mento
    bregmatic:-
    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

    Clinical importance:-
    In this engaging
    diameter, baby has to be
    delivered by caesarean
    section.
    B. The transverse diameter are:-

    1. Bi parietal diameter:-
    It extend between 2 parietal
    eminences.
    Length:-9.5cm
    Attitude:-irrespective of position
    of head this diameter always
    engages.

    2. Bi temporal diameter:-
    Distance between the anterior-
    inferior ends of the coronal suture.
    Length:- 8.5 cm
    FETAL SKULL CHANGES IN LABOUR
    Mechanism:-
    GRADING
    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.
    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


    Cephalhematoma

    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.
    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.
    THANK YOU

    ANY QUESTION ?

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