Fetal Content

FETAL SKULL
Fetal skull is made up of the base of skull and the vault or cranium. The vault is made of
occipital bone posteriorly, the two parietals at the sides, and the temporal bones and frontal
bones anterior. These bones at birth are thin, easily compressible and joined by membrane.
AREAS OF SKULL
The skull is divided into several zones of obstetrical importance.
Vertex: It is a quadrangular area bounded anteriorly by the bregma and coronal sutures behind
by the lambda and lambdoid sutures and laterally by lines passing through the parietal
eminences.
Brow: It is an area bounded on one side by the anterior fontanel and coronal sutures and on the
other side by the root of the nose and supraorbital ridges of either side
Face: It is an area bounded on one side by root of the nose and supraorbital ridges and on the
other, by the junction of the floor of the mouth with neck.
SUTURES
1. Sagittal or longitudinal suture lies between two parietal bones.

2. Coronal sutures run between parietal and frontal bones on either side.
3. Frontal suture lies between two frontal bones.
4. lambdoid sutures separate the occipital bone and the two parietal bones.
IMPORTANCE
1. It permits gliding movement of one bone over the other during molding of the head, a
phenomenon of significance while the head passes through the pelvis during labor.
2. Digital palpation of sagittal suture during internal examination in labor gives an idea of the
manner of engagement of the head (asynclitism or synclitism), degree of internal rotation of the
head and degree of molding of the head.
FONTANELS
Wide gap in the suture line is called fontanel. Of the many fontanels (6 in number), two are of
obstetric significance:
1. Anterior fontanel or bregma
2. Posterior fontanel or lambda.
Anterior fontanel: It is formed by joining of the four sutures in the midplane. The sutures are
anteriorly frontal, posteriorly sagittal and on either side, coronal. The shape is like a diamond. Its
anteroposterior and transverse diameters measure approximately 3 cm each. The floor is formed
by a membrane and it becomes ossified 18 months after birth. It becomes pathological, if it fails
to ossify even after 24 months.
Importance:
 Its palpation through internal examination denotes the degree of flexion of the head.
 It facilitates molding of the head.
 As it remains membranous long after birth, it helps in accommodating the marked brain
growth; the brain becoming almost double its size during the first year of life.
 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 longitudinal sinus.
 Cerebrospinal fuid can be drawn, although rarely, through the angle of the anterior
fontanel from the lateral ventricle
Posterior fontanel: It is formed by junction of three suture lines — sagittal suture anteriorly and
lambdoid suture on either side. It is triangular in shape and measures about 1.2 × 1.2 cm (1/2" ×
1/2"). Its floor is membranous but becomes bony at term. Thus, truly its nomenclature as
fontanel is misnomer. It denotes the position of the head in relation to maternal pelvis.
DIAMETERS OF SKULL
The engaging diameter of the fetal skull depends on the degree of flexion present. The
anteroposterior diameters of the head which may engage are:
S.NO. Diameters Measurement Attitude of Presentation

in cm (inches) the head
1 Suboccipito – bregmatic: extends 9.5 cm (3 3/ 4’’) Complete Vertex
from the nape of the neck to the center Flexion
of the bregrma.
2 Suboccipito – frontal: extends from 10 cm (4’’) Incomplete Vertex
the nape of the neck to the anterior end Flexion
of the anterior fontanelle or center of
the sinciput.
3 Occipito – frontal: extends from the 11.5 cm (4 1 / 2’’) Marked Vertex
occipito eminence to the root of the deflexion
nose (Glabella).
4 Mento – vertical: extends from the 14 cm (5 1 /2’’) Parital Brow
midpoint of the chin to the highest extension
point on the sagittal suture.
5 Submento – vertical: extends from 11.5 cm (4 1/ 2 ’’) Incomplete Face
the junction of the floor of the mouth extension
and neck to the highest point on the
sagittal suture.
6 Submento – bregmatic: extends from 9.5 cm (3 3/ 4 ’’) Complete Face
junction of floor of the mouth and extension
neck to the center of the bregma.
TRANSVERSE DIAMETER
Biparietal diameter - 9.5 cm (3 ¾"): It extends between two parietal eminences. Whatever may
be the position of the head, this diameter nearly always engages. Super-subparietal—8.5 cm (3
½"): It extends from a point placed below one parietal eminence to a point placed above the
other parietal eminence of the opposite side.
Bitemporal diameter - 8 cm (3 ¼"): It is the distance between the anteroinferior ends of the
coronal suture.
Bimastoid diameter - 7.5 cm (3"): It is the distance between the tips of the mastoid processes.
Te diameter is incompressible and it is impossible to reduce the length of the bimastoid diameter
by obstetrical operation.
MOLDING
It is the alteration of the shape of the fore-coming head while passing through the resistant birth
passage during labor. There is, however, very little alteration in size of the head, as volume of
the content inside the skull is incompressible although small amount of cerebrospinal fluid and
blood escape out in the process. During normal delivery, an alteration of 4 mm in skull diameter
commonly occurs. Mechanism: There is compression of the engaging diameter of the head with
corresponding elongation of the diameter at right angle to it (Fig. 9.4). Thus, in well flexed head
of the anterior vertex presentation, the engaging suboccipitobregmatic diameter is compressed
with elongation of the head in mento-vertical diameter which is at right angle to
suboccipitobregmatic (Fig. 9.5). During the process, the parietal bones tend to overlap the
adjacent bones, viz. the occipital bone behind, the frontal bones in front and the temporal bones
at the sides. In first vertex position, the right parietal bone tends to override the left one and this
becomes reverse in second vertex position. Molding disappears within few hours after birth.
Grading: There are three gradings. Grade-1—the bones touching but not overlapping, Grade-2—
overlapping but easily separated and Grade-3—fixed overlapping. Importance: Slight molding
is inevitable and benefcial. It enables the head to pass more easily, through the birth canal.
Extreme molding as met in disproportion may produce severe intracranial disturbance in the
form of tearing of tentorium cerebelli or subdural hemorrhage. Shape of the molding can be a
useful information about the position of the head occupied in the pelvis

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FETAL SKULL

The skull is divided into several zones of obstetrical importance.

1. Sagittal or longitudinal suture lies between two parietal bones.

S.NO. Diameters Measurement Attitude of Presentation

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