The Fetal Skull: Bones of The Vault

The Fetal Skull
The fetal skull contains the delicate brain which may be subjected to great
pressure as the head passes through the birth canal. It is large in comparison
with the true pelvis and some adaptation between skull and pelvis must take
place during labour. The head is the most difficult part to deliver whether it
comes first or last.
An understanding of the landmarks and measurements of the fetal skull enables

the midwife to recognize normal presentations and positions and to facilitate
delivery with the last possible trauma to mother and child. Where
malpresentation or disproportion exists she will be able to identify it and alert
the medical staff.
Ossification. The bones of the fetal head originate in two different ways.
The face is laid down in cartilage and is almost completely ossified at birth, the
bones being fused together and firm. The bones of the vault are laid down in
membrane and are much flatter and more pliable. They ossify from the centre
outwards and this process is in complete at birth leaving small gaps which form
the sutures and fontanelles. The ossification centre on each bone appears as a
boss or protuberance.
Bones of the vault
There are five main bones in the vault of the fetal skull.
The occipital bone lies at the back of the head and forms the region of the
occiput. Part of it contributes to the base of the skull as it contains the foramen
magnum which protects the spinal cord as it leaves the skull. At the centre the
occipital protuberance.
The two parietal bones lie on either side of the skull. The ossification
centre of each is called the parietal eminence.
The two frontal bones form the forehead or sinciput. At the centre of is
each in frontal eminence. The frontal bones fuse into a single by 8 years age.
In addition to these five the upper part of the temporal bone is also flat
forms a small part of the vault.
Sutures and fontanelles
Sutures are cranial joints and are formed where two bones adjoin. Where two or
more sutures meet, a fontanelle is formed. There are several sutures and
fontanelles in the fetal skull; those of most obstetrical significance are described
below.
The lambdoidal suture is shaped like the Greek letter lambda () and
separates the occipital bone from the two parietal bones.
The sagittal suture lies between the two parietal bones.
The coronal suture separates the frontal bones from the parietal bones,
passing from one temple to the other.
The frontal suture runs between the two halves of the frontal bone.
Whereas the frontal suture becomes obliterated in time, the other sutures
eventually become fixed joints. Ossification of the skull is not complete until
early adulthood.
The posterior fontanelle or lambda is situated at the junction of the

lambdoidal and sagittal sutures. It is small, triangular in shape and can be
recognized vaginally because a suture leaves from each of the three angles. It
normally closes by 6 weeks of age.
The anterior fontanelle or bregma is found at the junction of sagittal,

coronal and frontal sutures. It is broad, kite-shaped and recognizable vaginally
because a suture leaves from each of the four corners. It measures 3-4 cm long
and 1.5-2 cm wide and normally closes by the time the child is 18 months old.
Pulsations of cerebral vessels can be felt through it.
The sutures and fontanelles, because they consist of membranous spaces, allow
for a degree of overlapping of the skull bones during labour and delivery.
Regions and landmarks of the fetal skull
The skull is divided into the vault, the base and the face. The vault is the large,
dome-shaped part above an imaginary line drawn between the orbital ridges and
the nape of the neck. In the vault the bones are relatively thin and pliable at birth
which allows the skull to alter slightly in shape during birth. The base is
comprised of bones which are firmly united to protect the vital centres in the
medulla. The face is composed of 14 small bones which are also firmly united
non-compressible. The regions of the skull are described as follows:
The occciput lies between the foramen magnum and the posterior
fontanelle. The part below the occipital protuberance is known as the
suboccipital region. The protuberance itself can be seen and felt as a prominent
point on the posterior aspect of he skull.
The vertex is bounded by the posterior fontanelle, the two parietal

eminences and the anterior fontanelle. Of the 96% of the babies born head first,
95% present by the vertex.
The sinciput or brow extends from the anterior fortanelle and the
coronal suture to the orbital ridges.
The face is small in the newborn baby. It extends from the orbital ridges
and the root of the nose to the junction of the chin and the neck. The point
between the eyebrows is known as the glabella. The chin is termed the mentum
and is an important landmark.
Diameters of the fetal skull
The measurements of the skull are important because the midwife needs a
practical understanding of the relationship between the fetal head and the
mother’s pelvis. It will become clear that some diameters are more favourable
for easy passage through the pelvic canal and this will depend on the attitude of
the head.
There are two transverse diameters:
Bipatrietal diameter 9.5 cm – between the two parietal eminences.
Bitemporal diameter 8.2 cm – between the furthest points of the coronal

suture at the temples.
The remaining diameters described are antero-posterior or longitudinal:
Suboccipitobregmatic 9.5 cm – from below the occipital protuberance to

the centre of the anterior fontanelle or bregma.
Suboccipitofrontal 10 cm – from below the occipital protuberance to the

centre of the frontal suture.
Occipitofrontal 11.5 cm – from the occipital protuberance to the glabella.
Mentovertical 13.5 cm – from the point of the chin to the highest point on
the vertex, slightly nearer to the posterior than to the anterior frontalelle.
Submentovertical 11.5 cm – from the point where the chin joins the neck
to the highest point on the vertex.
Submentobregmatic 9.5 cm – from the point where the chin joins the
neck to the centre of the bregma.

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The Fetal Skull

An understanding of the landmarks and measurements of the fetal skull enables

Bones of the vault

Sutures and fontanelles

The posterior fontanelle or lambda is situated at the junction of the

The anterior fontanelle or bregma is found at the junction of sagittal,

Regions and landmarks of the fetal skull

The vertex is bounded by the posterior fontanelle, the two parietal

There are two transverse diameters:

Bipatrietal diameter 9.5 cm – between the two parietal eminences.

Bitemporal diameter 8.2 cm – between the furthest points of the coronal

The remaining diameters described are antero-posterior or longitudinal:

Suboccipitobregmatic 9.5 cm – from below the occipital protuberance to

Suboccipitofrontal 10 cm – from below the occipital protuberance to the

Occipitofrontal 11.5 cm – from the occipital protuberance to the glabella.

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