Fetal Skull

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Introduction:
Fetal skull is to some extent compressible, and made mainly of thin pliable tabular (flat) bones forming the vault. This is anchored to the rigid and incompressible bones at the base of the skull.
Areas of skull: the skull is arbitrarily divided into several zones of obstetrical importance.
These are
Vertex: It is a quadrangular area bounded  interiorly by the bregma and coronal sutures behind by the lambda and labdoid sutures and laterally by lines passing through the parietal eminences.
Brow: It is an area bounded on one side by the anterior fontanelle and  on the other side by the root of the nose and supra-orbital ridges of either side.
Face: it is an area bounded on one side by root of the nose and supra-orbital ridges and on the other, by the junction of the floor of the mouth with neck.







Sinciput is the area lying in front of the anterior fontanelle and corresponds to the area of brow and the occiput is limited to the occipital bone.
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.
Sutures:
1.       Sagittal or longitudinal suture: Lies between two parietal bones bones
2.       Coronal sutures: Run between parietal and frontal bones  on either side
3.       Frontal sutures: lies between two frontal bones.
4.       Lamboid sutures: separate the occipital bone and the two parietal bones.


Importance:
l. Permits gliding movement during moulding.
2. Digital palpation of sagittal suture during internal examinsation during labour.
Fontanelles: Wide gap in the Suture is called fontanelle.
Anterior fontanelle: It is formed by the joining of the four sutures in the midplane. The shape is like a diamond, antero-posterior and transverse diameters measure approximately 3 cm each. The floor is formed by a membrane and it becomes ossified 18 months after birth.
Importance:
l . Its palpation thought internal examination denotes the degree of flexion of the head
2. Facilitate moulding of the head.
3. Palpation of the floor reflects intracranial status -Depressed in dehydration, elevated in raised intracranial tension.
Posterior fontanelle: 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 1.2x1.2 cm .Its floor is membranous but becomes bony at term.

Transverse Diameters of the Fetal Skull:
Biparietal Diameter
9.5 cm
Between the 2 parietal eminences
Bitemporal Diameter

8 cm
It is the distance between the antero-inferior ends of the coronal suture.
Bimastoid Diameter
7.5 cm
Between the 2 mastoid processes (Not reducible nor destroyable even by destructive procedures)
Super-subparietal
8.5cm
It extends from a point placed below one parietal eminence to a point placed above the other parietal eminence of the opposite side
            .           .
Diameters of skull:
Diameter
Length
Attitude
Presentation
Suboccipito-bregmatic
Nape of neck to centre of bregma
9.5 cm
Complete flexion
vertex
Suboccipito-frontal
Nape of neck to 2.5-cm. In front of bregma
10 cm
Incomplete -flexion
Vertex
Occipito-frontal
Root of nose to occipital protuberance
11.5 cm
Marked deflexion
Vertex
Mento-vertical
Point of chin to above posterior fontanelle
14 cm
Partial extension
Brow
Submento-bregmatic
From below chin to centre of bregma
11.5 cm
Incomplete extension
Face
Submento-vertical
From below chin to in front of post. fontanelle
9.5 cm
Complete extension
face
                       
Moulding: It is the alteration of the shape of the forecoming head while passing through the resistant  during labour.
 During normal delivery, an alteration of 4mm in skull diameter commonly occurs.
Caput succedaneum:
It is the formation of swelling due to stagnation of fluid in the layers of scalp beneath the gridle of contact.

Diffuse scalp edema resulting from venous congestion due to prolonged pressure on the fetal head by the pelvis bones.



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notes.nursium.com: Fetal Skull
Fetal Skull
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