FETAL SKULL

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
Brow
Face
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.
Sinciput is the area lying in front of the anterior
fontanel and corresponds to the area of brow and the
occiput is limited to the occipital bone.
SUTURES :Space between the bones of the skull.
Flat bones of the vault are united together by non-
ossified membranes attached to the margins of the
bones. These are called sutures and fontanels.
Saggital suture
Coronal suture
Lamdoidal suture
Frontal suture
TYPES OFSUTURES :

The sagittal or longitudinal suture lies

between two parietal bones. „
The coronal sutures run between parietal
and frontal bones on either side. „
The frontal suture lies between two frontal
bones. „
 The 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.
FONTANNELS
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 and
(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 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.
 It becomes pathological, if it fails to ossify even after 24
months.
 Importance:
 Its palpation through internal examination denotes the degree of
fexion 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.
 DIAMETERS OF SKULL
The engaging diameter of the fetal skull depends on the degree
of flexion present.
The antero-posterior diameters of the head which may engage
are as follows:
Suboccipitobregmatic
Suboccipito-frontal
Occupitofrontal
Mento-vertical
Submentovertical
Submentobregmatic
IMPORTANT DIAMETERS OF THE SKULL ( ANTERIOR POSTERIOR DIAMETERS )
Diameters Measureme Attitude of Presentation
nt in Cm the Head
(inches)

Suboccipitobregmatic — extends from 9.5 cm (3 ¾") Complete Vertex

the nape of the neck to the center of flexion
the bregma

Suboccipito-frontal — extends from 10 cm (4") Incomplete Vertex

the nape of the neck to the anterior flexion
end of the anterior fontanel or center
of the sinciput

Occupitofrontal — extends from the 11.5 cm (4 Marked Vertex

occipital eminence to the root of the ½") deflexion
nose (Glabella)

Mento-vertical — extends from the 14 cm (5 ½") Partial Brow

midpoint of the chin to the highest extension
point on the sagittal suture
IMPORTANT DIAMETERS OF THE SKULL

Diameters Measureme Attitude of Presentation

nt in Cm the Head
(inches)
Submentovertical — extends from 11.5 cm (4 Incomplete Face
junction of floor of the mouth and neck ½") extension
to the highest point on the sagittal
suture .

Submentobregmatic — extends from 9.5 cm (3 ¾") Complete Face

junction of floor of the mouth and neck extension
to the center of the bregma
TRANSVERSE DIAMETER
The transverse diameters which are concerned in
the mechanism of labor are : „
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. The 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 birth canal.
OR
It is the extent to which the bones of the fetal skull are overlapping each
other as the baby’s head is forced down the birth canal;
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. resistant
birth passage during labor.
CAPUT SUCCEDANUM
CAPUT SUCCEDANEUM

Definition
A caput succedaneum is an edema of the scalp at
the neonate’s presenting part of the head. It often
appears over the vertex of the newborn’s head as a
result of pressure against the mother’s cervix
during labor.
The edema in caput succedaneum crosses the
suture lines. It may involve wide areas of the head.
Causes

Mechanical trauma of the initial portion of scalp pushing

through a narrowed cervix
Prolonged or difficult delivery
Vacuum extraction
The pressure (at birth) interferes with blood flow from the
area causing a localized edema. The edematous area
crosses the suture lines and is soft.
Caput Succedaneum also occurs when a vacuum extractor is
used. In this case, the caput corresponds to the area where
the extractor is used to hasten the second stage of labor.
Signs and Symptoms

Scalp swelling that extends across the midline and

over suture lines
Soft and puffy swelling of part of a scalp in a
newborn’s head
May be associated with increased molding of the
head
The swelling may or may not have some degree of
discoloration or bruising
Management
Needs no treatment. The edema is gradually
absorbed and disappears about the third day of life.
Complication
Jaundice – results as the bruise breaks down into
bilirubin.
CEPHALHEMATOMA
CEPHALHEMATOMA

Definition
Cephalhematoma is a collection of blood between
the periosteum of a skull bone and the bone itself.
It occurs in one or both sides of the head.
It occasionally forms over the occipital bone.
The swelling with cephalhematoma is not present
at birth rather it develops within the first 24 to 48
hours after birth.
Causes
Cephalohematoma is a birth injury that occurs
during labor and delivery.
It often occurs as a result of difficult or
prolonged labor as the baby moves through the
birth canal.
 Sometimes the infant’s is hit against the
mothers pelvic bone during delivery, which can
rupture blood vessels.
Other times, the birth canal is narrow and
tight, which puts pressure on the infant’s skull
that can also cause blood vessels to rupture.
Signs and Symptoms
Swelling of the infant’s head 24-48 hours after
birth
Discoloration of the swollen site due to presence
of coagulated blood
Has clear edges that end at the suture lines
RISK FACTORS
The best way to prevent cephalohematoma is to
recognize possible risk factors and adjust prenatal
care accordingly. Primary risk factors for 
cephalohematoma include:
Fetal Macrosomia
Weak or ineffective uterine contractions
Difficult, prolonged labor
Abnormal fetal presentation
Multiples
Management
Observation and support of the affected
part.
Transfusion and phototherapy may be
necessary if blood accumulation is
significant
Complication

Jaundice
Infants with cephalohematoma are also at a
heightened risk for developing jaundice,
because as the blood cells break down 
the levels of bilirubin increase.
In these instances, and if the bilirubin is
excessively high, cephalohematoma
treatment may include phototherapy.
 Difference between a Caput Succedaneum and Cephalhematoma

INDICATORS CAPUT SUCCEDANEUM CEPHALHEMATOMA

Periosteum of skull bone and

Location Presenting part of the head
bone

Both hemispheres; CROSSES the Individual bone; DOES NOT

Extent of Involvement
suture lines CROSS the suture lines

Period of Absorption 3 to 4 days Few weeks to months

Treatment None Support