Fetal skull.pptx

Fetal skull is important in obstetrical standpoint as cephalic presentataion is common and a competent midwife must have knowledge about it along with female pelvis.

1. FETAL SKULL PREPARED BY: SRUJANI SWETASINA DASH NURSING TUTOR G.N.M.INSTITUTE A.N.M.M.C.H, GAYA

2. OBJECTIVES NEED FOR STUDY ABOUT FETAL SKULL IN OBSTETRIC FUNCTIONS OF SKULL BONES OF FETAL SKULL SUTURES FONTANELLES AREAS OF SKULL DIAMETERS OF FETAL SKULL SUMMARY BIBLIOGRAPHY

3. NEED FOR STUDY ABOUT FETAL SKULL IN OBSTETRIC The common presentation of fetus is cephalic during labour and hence it is the head which first enters the birth canal. The head or skull is the largest and least compressible part of fetus . Once it is born, the rest part of the fetus comes out smoothly from birth canal.

4. FUNCTIONS OF FETAL SKULL Cranium protects the brain. Bony eye sockets protects the eye against injury Temporal bone protects the ear. Mandible helps in chewing of food. Skull or head is the most common presenting part which comes out through the birth canal.

5. BONES OF FETAL SKULL Skull is divided into two parts- a. CRANIUM b. FACE

6. BONES OF FETAL SKULL CRANIUM FACIAL Upper bowl shaped part of the skull which contains the brain. 9 bones in cranium- Anterior portion of skull forms facial bones. 14 bones of face- Bone Name No. Frontal 2 Parietal 2 Occipital 1 Temporal 2 Sphenoid 1 Ethmoid 1 Total 9 Bones No. Zygomatic 2 Lacrimal 2 Nasal 2 Inferior nasal Concha 2 Vomer 1 Palatine 2 Maxilla 2 Mandible 1 Total 14

7. SUTURES Immovable joint between skull bones Frontal Suture- Frontal Bone + Frontal Bone Coronal Suture- Frontal Bone + Parietal Bone Sagittal Suture Parietal Bone + Parietal Bone Lambdoid Suture Parietal Bone + Occipital Bone Squamous Suture Temporal Bone + Parietal Bone

8. FONTANELLES Area where two or more sutures join. There are 6 fontanelles in skull but only two are of obstetric importance. ANTERIOR FONTANELLE POSTERIOR FONTANELLE Also called as Bregma Also called as Lambda Located anteriorly at junction of sagittal , frontal and coronal sutures. Located posteriorly at sagittal and lamdoidal sutures. Diamond shape Traingle shape 2.5 cm long, 1.5 cm wide 1.2 cm long , 1.2 cm wide Larger than lambda Smaller than bregma Ossifies by 18 months after birth Ossifies by 6 weeks after birth

9. CLINICAL SIGNIFICANCE OF SUTURES AND FONTANELLES SUTURES Helps in moulding neccessary during vaginal delivery. Digital palpation of sagittal suture during p/v examination gives an idea of engagement and degree of internal rotation. FONTANELLES Facilitates moulding Palpation denotes degree of flexion Depressed fontanelle indicates dehydration Elevated fontanelle indicates raised ICP CSF can be drawn through fontanelles

10. AREAS OF SKULL Skull is divided into- 1.Vault 2.Base 3.Face

11. Areas/Landmarks of Obstetrical Importance AREA DESCRIPTION VERTEX Quadrangular area bounded anteriorly by bregma and coronal sutures and behind by the lambda and lambdoid sutures and laterally by lines passing through the pariatal eminences. BROW Area bounded on one side by bregma and coronal sutures and on other side by root of nose and supra orbital ridges of either side. FACE Area bounded on one side by root of the nose and supraorbital ridges and on the other by the junction of the floor of mouth and neck. OCCIPUT Area of surrounded within occipital bone SINCIPUT Area lying in front of bregma and corresponds to area of brow

12. FETAL DIAMETERS It has two types of diameters- a. Anteroposterior Diameters b. Transverse Diameters

13. ANTERO POSTERIOR DIAMETERS Submento Vertical, 11.5 cm

14. Diameter Description Measurement Attitude Presentation Suboccipito Bregmatic (SOB) Extends from neck to centre of bregma 9.5 cm Complete Flexion Vertex Sub Occipito Frontal (SOF) Extends from nape of neck to centre of sinciput 10 cm Incomplete Flexion Vertex Occipito Frontal (OF) Extends from occipital eminence to root of nose 11.5 cm Marked Deflexion Vertex Mento Vertical (MV) Extends from midpoint of chin to the highest of sagittal suture 14 cm Partial extension Brow Sub Mento Vertical (SMV) Extends from junction of floor of mouth and neck to the highest point of sagittal suture 11.5 cm Incomplete extension Face Sub Mento Bregmatic (SMB) Extends from junction of floor of mouth and neck to the centre of bregma 9.5 cm Complete extension Face

15. TRANSVERSE DIAMETERS

16. Diameter Description Measurement Biparietal Diameter (BPD) Extends between two parietal eminences 9.5 cm Super Sub Parietal Diameter (SSPD) Extends from a point placed below one parietal eminence to a point placed above the opposite side parietal eminence 8.5 cm Bitemporal Diameter (BTD) Extends from both antero inferior ends of coronal suture 8 cm Bi Mastoid Diameter (BMD) Extends from both tip of mastoid process 7.5 cm

17. SUMMARY Fetal skull is significant in obstetrical standpoint because it is the first part and hardest part which comes out during delivery in normal cases and if it is delivered smoothly then the rest of the trunk follows smoothly as well. A midwife must be competent to recognise areas, sutures, fontanelles of fetal skull in order to understand the attitude, degree of rotation, presentation & presenting part, status of intracranial pressure and able to detect deviations from normal.

18. BIBLIOGRAPHY Dutta D.C, “Textbook Of Obstetrics”, Jaypee Brothers , The Health Science Publishers, 8 th edition, Pg.96-98 Jacob Annamma , “A Comprehensive Textbook of Midwifery”, Jaypee Brothers Medical Publishers(P)LTD, 2 nd edition, Pg.43-51 Elizabeth Marie, “Midwifery for Nurses”, CBS Publishers and Distributors Pvt Ltd, 2 nd edition, Pg.90-96 Kaur Sandeep , “ Midwifery and Gynaecological Nursing”, CBS Publishers and Distributors Pvt Ltd, 1 st edition , 2019, Pg.39-40