A TERM PAPER ON

THE ANATOMY OF THE FETAL SKULL AND ITS CLINICAL

SIGNIFICANCE

SUBMITTED BY GROUP 5

ONUNZE CHUKWUNONSO CWCNS/2022/0162

ELEJE CHIAMAKA JULIETH CWCNS/2022/0100

ENEMCHUKWU PRECIOUS U. CWCNS/2022/0101

ENEMUOH KOSISOCHUKWU C. CWCNS/2022/0102

ENENDU MARY-CYNTHIA C. CWCNS/2022/0103

EZE FAVOUR NMESOMA CWCNS/2022/0104

EZE NANCY UCHENNA CWCNS/2022/0105

EZEONYIMA LOVELYN CWCNS/2022/0109

EZIKE PERPETUAL O CWCNS/2022/010

IFEANYI CHIDERA FAVOUR CWCNS/2022/0112

JAMES MERCY DUNGRIT CWCNS/2022/0113

JOHN PRINCE CHILE CWCNS/2022/0114

MAX-OTI RICH CWCNS/2022/0115

MGBEASIRI MARYANN CWCNS/2022/0116

COURSE TITLE: HUMAN ANATOMY 11

DEPARTMENT OF NURSING SCIENCES

CENTRAL WASHINGTON COLLEGE OF NURSING AND HEALTH SCIENCES,

ENUGU STATE

JANUARY 2024.
 TABLE OF CONTENTS

1. Introduction: What is the fetal skull?

2. Anatomy of the Fetal Skull
a. Bones
b. sutures
c. Fontanelles
3. Regions of the Fetal skull
4. Types of Fetal Skull presentations
5. The diameter of the fetal skull
a. Biparietal Diameter (BPD)
b. Occipitofrontal Diameter (OFD)
c. Occipitomental Diameter (OMD)
d. Suboccipitobregmatic Diameter (SOD)
6. Importance of Fetal Skull to the Midwife
7. Mechanics of Fetal Skull Movement During Labor
8. Summary
INTRODUCTION

What is the fetal skull?

The fetal skull is a complex structure that is critical in the delivery process. The skull protects the
brain during birth and allows for the head to change shape to fit through the birth canal.

The fetal skull is one of the most important structures in obstetrics, as its shape and size
determine the course of labor and delivery. Understanding the diameter of the fetal skull is
crucial for obstetricians and midwives in assessing the progress of labor, determining the mode
of delivery, and identifying potential complications.

ANATOMY OF THE FETAL SKULL

The fetal skull is made up of several bones, including the occipital bone, two parietal bones, two
temporal bones, the frontal bone, and the sphenoid bone. These bones are connected by fibrous
joints called sutures, which allow for movement and flexibility during labor.

The fetal skull has several key features that are critical for the delivery process. The fontanels, or
soft spots, are areas where the bones of the skull have not yet fused. The anterior fontanelle is
located at the top of the skull, and the posterior fontanel is located at the back of the head. The
fontanels allow the skull to change shape during delivery, as the bones move to accommodate the
size of the birth canal.

The fetal skull also has several cranial sutures, which are fibrous joints between the bones of the
skull. The coronal suture is located between the frontal and parietal bones, the sagittal suture
runs along the midline of the skull, and the lambdoid suture is located between the parietal and
occipital bones. These sutures allow for movement and flexibility during labor, as the bones of
the skull shift to fit through the birth canal.

Fetal skull bones

The skull bones encase and protect the brain, which is very delicate and subjected to pressure
when the fetal head passes down the birth canal. Correct presentation of the smallest diameter of
the fetal skull to the largest diameter of the mother’s bony pelvis is essential if delivery is to
proceed normally. But if the presenting diameter of the fetal skull is larger than the maternal
pelvic diameter, it needs very close attention for the baby to go through a normal vaginal
delivery.

Figure 1: Bones of the fetal skull — side view facing left.

The fetal skull bones are as follows:

 The frontal bone, which forms the forehead. In the fetus, the frontal bone is in two
halves, which fuse (join) into a single bone after the age of eight years.

 The two parietal bones, which lie on either side of the skull and occupy most of the
skull.

 The occipital bone, which forms the back of the skull and part of its base. It joins with
the cervical vertebrae (neck bones in the spinal column, or backbone).

 The two temporal bones, one on each side of the head, closest to the ear.

Understanding the landmarks and measurements of the fetal skull will help you to recognise
normal and abnormal presentations of the fetus during antenatal examinations, labour and
delivery.

Sutures
Sutures are joints between the bones of the skull. During early childhood, these sutures harden
and the skull bones can no longer move relative to one another, as they can to a small extent in
the fetus and newborn. You may be able to tell the angle of the baby’s head as it ‘presents’ in the
birth canal by feeling for the position of the main sutures with your examining fingers. You can
see the position of the sutures in the fetal skull in the figure below and also the diameters at two
points.

The lambdoid suture forms the junction between the occipital and the frontal bone.

The sagittal suture joins the two parietal bones together.

The coronal suture joins the frontal bone to the two parietal bones.

The frontal suture joins the two frontal bones together.

Note: if the mother’s pelvis and the fetal skull are the average size, there is just sufficient room
for the baby’s head to pass through the pelvic canal if the head rotates to present to the widest
dimension of the pelvis.

Fontanelles

A fontanelle is the space created by the joining of two or more sutures. It is covered by thick
membranes and the skin on the baby’s head, protecting the brain underneath the fontanel from
contact with the outside world. Identification of the two large fontanels on the top of the fetal
skull helps you to locate the angle at which the baby’s head is presenting during labour and
delivery. They are:

 The anterior fontanel (also known as the bregma) is a diamond-shaped space towards
the front of the baby’s head, at the junction of the sagittal, coronal and frontal sutures. It
is very soft and you can feel the fetal heart beat by placing your fingers gently on the
fontanel. The skin over the fontanel can be seen ‘pulsing’ in a newborn or young baby.

 The posterior fontanel (or lambda) has a triangular shape, and is found towards the back
of the fetal skull. It is formed by the junction of the lambdoid and sagittal sutures.
Figure 2: The Sutures & Fontanelles of the fetal skull

REGIONS AND LANDMARKS IN THE FETAL SKULL

certain regions and landmarks in the fetal skull which have particular importance for obstetric
care are called presenting part of the fetus — that is, the part leading the way down the birth
canal. They include:

 The vertex is the area midway between the anterior fontanel, the two parietal bones and
the posterior fontanel. A vertex presentation occurs when this part of the fetal skull is
leading the way. This is the normal and the safest presentation for a vaginal delivery.

 The brow is the area of skull which extends from the anterior fontanel to the upper border
of the eye. A brow presentation is a significant risk for the mother and the baby.

 The face extends from the upper ridge of the eye to the nose and chin (lower jaw). A face
presentation is also a significant risk for the mother and baby.

 The occiput is the area between the base of the skull and the posterior fontanel. It is
unusual and very risky for the occiput to be the presenting part.
Figure 3: Regions and landmarks in the fetal skull facing to the right, as seen from above.
Notice the average diameters in red.

TYPES OF FETAL SKULL PRESENTATIONS

The fetal skull can present in several different ways during labor, depending on the position of
the head in relation to the birth canal. The most common presentation is the vertex presentation,
where the head is flexed and the occiput is the presenting part.

In a face presentation, the fetal head is hyperextended, and the face is the presenting part. This
presentation is rare and may require a cesarean delivery.

In a breech presentation, the fetal buttocks or feet are the presenting part. Breech presentations
are less common and may require a cesarean delivery.

In a transverse presentation, the fetal head is in a horizontal position, and a cesarean delivery is
required.

THE DIAMETER OF THE FETAL SKULL

The fetal skull is composed of several bones that are connected by sutures and fontanelles, which
allow the skull to mold during the birth process. The diameter of the fetal skull is measured in
different ways, including biparietal diameter (BPD), occipitofrontal diameter (OFD),
occipitomental diameter (OMD), and suboccipitobregmatic diameter (SOD).
Bi-Parietal Diameter (BPD)

The biparietal diameter (BPD) is the most commonly used measurement of fetal skull diameter.
It is measured between the two parietal bones of the fetal skull using ultrasound. The BPD is
usually measured in the transverse plane at the level of the thalamus and cavum septum
pellucidum, and represents the widest diameter of the fetal skull. The BPD is an important
indicator of fetal growth and can be used to estimate fetal weight.

Occipitofrontal Diameter (OFD)

The occipitofrontal diameter (OFD) is measured from the fetal occiput (back of the head) to the
fetal frontal bone (forehead) using ultrasound. The OFD is a less commonly used measurement
of fetal skull diameter but can be helpful in diagnosing conditions such as microcephaly or
macrocephaly.

Occipitomental Diameter (OMD)

The occipitomental diameter (OMD) is the distance between the fetal occiput and the fetal
mentum (chin). It is measured manually during labor and delivery to assess the descent of the
fetal head through the birth canal. The OMD is used to determine the adequacy of the maternal
pelvis and can help identify potential cephalopelvic disproportion.

Suboccipitobregmatic Diameter (SOD)

The suboccipitobregmatic diameter (SOD) is the shortest diameter of the fetal skull and is
measured from the suboccipital bone (base of the skull) to the bregma (the junction of the sagittal
and coronal sutures). The SOD is used to assess the position of the fetal head during labor and
delivery and can help identify potential malpositions or malpresentation.

Importance of Fetal Skull Diameter

Knowledge of fetal skull diameter is critical for the safe and effective management of labor and
delivery. The diameter of the fetal skull can affect the course of labor, the mode of delivery, and
the risk of complications such as cephalopelvic disproportion, shoulder dystocia, and perinatal
asphyxia.
Measurement of fetal skull diameter using ultrasound can help identify potential fetal growth
abnormalities, such as macrocephaly or microcephaly, which may require intervention during
pregnancy or delivery. Manual measurement of fetal skull diameter during labor can help guide
the use of interventions such as forceps or vacuum extraction and can assist in identifying
potential complications that may require a cesarean section.

Figure 4: Diameter of the fetal skull

IMPORTANCE OF THE FETAL SKULL TO THE MIDWIFE

1. It contains the delicate brain and about 95% of babies present by head.
2. Sound knowledge of fetal diameter and measurement cause least problems during labour
and delivery through diagnosis of abnormalities presentation and position, also
disproportion between the fetal head and the pelvis can be easily recognized.
3. Delivery can be conducted with minimal injuries to the mother and baby.
4. It is large in comparison with the fetal body and true pelvis; some adaptation has to be
made between the head and the pelvis.
5. The head is the most difficult part to be delivered either it comes first or last
 6. Palpation of posterior fontanelle during vaginal examination denotes the degree of
flexion of the head.
7. Palpation of anterior fontanelle will denote the degree of flexion of the head.
8. After birth, fontanelle are useful to assess the condition of the baby.
9. The fontanelles remain membranous for some time after birth. This helps to
accommodate the marked growth of the brain.

MECHANICS OF FETAL SKULL MOVEMENT DURING LABOR

During labor, the fetal skull must undergo several movements to navigate through the birth canal.
These movements are known as the cardinal movements of labor and include engagement,
descent, flexion, internal rotation, extension, and external rotation.

Engagement occurs when the fetal head enters the pelvic inlet, and the widest part of the head
passes through the pelvic brim.

Descent occurs as the fetal head moves downward through the birth canal, with the head rotating
to fit through the narrowest part of the pelvis.

Flexion occurs as the fetal head meets resistance from the cervix and pelvic floor muscles. The
chin is tucked into the chest, and the occiput moves toward the back of the neck. Internal rotation
occurs as the fetal head rotates to align with the widest part of the pelvis.

Extension occurs as the fetal head emerges from the birth canal, and the head is extended to pass
through the pelvic outlet. External rotation occurs as the head rotates back to its original position,
aligning with the shoulders.

SUMMARY

We have learned that:

1. The skull is formed by several bones joined tightly together by joints called sutures. In
the fetus and newborn, spaces called fontanels exist between some of the skull bones on
 the top of the baby’s head. The position of the sutures and the fontanels can tell you about
the angle at which the baby’s head is presenting during labour and delivery.

2. The vertex presentation (where the top of the baby’s head is the presenting part) is the
most common and the safest presentation for a normal vaginal delivery. Other
presentations carry a much higher risk for the mother and baby.

3. The diameter of the fetal skull can affect the course of labor, the mode of delivery, and
the risk of complications such as cephalopelvic disproportion, shoulder dystocia, and
perinatal asphyxia.

4. Measurement of fetal skull diameter using ultrasound can help identify potential fetal
growth abnormalities, such as macrocephaly or microcephaly, which may require
intervention during pregnancy or delivery.

5. During labor, the fetal skull must undergo several movements to navigate through the
birth canal. These movements are known as the cardinal movements of labor and include
engagement, descent, flexion, internal rotation, extension, and external rotation.
REFERENCES

1. Importance of the fetal skull to the midwife. BrainKart. (n.d.).

https://www.brainkart.com/article/Importance-of-the-fetal-skull-to-the-midwife_22341/
2. Neil S. Norton, Ph.D. and Frank H. Netter, MD, Netter’s Head and Neck Anatomy for
Dentistry, 2nd Edition, Elsevier Saunders, Chapter 1 Development of the Head and Neck,
Pages 10 to 12.
3. T.W. Sadler, Langman’s Medical Embryology, 12th Edition, Wolters Kluwer: Lippincott,
Williams and Wilkins, Part 2, Chapter 17 Head and Neck, Pages.
4. Parika Parika (2023, February 24). The fetal skull -anatomy, diameter, types.
NursingNotes. https://nursingenotes.com/the-fetal-skull-anatomy-diameter-types/