INTRODUCTION

Name- Sukhvir Kaur

Class- Msc. Nursing 1st yr.

Subject- Obstetrics and gynaecology.

Topic- Fetal skull.

Group- Bsc Nursing 3rd yr.

Method of teaching- Lecture cum discussion

Av aids – chalk board, chart, flashcards, bibliography card

Previous knowledge- Students have little knowledge about the fetal skull.

General objectives- At the end of the teaching group will be able to discuss about fetal skull.

Specific objectives- At the end of teaching group will be able to;

 Explain term fetal skull.
 Enlist various areas of fetal skull.
 Enumerate the bones of skull.
 Discuss various sutures present on fetal skull.
 Explain fontanelle of fetal skull.
 Illustrate briefly diameters of fetal skull.
 Explain briefly about process of moulding.
 Explain the importance of moulding.
 Discuss in brief about caput succedaneum.
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objective learning aids
activity
1. Develop 30 sec Self introduction -I am Sukhvir Kaur, student of Introducing Verbal
rapport Msc nursing 1st yr. in Mohan Dai Oswal College of self and ly
with the nursing, Ludhiana. topic.
group. 30 sec Topic-Today we will discuss about fetal skull.

2. Assess the 1 min Previous knowledge-What do you understands by

previous term fetal skull?
knowledg
e of the
group.

3. Explain 2 min Definition; What do Roller

the Fetal skull to some extent compressible, and made you mean board
definition mainly of thin pliable tabular (flat) bones forming by fetal
of fetal the vault this is anchored to the rigid and skull?
skull. incompressible bones at the base of the skull.

4. Enlist 5 min Areas of Fetal skull: What are Transp

various 1. Vertex: the arency
areas of It is a quadrangular area bounded anteriorly by various
fetal skull. the bregma and coronal sutures behind by the areas of
lambda and lambdoid sutures and laterally by fetal skull?
lines passing through the parietal eminence.

2. Brow:
It is an area bounded on one side by the
anterior fontanels and coronal sutures and on
the other side by the root of the nose and
supra-orbital ridges of either side.

3. Face: It is an area bounded on one side by

root of the nose and On the other, by the
junction of the floor of the mouth with neck.
Sinciput: it is an area lying in the front of
anterior fontanelle and corresponds to the
area of brow and the occiput is limited to the
occipital bone.
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Landmarks of skull:
-vault: large dome shaped part above the
imaginary line,drawn b/w orbital ridges and the
nape of the neck. bones are thin and pliable
which helps in alteration during birth.
-face: it is composed of 14 non-compressible
bones.
-base: it is comprised if bones which are firmly
united to protect the vital centers of medulla.
5. Enumerat 4 min Five bones of the skull are:
e the 1.Two frontal bones:
bones of they form the forehead and sinciput. Centre of
skull each is a frontal eminence. they fuse into single at
8 years of age.
2.Two parietal bones:
they lie on the either part of the skull.The
ossification centre of each is called parietal
eminence.
3.occipital bone:
It lies at the back of head and forms the region of
occiput part of it contribute to the base of the
skull as it contains foramen magnum ,which
protacts the spinal cordas it leaves the skull.at the
centre is occipital protuberance.

5. Discuss 5 min Sutures: What are Demo

various 1.The saggittal or longitudinal suture lies between the various nstrati
sutures two parietal bones. sutures on
present 2.The coronal sutures run between parietal and present on and
on the frontal bones on either sides. fetal skull? transp
skull. 3.The frontal sutures lies between two frontal arecy
bones.
Importance:
1. It permits gliding movement of one over the
other during moulding of the head, a
phenomenon of significance while the head
passes through pelvis.
2.Digital palpation of saggital suture during
internal examination in labor gives the idea of
the manner of engagement of the head, degree
of internal rotation of the head and degree of
the moulding of the head.

6. Explain 7 min Fontanelle: What are Chart

 fontanelle Wide gap in the suture line is called fontanelle, of the and
of fetal the many fontanel’s two are of obstetric fontanel’s verball
skull. significance. of fetal y
1. Anterior fontanelle or bregma: It is formed by skull?
joining of four sutures in the midplane, the sutures
are interiorly frontal, posterior saggittal and on
other side coronal. The shape is like diamond. Its
anterior posterior and transverse diameters are
approx. 3 cm each. The floor is formed by
membrane and it becomes ossified 18 months
after birth.
Importance:
 Its palpation through internal examination
denotes the degree of flexion of the head.
 It facilitates the moulding of head.
 It helps in accommodating the marked brain
growth; the brain becomes almost double in
its size in first year of life.
 Palpation of floor reflects intracranial
pressure.
 Collection of blood and brain transfusion
 Can be performed through sinus.
 Cerebrospinal fluid can be drawn through
lateral ventricles.
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2. Posterior fontanelle or lambda:
It is formed by junction of three suture lines-
saggital suture anteriorly and lambdoid suture
on the either side. It is triangular in shape and
measures about 1.2*1.2. Its floor is membranous
but becomes bony at term.
3.Saggital fontanelle:
It is inconsistent in its presence. When present,
it is present on sagittal suture at the junction of
anterior two third and posterior two third. It has
not any clinical importance.

7. Illustrate 7 min  Suboccipito-bragmatic: 9.5cm Complete What are Flash

briefly  -extends from nape of neck to flexion various cards
diameters centre of bregma. diameters and
of fetal  Suboccipito-frontal: 10 cm Incomplete of fetal verball
skull. -nape of neck to anterior flexion skull? y
end of anterior fontanelle.
 Occipito-frontal: 11.5cm Marked
 -occipital eminence to the deflexion
root of the nose.
 Mento-vertical: 14 cm
-mid point of the chin to Partial
the highest point on the extension
saggital suture.
 Submento-vertical: 11.5cm
Junction of floor of mouth and Incomplete
neck to highest point on the extension
sagittal suture.
 Submento-bregmatic: 9.5cm Complete e
Junction of floor of mouth xtension
and neck to centre of bregma.
Transverse diameters concerned
with mechanism of labor:
-Biparietal diameter: 9.5 cm
It extends between two parietal
eminences.
-Super-subparietal: 8.5 cm It
extends from a point placed
below one parietal eminence to a
point placed above the other
parietal eminence of the opposite
side.
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-Bi-temporal diameter: 8 cm What do Transparen

It is the distance between the anterior- you mean cy and
inferior ends of the coronal suture. by lie, demonstar
-Bi-mastoid diameter: 7.5 cm presentatio tion.
It is distance between the tips of the n, attitude,
mastoid processes. The diameter is in denominat
compressible and it is impossible to ed and
reduce the length of the length of the bi- position?
mastoid diameter by obstetrical
operation.
Feto-pelvic relationships:
 Lie- it denotes relationship b/w long axis
of fetus to the long axis of maternal
spine. e.g- long., transverse etc.
 Presentation-it refers to the part of fetus
that lies over the pelvic inlet. e.g-
cephalic,breech , shoulder.
 Attitude-it refers to relationship of fetal
parts to each other.e.g- most common is
 flexion with head bent forwards.
 Denominator- it refers to name of the
part of the presentation which is used
when referring to the fetal position
,which refers to different quadrants of
maternal pelvis.e.g-vertex prstn.(occipit)
 Position-Relationship b/w denominator
and six pounts on the pelvic brim.e.g-
front ,back and sides of maternal pelvis.

8. Describe the 5 min The diameters presenting in cephalic or

various head presentations are the following:
presenting 1.Vertex presentstion: When the head is
diameters. well flexed,the suboccipitobregmatic and
the biparietal diameter of 9.5 cm are
present. The presenting area is round and
most favorable for dilation of cervix.
-the diameter distending the vaginal
orifice will be suboccipitofrontal 10 cm.
2.Brow ptresentation: when the head is
partially extended,the mentovertical
diameter 13.5 cm and bitemporal
diameter 8.5 are present. occipitofrontal
diameter 11.5 cm will distend the vaginal
wall.
3.face presentation:
When the head is completely
extended,the presenting diameters are
submentobregmatic 9.5 cm and the
bitemporal diameter 8.5 cm
.submentovertical will distend the vaginal
orifice.
9. Explain briefly 6 min Moulding: What do Transparen
about process It is the alteration of the shape of the fore you mean cy and
of moulding. coming head while passing through the by verbally
resistant birth passage moulding?
during labor. There is very little alteration
in size of the head, as the volume of the
content inside the skull is incompressible
although small amount of cerebero-spinal
fluid and blood escape out in the
process .during normal delivery ,an
alteration of 4 mm in skull diameter
occurs.

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Mechanism:
There is compression of the engaging
diameter of the head with corresponding
elongation of the diameter at right angle
to it.
Thus, in well flexed of the anterior vertex
presentation, the engaging suboccipito-
bragmatic diameter is compressed
elongation of the head in mento-vertical
diameter which is at right angle to
suboccipito-bregmatic.It is disappears
within few hours after birth.
9. Explain the 3 min Importance: What is the Transparen
importance of -Sight moulding is inevitable and importance cy and
moulding. beneficial. It enables the head to pass of verbally
easily , through the birth canal . moulding?
-Extreme moulding as met in
disproportion may produce severe
intracranial disturbance in the form of
tearing of tentorium cerebella or subdural
haemorrhage.
-Shape of the moulding can be an useful
about the position of the head occupied in
the pelvis.
9. Discuss in 5 min Caput succedaneum: What do Transparen
brief about It is the formation of swelling due to you maen cy and
caput stagnation of fluid in the layers of the by caput verbally
succedaneum. scalp beneath the girdle of contact. succedane
The girdle of contact is either bony or the um?
dilating cervix or vulval ring. The swelling
is diffuse, boggy and is not limited by the
suture line . It may be confused with
cephalhaemotoma. It disappears
spontaneously within 24 hours after birth.
Mechanism of formation:
While the head descends to press over the
dilating cervix or vulval ring, the overlying
scalp is free from pressure, but the tissues
in contact with the full circumference of
the girdle of contact with the full
circumference.
Caput usually occurs after rupture of the
membrane
Importance :
-It signifies static position of the head for a
 long period of time.
-location of caput gives an idea about the
position of the head occupied in the pelvis
and the degree of flexion, with increasing
flexion ,the caput is placed more
posterior.

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10. Discuss in 2 min Cephalohaemotoma:
brief about Collection of blood inbetweem
cephalohaem pericranium and the flat bone of the skull
otoma. usually unilateral and over the parietal
bone.it is due to rupture of a small
emissary vein from the skull and may be
associated with the fracture of the skull
bone.This may be caused by forceps
delivery but also with normal labor.
-it is never present at birth but develops
after 12-24 hrs. Swelling is limited by
suture lines.it is
circumscribed,soft,fluctuant and
incompressible.It may be confused with
caput succedenum
10. Strengthen 1.5 Summarization:
the min  Definition of fetal skull.
knowledge of  Various areas of fetal skull.
the group  Various sutures present on fetal
with sum- skull
arization.  Fontanelle of fetal skull.
 Diameters of fetal skull.
 Process of moulding and
its importance.
 Mechanism and importance
Of caput succedaneum.

11. Enhance the 2 min Recaputalization: verbally

knowledge of  What do you mean by term fetal skull?
the group.  What are various areas of fetal skull?
 What are the various sutures present
on fetal skull?
 What is Fontanelle of fetal skull?
  What are the diameters of fetal skull?
 What is process of moulding?
 What is mechanism and importance of
the caput succedaneum?
12. Raise the 1.5 Bibliography: Bibliograph
knowledge of min  Dutta,D.C,(2004),Text book of y card
the group obstetrics,6th ed.,Pp-83-86.
with  Kumari,Neelam and Sharma.Shivani
reference. and Dr.Gupta.Preeti,(2010),Midwifery
and gynaecology nursing.1st
edition,Jalandhar:Pee Vee Publishers.Pp-
80-83.
 Jacob,Annama(2005),Manual of
midwifery ,1st ed.,Delhi:Jaypee
Brother.Pp-195-2000.

LESSON PLAN

SUBJECT- OBSTETRICS AND

GYANAECOLOGY.
TOPIC- FETAL SKULL

SUBMITTED TO-
Respected mam:

SUBMITTED BY-
Ms.Sukhvir Kaur
Msc Nursing