6.3.

1 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 mothers 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.

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.

Sutures

Sutures are joints between the bones of the skull. In the fetus they can give a little under the pressure on the babys head as it passes down the birth canal. 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.

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. At its widest part, the fetal skull is (on average) 9.5 cm wide. This is 3.5 cm less than the widest diameter of the pelvic inlet, and 1.5 cm less than the widest diameter of the pelvic outlet.

6.3.3 Fontanels A fontanel is the space created by the joining of two or more sutures. It is covered by thick membranes and the skin on the babys head, protecting the brain underneath the fontanel from contact with the outside world.

The anterior fontanel (also known as the bregma) is a diamond-shaped space towards the front of the babys head, at the junction of the sagittal, coronal and frontal sutures. 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.

Regions and landmarks in the fetal skull particular importance for obstetric care because they may form the so-called presenting part of the fetus that is, the part leading the way down the birth canal.

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.