INTRODUCTION Name-
Sukhvir Kaur
Class-
Msc. Nursing 1 yr.
Subject-
Obstetrics and gynaecology.
Topic-
Fetal skull.
Group-
Bsc Nursing 3 yr.
st
rd
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 objectivesobjectives- At the end of the teaching group group will be able to discuss about about fetal skull.
Specific objectives- At the end of teaching group will be able to; y
Explain term fetal skull.
y
Enlist
y
Enumerate the bones of skull.
y
Discuss various sutures present on fetal skull.
y
Explain
y
Illustrate briefly diameters of fetal skull.
y
Explain
y
Explain the importance of moulding.
y
Discuss in brief about caput succedaneum.
various areas of fetal skull.
fontanelle of fetal skull. briefly about process of moulding.
Sr.no
Specific objective
Time
1.
Develop rapport with the group.
30 sec
2.
Assess the previous knowledg e of the group.
1 min
Previous knowledge-What do you understands by term fetal skull?
3.
Explain
2 min
Definition; Fetal skull to some e xtent compressible, and made mainly of thin pliable tabular (flat) bones forming the vault this is anchored to the rigi d and incompressible bones at the base of the the skull.
What do you mean by fetal skull?
Roller board
5 min
Areas of Fetal skull: 1. 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 eminence.
What are the various areas of fetal skull?
Transp arency
30 sec
the definition of fetal skull.
4.
Enlist
various areas of fetal skull.
Content matter
Self introduction -I am Sukhvir Kaur, student of Msc nursing 1st yr. in Mohan Dai Oswal College of nursing, Ludhiana. Topic-Today we will discuss about fetal skull.
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 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 limite d to the occipital bone.
Teaching learning activity Introducing self and topic.
AV aids
Verbal ly
Sr.no
5.
Specific objective
Enumerat
Time
4 min
e the bones of skull
5.
Discuss various sutures present on the skull.
5 min
Content matter
Teaching learning activity
AVaid
What are the various sutures present on fetal skull?
Demo nstrati on and transp arecy
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. Five bones of the skull are: 1.Two frontal bones: they form the forehead and sinciput. Centre of 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. Sutures: 1.The 1. The saggittal or longitudinal suture lies between two parietal bones. 2.The 2. The coronal sutures run between parietal and frontal bones on either sides. 3.The 3. The frontal sutures lies between two frontal 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 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 of fetal skull.
Fontanelle: Wide gap in the suture line is called fontanelle, of the many fontanels two are of obstetric significance. 1. Anterior fontanelle or bregma: It is formed by 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.
What are the fontanels of fetal skull?
Chart and verball y
Teaching learning method
AV aids
What are various diameters of fetal skull?
Flash cards and verball y
y
y y
y
y y y
Cerebrospinal fluid can be drawn through lateral ventricles.
Sr.no
Specific objective
Time
Content matter
2. Posterior fontanelle or lambda: It is formed by junction of three suture linessaggital 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 briefly diameters of fetal skull.
7 min
Suboccipito-bragmatic: 9.5cm -extends from nape of neck to centre of bregma. Suboccipito-frontal: 10 cm -nape of neck to anterior end of anterior fontanelle. y y
y
Complete flexion Incomplete flexion
Occipito-frontal: 11.5cm -occipital eminence to the root of the nose. Mento-vertical: 14 cm -mid point of the chin to the highest point on the saggital suture. Submento-vertical: 11.5cm Junction of floor of mouth mouth and neck to highest point on the sagittal suture. Submento-bregmatic: 9.5cm Junction of floor of mouth 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. Time Content matter y
Marked deflexion
y
Partial extension
y
y
Sr.no
Specific objective
Incomplete extension Complete e xtension
Teaching learning methods
A V aids
-Bi-temporal diameter: 8 cm It is the distance between the anteriorinferior ends of the coronal suture. -Bi-mastoid diameter: 7.5 cm It is distance between the tips of the mastoid processes. The diameter is in compressible and it is impossible to reduce the length of the length of the bimastoid diameter by obstetrical operation. Feto-pelvic relationships: Lie- it denotes relationship b/w long a xis of fetus to the long a xis of maternal spine. e.g- long., transverse etc. Presentation-it refers to the part of fetus that lies over the pelvic inlet. e.gcephalic,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.gfront ,back and sides of maternal pelvis. y
y
y
y
y
What do you mean by lie, presentatio n, attitude, denominat ed and position?
Transparen cy and demonstart ion.
8.
Describe the various presenting diameters.
9.
Explain briefly
about process of moulding.
5 min
The diameters presenting in cephalic or head presentations are the following: 1.Vertex presentstion: When the head is 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. 6 min Moulding: It is the alteration of the shape of the fore coming head while passing through the resistant birth passage 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. occurs.
What do you mean by moulding?
Transparen cy and verbally
Teaching learning methods
A V aids
Sr.no Specific objective
Time
Content matter
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 fle xed of the anterior vertex presentation, the engaging suboccipitobragmatic 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 importance of moulding.
3 min
9.
Discuss in brief about caput succedaneum.
5 min
Importance: -Sight moulding is inevitable and beneficial. It enables the head to pass easily , through the birth canal . -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. Caput succedaneum: It is the formation of swelling due to stagnation of fluid in the layers of the scalp beneath the girdle of contact. The girdle of contact is either bony or the dilating cervix or vulval ring. The sw elling 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 fle xion, with increasing flexion ,the caput is placed more posterior.
What is the importance of moulding?
Transparen cy and verbally
What do you maen by caput succedane um?
Transparen cy and verbally
Sr.no
Specific objective
Time
10.
Discuss in brief about cephalohaem otoma.
2 min
10.
Strengthen the knowledge of the group with sumarization.
1.5 min
Content matter
Teaching learning activity
A V aids
Cephalohaemotoma: Collection of blood inbetweem pericranium and the flat bone of the skull 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 Summarization: Definition of fetal skull. Various areas of fetal skull. Various sutures present on fetal skull Fontanelle of fetal skull. Diameters of fetal skull. Process of moulding and its importance. Mechanism and importance Of caput succedaneum.
y
y
y
y y y
y
11.
Enhance
the knowledge of the group.
2 min
Recaputalization: What do you mean by term fetal skull? 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? Bibliography: Dutta,D.C,(2004),Text book of th obstetrics,6 ed.,Pp-83-86. Kumari,Neelam and Sharma.Shivani and Dr.Gupta.Preeti,(2010),Midwifery st and gynaecology nursing.1
verbally
y y y
y y y y
12.
Raise the knowledge of the group with reference.
1.5 min
y
y
Bibliograph y card
edition,Jalandhar:Pee Vee Publishers.Pp80-83. Jacob,Annama(2005),Manual of st midwifery ,1 ed.,Delhi:Jaypee Brother.Pp-195-2000. y
LESSON PLAN SUBJECT- OBSTETRICS AND GYANAECOLOGY. TOPIC-
FETAL SKULL
SUBMITTED TORespected mam:
SUBMITTED BY-
Ms.Sukhvir Kaur Msc Nursing
