Obstetrical Nursing: A Text-Book on the Nursing Care of the Expectant Mother, the Woman in Labor, the Young Mother and Her BabyVan Blarcom, Carolyn Conant
Science
Obstetrical Nursing: A Text-Book on the Nursing Care of the Expectant Mother, the Woman in Labor, the Young Mother and Her Baby
Van Blarcom, Carolyn Conant
Infants -- Care; Maternity nursing; Pregnancy
=The head= is the most important part of the fetus, from an obstetrical
standpoint, since the process of labor is virtually a series of
adaptations of the size, shape and position of the fetal skull to the
size and shape of the maternal pelvis. And since the pelvis is rigid and
inflexible the adjustment must all be made by the fetal head, which is
mouldable because of being incompletely ossified at birth. If the head
passes through the inlet safely, the rest of the delivery will usually
be accomplished with comparative safety. But a marked disproportion
between the diameters of the head and pelvis, or limited mouldability of
the head, constitutes a serious complication, which will be discussed
later in connection with obstetrical operations.
A baby’s head is larger, in proportion to its body, than an adult’s,
while the face forms a relatively smaller part of the baby’s than of the
adult’s head. The major portion is the dome or vault-like structure
forming the top, sides and back of the head, which in turn is made up of
separate and as yet ununited bones. They are the two _frontal_, two
_parietal_, two _temporal_ and the _occipital_ bone, with which the
wings of the _sphenoid_ bones, though less important, may be included.
These bones are not joined in the fetal skull, but are separate
structures, with soft, membranous spaces between their margins, called
_sutures_; while the irregular spaces formed by the intersection of two
or more sutures are called _fontanelles_, possibly so called by the
early observers because the pulsation of the soft tissues beneath these
spaces suggests the spurting of a fountain.
The sutures are named and situated as follows: The _frontal_ lies
between the two frontal bones; the _sagittal_ extends antero-posteriorly
between the parietal bones; the _coronal_ between the frontal bones and
the anterior margins of the parietal, while the _lambdoidal_ suture
separates the posterior margin of the parietal from the upper margin of
the occipital bone. There are also the temporal sutures between the
upper margins of the temporal bones and the lower margins of the two
parietals, but they are of no obstetrical importance, as they cannot be
felt on vaginal examination. (Fig. 30.)
There are two fontanelles of obstetrical significance. The greater, or
_anterior fontanelle_, also called the _bregma_ or _sinciput_, is
located at the meeting of the coronal, sagittal and frontal sutures. It
is diamond or lozenge shaped, about an inch in diameter and is not
obliterated during labor.
[Illustration:
FIG. 30.—Side and top views of fetal skull giving average length of
important diameters.
]
The smaller or _posterior fontanelle_ is the triangular space at the
inter-section of the sagittal and lambdoidal sutures, and may be
obliterated as the surrounding bony margins approach each other during
labor.
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