Female Pelvis

Presented by,
Mr. ALKALI M. JABBY
SENIOR LECTURER
SON/M
 OUT LINE
• Parts of the female pelvis
• Functions of the pelvis
• Pelvic bones
• Pelvic joint
• Pelvic ligaments
• Boundaries of the true pelvis
• Important landmarks
• The female pelvis because of its
characteristics, aids in child birth.
The bony pelvis in normal standing
posture transmits the body weight of
head, trunk and the upper
extremities to the lower extremities.
In female it is adapted for child
bearing. The obstetrical anatomy of
a typical female pelvis is best
considered as one unit.
 FUNCTIONS OF FEMALE PELVIS
• The primary function of the pelvic girdle is to allow
movement of the body, especially walking and running.
It permits the person to sit and kneel. The women pelvis
is adapted for child bearing, and because of its
increased width and rounded brim women are less
speedy than men.
• The pelvis transmits the weight of the trunk to the legs,
acting as a bridge between the femur. This makes it
necessary for the sacro-iliac joint to the immensely
strong and virtually immobile. The pelvis also takes the
weight of the sitting body on to the ischial tuberosities.
• The pelvis affords protection to the pelvic organs and,
to a lesser extent, to the abdominal contents. The
sacrum transmits the cauda equina and distributes the
nerves to the various parts of the pelvis.
Pelvic bones
• There are four pelvic bones
– Two innominate( nameless) or hip bones
– One sacrum
– One coccyx
• Innominate bones: each innominate bone is
composed of three parts
oIlium
oIschium
oPubic bones
• The ilium- ilium is the larger flared out part. When
the hand is placed on the hip it rests on the iliac
crest, which is the upper border. At the front of the
iliac crest can be felt a bony prominence known as
the anterior superior iliac spine .
A short distance below it is the anterior
inferior iliac spine. There are two similar points at
the other end of the iliac crest, namely the
posterior superior and the posterior inferior iliac
spines. The concave anterior surface of the ilium is
the iliac fossa.
• The ischium- ischium is the thick lower
part. It has a large prominence known as
the ischium tuberosity, on which the body
rests when sitting. Behind and a little
above the tuberosity is an inward
projection, the ischial spine. in labour the
station of the fetal head is estimated in
relation to the ischial spines.
• The pubic bone- this bone forms the
anterior part. It has a body and two
oar like projections, the superior
ramus and the inferior ramus. The
two pubic bones meet at the symphysis
pubis and the two inferior rami from
the pubic arch, merging into a similar
ramus and the ischium. The space
enclosed by the body of the pubic
bone, the rami and the ischium is
called the obturator foramen.
• The innominate bone contains a deep cup to
articulate with the head of the femur. This is
termed as Acetabulum . all three parts of the
bone contribute to the acetabulum in the
following proportions: 2/5th ilium, 2/5th
ischium and 1/5th pubic bone.
• On the lower border of the innominate bone
are found two curves. One extends from the
posterior inferior iliac spine up to the ischial
spine and is called the greater sciatic notch.
It is wide and rounded. The other lies
between the ischial spine and the ischial
tuberosity and is the lesser sciatic notch.
• Sacrum: the sacrum is a wedge shaped bone
consisting of five fused vertebrae. The
upper border of the first sacral vertebra
juts forward and id known as the sacral
promontory. The anterior surface of the
sacrum is concave and is referred to as the
hollow of sacrum. Laterally the sacrum
extends into a wing or ala. Four pairs of
holes or foramina pierce the sacrum and
through these, nerves from the Cauda
Equina emerge to supply the pelvic organs.
The posterior surface is roughened to
receive attachments of muscles.
• Coccyx: the coccyx is a vestigial tail. It
consists of four fused vertebra forming a
small triangular bone. With its base
uppermost articulating with the lower end
of the sacrum. During labour it moves
backward, having more space for the
delivery of the fetus this is called
nodding.
Pelvic joints
There are four pelvic joints
• One symphysis pubis
• Two sacroiliac joints
• One sacro-coccygeal joint
• The symphysis pubis is formed at the
junction of the two pubic bones, which are
united by a pad of cartilage.
• The sacroiliac joints – these are the
strongest joints in the body. They join the
sacrum to the ilium and thus connect the
spine to the pelvis.
• The sacro coccygeal joint – this joint is
formed where the base of the coccyx
articulate with the tip of the sacrum.
• In the non-pregnant state there is very
little movement in these joints, but during
pregnancy endocrine activity causes the
ligaments to soften, which allows the joints
to give. This may provide more room for the
fetal head as it passes through the pelvis.
The symphysis pubis may separate slightly
in later pregnancy. If it widens appreciably,
the degree of movement permitted may
give rise to pain on walking.
• The sacro-coccygeal joint permits coccyx to
the deflected backward during the birth
of the head.
Ligaments of the Pelvis
The sacrotuberous and sacrospinous ligaments complete the
greater and lesser sciatic foraminae
Pelvic ligaments
Each of the pelvic joints is held together by
ligaments
• Interpubic ligaments at the symphysis pubis
• Sacro-iliac ligaments
• Sacro-coccygeal ligaments
• There are two other ligaments important in
midwifery
• The sacro-tuberous ligament
• The sacro-spinous ligament
• The sacro-tuberous ligament runs
from the sacrum to the ischial
tuberosity and the sacro-spinous
ligament from the sacrum to the
ischial spine. These two ligaments
cross the sciatic notch and from the
posterior wall of the pelvic outlet.
 The pelvis is broadly divided into true pelvis and
false pelvis.
• The false pelvis: is divided by the linea
terminalis into the false pelvis above this
demarcation and the true pelvis below it. The
false pelvis is the portion above the pelvic brim.
It has no obstetric significance relevant to the
passage of the fetus through the pelvis.
• The true pelvis: the true pelvis constitutes the
bony passage through which the fetus must
pass through to be born vaginally. Therefore,
its construction planes and diameters are of
utmost interest in obstetrics.
Boundaries of true pelvis;
The true pelvis has the following as its
boundaries
• Superiorly it is bounded by the sacral
promonitory, linea terminalis and the upper
margin of pubic bones.
• Inferiorly it is bounded by the inferior
margins of the ischial tuberosities and the tip
of the coccyx.
• Laterally it has sacroiliac notches and
ligaments, and inner surface of ischial bones
• Anteriorly by the obturator foramina an dthe
posterior surface of the symphysis pubis, pubic
bones and the ascending rami of ischial bones.
• Posteriorly bounded by the anterior surface
of sacrum and coccyx.
• The true pelvis has three parts namely
brim, a cavity and an outlet
• The brim or inlet – its boundaries are the
sacral promontory and wings of the
sacrum behind the iliac bones in the front.
The shape of the pelvic inlet is
transversely oval, with a slight posterior
indentation caused by the sacral
promontory.
Land marks of the brim: the inlet has the
landmarks, these are the fixed anatomical
points on the brim.
1. Sacral promontory
2. Sacral wing or sacral ala
3. Sacro-iliac joint
4. The ileo-pectineal line- the edge formed at
the inward aspect of the ilium
5. The ilio-pectineal eminence- a roughened
area where the superior ramus of the pubic
bone meets the ilium
6. Superior ramus of the pubic bone
7. Upper inner border of the body of pubic
bone.
8. Upper inner border of the symphysis pubis.
• The pelvic cavity
This extends from the pelvic brim to the pelvic outlet.
It
forms the curve of Carus, which the fetus has to
navigate
in order to be born and has no specific landmarks.
The pelvic outlet
This is either an ovoid or diamond-shaped space; its
perimeter is partially comprised of ligaments. The
landmarks of the pelvic outlet are as follows:
• _ Lower border of the symphysis pubis
• _ Pubic arch
• _ Ischial spines and ischial tuberosities
• _ Sacrotuberous and sacrospinous ligaments
• _ Lower aspect of the sacrum and the coccyx
The diameters of the pelvis
The major obstetric interest in the female bony pelvis is that
it is not distensible, with only minor degrees of movement
being possible at the symphysis pubis and sacroiliac joints.
The various dimensions of the pelvis are therefore
particularly significant in the context of childbirth and the
successful passage of the fetus through the bony pelvic
structure. The most common type of female pelvis
(gynaecoid) is considered to be the optimal shape and size
for childbirth; this is providing the fetus isn’t above average
size and the pelvis isn’t smaller than average, or where
there is a combination of both factors.
The pelvic brim
There are three diameters that are measured and,
as a
midwifery student, you will frequently hear these
being
referred to:
• _ Anterior-posterior diameter
• _ Oblique diameter (left and right)
• _ Transverse diameter
The diagrams presented here show the points from
where these measurements are taken and the
associated
Table gives a clear format for the measurement of
the pelvic canal in centimetres.
Normal Variants
The puborectalis is actually a part of the
pubococcygeus muscle that wraps around the
posterior aspect of the rectum forming a sling that
holds the rectum forward in the pelvis.

The pubococcygeus and iliococcygeus muscles make

up the levator ani. The muscles of the levator ani
are important supportive muscles for the midline
organs of the pelvis. Any weakness in these muscles
can cause clinical problems of urinary or fecal
incontinence.
The levator ani muscles otherwise known as the pelvic
diaphragm or pubovisceralis (pubococcygeus) and
iliococcygeus, are composed of striated muscle fibre. They
are covered by fascia on their superior and inferior aspects.
The anterior midline cleft in the muscles is known as the
urogenital hiatus, through which the urethra, vagina and
anorectum pass.
The perineal membrane is sometimes called the urogenital
diaphragm, or the triangular ligament. It lies inferior to
the levator ani and attaches the edges of the vagina to the
ischiopubic ramus, provides lateral attachments for the
perineal body and assists in the support of the urethra. It is
suggested that it has a greater supportive function when
the levator ani muscles are relaxed.
levator ani is considered as several separate muscle parts:

•pubovaginalis
•coccygeus
•iliococcygeus
•pubococcygeus
•Puborectalis

origin:
from a tendinous arch between the pubis and ischial spine
on the internal surface of the pelvis

insertion:
perineal body
external wall of anal canal
anococcygeal ligament
coccyx
Pubovaginalis

originate from the posterior pelvic surface of the body of the pubis bone. Fibres pass
inferiorly, medially and posteriorly.

inserts into the central perineal tendon posterior to the vagina.

The levator ani muscle seen

from above looking over the
sacral promontory (SAC)
showing the pubovaginal
muscle (PVM). The urethra,
vagina, and rectum have been
transected just above the
pelvic floor. PAM = puboanal
muscle; ATLA = arcus
tendineus levator ani; and
ICM = iliococcygeal muscle
The arcus tendineus
levator ani (ATLA);
external anal sphincter
(EAS); puboanal muscle
(PAM); perineal body (PB)
uniting the 2 ends of the
puboperineal muscle (PPM)
; iliococcygeal muscle (ICM)
; puborectal muscle (PRM).
The arcus tendineus fascia of the pelvis (ATFP) is a linear fascial thickening of
the obturator fascia attached anteriorly to the pubic bone and posteriorly to
the ischial spine and is believed to be of great importance in the continence
mechanism
levator ani Muscle showed that it was made up of large diameter type I
(slow twitch) and type II (fast twitch) striated muscle fibres, with muscle
spindles observed.

Muscle activity may be recorded by electromyograph (EMG) from the

levator ani muscle ‘at rest’ and even in sleep; presumably the type I fibres
are responsible for this. By contrast, type II fibres are highly fatiguable
but produce a high order of power on contraction.

All these facts support the contention that the levator ani muscle is a
skeletal muscle adapted to maintain tone over prolonged periods and
equipped to resist sudden rises in intra-abdominal pressure, as for
example on coughing, sneezing, lifting or running.

It has been shown that there is reflex activity such that a fast-acting
contraction occurs in the distal third of the urethra, which contributes to
the compressive forces of the proximal urethra during raised intra-
abdominal pressure
The perineal body is a central cone-shaped fibromuscular
structure which lies just in front of the anus. The cone is about
4.5 cm high and its base, which forms part of the perineum, is
approximately 4 cm in diameter. Anteriorally it fuses with the
vaginal wall, the superficial transverse perineal muscles, the
perineal membrane and the levator ani muscles insert into it.
The perineal body also affords support to the posterior wall of
the vagina. The integrity of the perineal body and its
connections have been thought to be of considerable importance
in the supportive role of the pelvic floor. This explains the
concern that obstetricians have had for the welfare of the
perineal body in labour, particularly in the second stage when,
toward delivery, the pelvic floor stretches considerably and
provides a gutter to guide the foetal head towards and down the
birth canal.
Thank you