Mrs Choonga MSc Midwifery

layout

Introduction
The pelvic bones, joints and ligaments
The true pelvis
Diameters of the brim
Functions of the pelvis
Conclusion
References
 INTRODUCTION


The human pelvis is an irregular ring-
shaped bony structure connecting the
spine to the femurs.

"Pelvis" is the Latin word for a "basin"

and the pelvis thus got its name from
its shape. It is also known as hip girdle.
 Introduction cont,
The Pelvic Bones

The bones of the pelvis join to form a canal
through which a fetus passes during the process
of child birth.
The pelvis is made up of four pelvic bones
namely;
Two innominate or hip bones
Sacrum
Coccyx
The female pelvis

The female pelvis

The Pelvic Bones contd…

The Innominate Bones
There are two innominate bones and
each is composed of three parts namely
the ilium, ischium and the pubis.

The three bones fuse completely during

puberty or early adulthood.
The Innominate Bone


The Innominate Bone

The Innominate Bone

The Innominate Bone

The Innominate Bones


The Pelvic Bones contd…

The Ilium
This is the strong heavy bone that
makes up the superior portion of the
innominate bones and forms the large
flared part of the pelvis referred to as
the false pelvis.
 The Pelvic Bones
contd…

• Forms the upper expanded part of the
innominate bone and gives rise to the
female shape of the hips.
• The concave anterior surface forms the
iliac fossa.
• The iliac crest is the curved upper
border of the ilium.
 The Pelvic Bones
contd…

The ischium
This is the thick lower part of the
innominate bones with a thickened
lower border known as the ischial
tuberosity on which the body rests
when sitting and they form part of the
pelvic outlet.
 The Pelvic Bones
contd…

Directly above and behind the
tuberosity is an inward projection, the
ischial spines, seperating the greater
schiatic notch from the lesser schiatic
notch.
 The Pelvic Bones
contd…
The pubic bone

This bone consists of a body and two
arms, the superior and inferior pubic rami
and forms the anterior part of the pelvis.
The bodies of the two pubic bones meet
anteriorly at the symphisis pubis and the
two inferior rami form the pubic arc
which also forms part of the outlet to the
pelvic cavity.
 The Pelvic Bones
contd…

The space enclosed by the body of the
pubic bone, the rami, and the ischium is
called the obturator foramen through
which pass the obturator nerve and
blood vessels leading to the thigh.
 The Pelvic Bones
contd…

The scrum
 This is a strong, heavy wedge-shaped
bone consisting of five fused bones
which forms the posterior portion of
the pelvis and articulates on either side
with the ilium at the sacro-iliac joints.
 The Sacrum contd…

The full weight of the body is taken
unto this bone and is transferred to the
legs via the sacro-iliac joints.
The upper wider part articulates with
the fifth lumber vertebra where the
anterior border of the first sacral
vertebra juts forwards and forms the
sacral promontory.
 The Sacrum contd…

The lower and narrow part of the
wedge is directed downward and
backward and its inferior border
articulates with the upper end of the
coccyx.
The anterior surface of the sacrum is
concave and forms what is referred to
as the hollow of the sacrum.
 The Sacrum contd…

Laterally the sacrum extends into wings or
alae.
The alae are the widest out wings of bones
on each side of the 1 st sacral vertebra.
There are four pairs of holes or foramen that
pierce the sacrum through which the nerves
from the cauda equina emerge to supply the
pelvic organs.
 The Sacrum contd…

The posterior surface of the sacrum is
roughened to receive an attachment of
muscles.

In females the sacrum is shorter as

compared to that of the males.
 The coccyx

It is a small wedge-shaped bone,
consisting of four fused rudimentary
vertebrae and is found at the end of the
vertebrae column.
The coccyx serves as an origin for
important muscles of the pelvic floor
and the hip.
 The Pelvic Joints

There are four pelvic joints that are
very strong and the ligaments
strengthening them are partly
cartilaginous and partly fibrous.
In normal circumstances, there is very
little movement in these joints.
Pelvic joints

Sacroiliac joint and symphysis
pubic joint

The Pelvic Joints contd…

However, during pregnancy, due to the
influence of hormones, there is
softening and stretching of the
ligaments allowing some degree of
movement or ‘give’ in the joints.
 The Pelvic Joints contd…

The symphysis pubis joint
This is the joint that joins the two pubic
bones and is covered by a pad of cartilage
and forms the anterior wall of the pelvis.
The symphysis pubis may separate
slightly in later pregnancy, but if it widens
appreciably, the degree of movement
permitted may give rise to pain on
walking.
 The Pelvic Joints contd…
The sacral-iliac joints

These are the two strongest joints in the body
and are situated posteriorly joining the ilium to
the sacrum on either sides of the pelvis.
They are named right and left sacral-iliac joints.
These joints also serve as a land mark for
positioning the fetus in relation to the pelvis.
 The Pelvic Joints contd…

The sacral-coccygeal joint
This joint lies posteriorly and is formed
where the base of the coccyx articulates
with the tip of the sacrum and is much
looser than any other pelvic joints.
This joint enables the coccyx to bend
backwards, allowing the fetal head to
negotiate the outlet of the pelvic canal.
 The Pelvic Joints contd…

The lumbo-sacral joint
It lies at the posterior aspect of the
pelvis, forming the joint between the
fifth lumber vertebra and the sacrum.
 The Pelvic Joints contd…

It is also supported by strong
ligaments, but because of the backward
inclination of the sacrum, considerable
strain is experienced during pregnancy
because the lumber vertebra projects
forwards and downwards thereby
reducing the pelvic brim.
 The Pelvic Ligaments

Each of the pelvic joints discussed, is held
together by the ligaments;
Interpubic ligaments at the symphysis
pubis
Sacro-iliac ligaments that hold together
the sacro-iliac joints
Sacro-coccygeal ligament holding and
strengthening the sacro-coccygeal joint
The Pelvic Ligaments

The Pelvic Ligaments

The Pelvic Ligaments

The Pelvic Ligaments

 The Pelvic Ligaments

Sacro-spinous ligament runs from the
lower sacrum and coccyx, to the ischial
spine and encloses the lower border of
the greater sciatic notch.
The sacro-spinous ligament is covered
by the coccygeous muscle of the pelvic
floor.
 The Pelvic Ligaments

Sacro-tuberous ligament runs from the
lower sacrum and coccyx to the ischial
tuberosity enclosing the lesser sciatic
notch.
These two ligaments the sacro-spinous
and the sacro-tuberous ligaments cross
the sciatic notch forming the posterior
wall of the pelvic outlet.
 THE TRUE PELVIS

This is a bony canal through which the
fetus has to pass during child birth.
It has the brim, cavity and an outlet.
In the normal gynaecoid pelvis, these
areas have average dimensions.
True pelvis

True pelvis

 THE TRUE PELVIS
contd…

The Pelvic Brim or Inlet
The pelvic brim is round except where
the sacral promontory projects into it,
and is bounded by the pubic bones
anteriorly, while the sacral promontory
and the wings form its posterior
border, lateral borders are constituted
by the iliac bones.
 THE TRUE PELVIS
contd…

There are fixed points or areas (
landmarks) on the brim which are of
importance in obstetrics and the
midwife must know them referred to as
landmarks of the pelvic brim.
These include the following;
Land marks of the brim
(inlet)

 The Pelvic Brim or Inlet
contd…

Posteriorly
1. Sacral promontory
2. Alae (wings) of the sacrum
3. Sacro-iliac joints
The Pelvic Brim or Inlet
contd…

Laterally
4. Iliopectineal lines which is the edge
that is formed at the inward aspect of
the ilium
5. Iliopectineal eminence, a rough
rounded area formed where the
superior ramus of the pubic bone meets
the ilium.
The Pelvic Brim or Inlet
contd…

Anteriorly
6. Superior ramus of the pubic bone
7. upper inner border of the body of the
pubic bone
8. upper inner border of the symphysis
pubis
Land marks of the brim

Land marks of the brim

 MEASURENMENTS OF THE PELVIC
BRIM OR DIAMETERS OF THE BRIM

There are three diameters of the pelvic
brim of obstetric importance and these
are;
The antero-posterior diameters.
This is an imaginary line drawn from
the sacral promontory to the inner
upper border of the symphysis pubis.
Diameters of the brim

Antero-posterior diameters of the
pelvis

Antero-posterior diameters of the
pelvis

 The antero-posterior
diameters

Anatomical or true conjugate
This is measured from the sacral
promontory to the uppermost point of
the symphysis pubis and measures
12cm.
 The antero-posterior
diameters

Obstetrical conjugate

This is measured from the sacral

promontory to the upper inner border
of the symphysis pubis and measures
11 cm.
The antero-posterior diameters contd…


This diameter represents the available
space for the passage of the fetus and it
is the narrowest antero-posterior
diameter of the pelvic brim and can
only be accurately measured by
radiography.
The antero-posterior diameters contd…


Diagonal conjugate
This is estimated on vaginal
examination as part of pelvic
assessment and is measured from the
tip of the sacral promontory to the
lower border of the symphysis pubis
and measures 12-13 cm.
 The oblique diameters

There are two oblique diameters each
measured from the left or right sacro-
iliac joint, to the iliopectineal eminence
on the opposite side of the pelvis and
measures 12cm.
 The oblique diameters
contd…

Each takes its name from the sacroiliac
joint of origin and hence the names left
oblique diameter and right oblique
diameter arising from the left sacroiliac
joint and the right sacroiliac joint
respectively
Some structures pass through the pelvic
brim, such as the descending colon, and
thus encroaching on the space available
for the fetus on the left oblique diameter.
 The transverse diameters

This is measured from the widest
points of the brim on the iliopectineal
lines on either side and is the largest
diameter of the pelvic inlet and
measures 13cm.
The long axis of the fetal head usually
enters the pelvic brim in the transverse
diameter.
 The transverse diameters

Sacro-cotyloid dimension
This is measured from the sacral
promontory to the iliopectineal eminence
on each side and measures 9-9.5cm.
This dimension is important especially in
occipito-posterior position of vertex
presentation, where the bi-parietal
diameter of the fetal head is likely to be
caught up on this area.
 THE PELVIC CAVITY OR MID PELVIS


The pelvic cavity can be described as
an area bound by the pubic bone and
symphysis pubis in front, forming the
anterior wall (4cm deep), while the
posterior wall is formed by the curve of
the sacrum (12cm deep) and forms a
pelvic canal that extends from the brim
as inlet to the outlet of the pelvis
 THE PELVIC CAVITY OR MID PELVIS
contd…

Its lateral walls are the sides of the
pelvis, which are mainly covered by the
obturator internus muscle.

The cavity is almost round, as the

transverse and antero-posterior
diameters are similar at 12cm.
DIAMETERS OF THE
PELVIS

 THE PELVIC CAVITY OR MID PELVIS
contd …

The pelvic cavity landmarks include
the following;
Posteriorly
The posterior wall of the canal formed
by the sacrum and coccyx and is 12cm
deep.
 THE PELVIC CAVITY OR MID PELVIS
contd…

Anteriorly
Anterior wall formed by the bodies of
the pubic bones and is 4cm deep
Laterally
Lateral walls formed by the bones
making the innominate bones.
 THE PELVIC CAVITY OR MID PELVIS
contd…

The most important landmark of the
cavity is the ischial spines that are used
vaginally to assess the descent of the
head on vaginal examination (station),
because they protrude into the canal
approximately midway down the canal.
 THE PELVIC CAVITY OR MID PELVIS
contd…

Diameters of the Pelvic Cavity
a). Antero-posterior diameter
b). Oblique diameter
c). Transverse diameter
All these measurements are
approximately the same because the
pelvic cavity is almost round and
measures 12cm.
 THE PELVIC OUTLET


The pelvic outlet is diamond shaped and
two outlets are described, the anatomical
and obstetrical outlets.
The pelvic outlet is bounded in front by
the lower margin of the symphysis pubis,
on each side by the descending ramus of
the pubic bone, the ischial tuberosity and
the sacrotuberous ligament, and
posteriorly by the last piece of the sacrum.
Diameters of the outlet

 THE PELVIC OUTLET
contd…

Anatomical outlet
This is formed by the lower borders of
each of the bones together with the
sacrotuberous ligament.
Obstetrical outlet
This is the space between the narrow
pelvic strait and the anatomical outlet.
 THE PELVIC OUTLET
contd…

Obstetrical outlet is of greater obstetric
importance because it includes the
narrow pelvic strait which lies between
the sacrococcygeal joint, the two ischial
spines and the lower border of the
symphysis pubis forming a diamond-
shaped outlet.
 THE PELVIC OUTLET
contd…

The pelvic outlet has the following
landmarks;

Posteriorly
The coccyx and sacro-tuberous ligaments

Laterally
The ischial tuberosities
THE PELVIC OUTLET
contd…

Anteriorly
The pubic arch
Diameters of the Pelvic Outlet
Antero-posterior diameter
This is measured from the lower border of
the symphysis pubis to the sacrococcygeal
joint and measures 13cm.
THE PELVIC OUTLET
contd…

Oblique diameter
This is measured from the centre of the
sacro-tuberous ligament, to the junction
of the ischial ramus with inferior ramus
of the pubis on the opposite side of the
pelvis.
It measures 12cm.
THE PELVIC OUTLET
contd…

C) Transverse diameter
This is measured between the widest
points of the ischial tuberosities and
measures 11cm. it is also referred to as
the inter-tuberous diameter.
 Functions of the pelvis

Allowing movements of the body
especially when walking and standing.
To bear the weight of the upper body
when sitting and standing.
Provide attachments for and withstand
the forces of the powerful muscles of
locomotion and posture.
 Functions of the pelvis
contd…

The woman’s pelvis is adapted for
childbearing.

To contain and protect the pelvic and

abdomino-pelvic organs
 Functions of the pelvis
contd…

Transmits the cauda equina through
the sacrum, and distributes the nerves
to various parts of the pelvis.

Provide attachment for external

reproductive organs and associated
muscles and membranes.
 Types of pelvis

The pelves have been classified into four
categories according to the shape of the brim.
Gynaecoid pelvis
This is the ideal pelvis for child bearing.
Its characteristics include the following;
Round brim
Generous forepelvis
Straight side walls
 Gynaecoid pelvis contd

Shallow cavity
Broad well curved sacrum
Sub pubic angle is greater than 90
degrees
Blunt and flat ischial spines
Well rounded sciatic notch
 Android pelvis

This is referred to as the male pelvis and
has the following features;
Heart shaped brim
Narrow forepelvis
Transverse diameter more inclined at
the back
 Android pelvis contd…

Side walls converge
Funnel shaped with deep cavity
Straight sacrum
Prominent ischial spines
Narrow sciatic notch
Sub pubic angle is less than 90 degrees
 Anthropoid pelvis

This type of pelvis is usually found in
women who are tall with narrow
shouders.
Long oval brim
Narrowed forepelvis
Side walls diverge
 Anthropoid pelvis
contd…

Sacrum long and deeply concave
Iscial spines not prominent
Sciatic notch very wide
Sub pubic angle not less than 90
degrees
 Platypelloid pelvis

This is a flat pelvis with;
Kidney shaped brim
Anterio-posterio diameter reduced
Transverse diameter is wide
 Platypelloid pelvis
contd…

Side walls diverge
Flat sacrum
Cavity is shallow
Blunt ischial spines
Sub pubic angle wide
Sciatic notch is wide
TYPES OF PELVIS -
PICTURES

 CONCLUSION

 There are also recognised abnormalities of the pelvis
including justominor, Nagele’s pelvis (asymmetrical
due to abnormal bone formation on one side), and
Robert’s pelvis which is similar to Nagele but the
abnormal bone formation is bilateral. Pelvic shape
can also be affected by disease e.g rachitic pelvis due
to rickets.
 Abnormal pelvic shape is associated with problems
at delivery as the rotation of the presenting part may
be suboptimal.
 
 Attention should be paid to the woman’s gait as she
walks and the surgical history to help rule out
trauma to the pelvis and limbs that would cause
alterations in the angles and diameters and
consequently complicate labour.
 The age and height of a woman should also be taken
into consideration.
 A pelvic assessment should always be done before
the woman goes into labour to check the suitability
for vaginal birth.
 References

 Coad, J. with Dunstall, M. (2005) Anatomy and
Physiology for Midwives, 2nd Edition, Elsevier
Limited, Philadelphia, USA.

 Fraser, D. and Cooper, M. (2009) Myles Text book

for Midwives, fifteenth edition, Elsevier Limited,
London, U.K
 Verrals, S. (2011) Anatomy and Physiology Applied
to Obstetrics, 3rd Edition, Elsevier Limited, ,
Philadelphia, USA.
 
 http://www.bing.com/images/female-pelvis
THE END

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