Presenting by V.Jhansi M.Sc(N) I Year GCON FEMALE PELVIS
Knowledge of the female pelvis is very essential for the
midwife , especially during conduction of the labor.
SHAPE The pelvis is a basin shaped structure that supports the spinal column and protects the abdominal organs. FUNCTIONS
Protect the pelvic viscera.
Support the vertebral column Facilitate locomotion Childbearing BONES OF PELVIS The pelvis is comprised of four bones:
Two innominate bones
One sacrum
One coccyx PELVIC JOINTS The symphysis pubis-1
The sacroiliac joints-2
The sacrococcygeal joints-1
PELVIC LIGAMENTS
Interpubic ligament Sacroiliac ligaments Sacrococcygeal ligament Sacrotuberous ligament Sacrospinous ligament I.INNOMINATE BONE Each innominate bone composed of three parts INNOMINATE BONE-ILIUM The ilium is the large flared out part covering 1/3rd part of acetabulum. Inner upper wing like structure known wing/ala of ilium The concave anterior surface of the ilium is the iliac fossa. Anterior lower border of ilium known iliopectineal line which continues with pectineal line of pubis Upper crest and at the front of the 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. INNOMINATE BONE-ISCHIUM The Ischium is the thick lowest part formed by lower 2/3rd lower part of acetabulum and ½ portion of obturator foramen. It has a large prominence known as the ischial tuberosity on which the body rests when sitting. In relation to the ischial spines In labour the station of the foetal head is estimated INNOMINATE BONE-PUBIS The Pubic bone forms the anterior part by 1/3rd of acetabulum and ½ obturator foramen. It has a body and two rami—the superior and inferior. The projection between ilium and pubis known as ileo pubic eminence The rough portion just beside symphysis pubis is pubic crest Just beside pubic crest a projection called pubic tubercle The inferior borderline of the pubis is pectineal line The two pubic bones meet at the symphysis pubis and two inferior rami form the pubic arch, merging into a similar ramus on the ischium. On the lower border of the innominate bone are found two curves the greater sciatic notch and the lesser sciatic notch II. THE SACRUM The Sacrum is a wedge-shaped bone consisting of five fused vertebrae. The upper border of the first sacral vertebra projects forward and is known as the sacral promontory. The anterior surface of the sacrum is concave and is referred as the hollow of the sacrum. It has two wings or ala. III.THE COCCYX
It consists of four fused
vertebrae, forming a small triangular bone. Parts of Pelvis The pelvis is divided in two sections: i) The False Pelvis The false pelvis is formed by the iliac portions of the innominate bones and is limited above by the iliac crests. It has got little obstetric significance except that its measurements can to a certain extent, predict the size and configuration of the true pelvis. Its only obstetric function is to support the enlarged uterus during pregnancy. Its boundaries are : posteriorly — lumbar vertebrae, laterally -— iliac fossa and anteriorly — anterior abdominal wall. ii) The True Pelvis
This part of the pelvis is chiefly of concern to the
obstetricians, as it forms the canal through which the fetus has to pass. It is shallow in front, formed by symphysis pubis and deep posteriorly, formed by the sacrum and coccyx. True pelvis is divided into
Inlet
cavity
outlet. LANDMARKS OF PELVIC INLET/BRIM 1. Symphysis pubis 2. Pubic crest 3. Pubic tubercle 4. Pectineal line 5. Ilio-pubic eminence 6. Iliopectineal line 7. Sacroiliac articulation 8. Anterior border of ala of sacrum 9. Sacral promontary DIAMETERS IF PELVIC INLET
1.Antero posterior diameter: it
is divided into 3 conjugates Anatomical or true conjugate diameter: the : It is the distance between the midpoint of the sacral promontory to the inner margin of the upper border of symphysis It measures 11 cm Obstetric conjugate diameter: It is the distance between the midpoint of the sacral promontory to prominent bony projection in the midline on the inner surface of the symphysis pubis It measures 10 cm Diagonal conjugate diameter: It is the distance between the lower border of symphysis pubis to the midpoint on the sacral promontory. It measures 12 cm DIAMETERS IF PELVIC INLET
II. Oblique diameter:
There are two oblique diameters — right and left. Each one extends from one sacroiliac joint to the opposite iliopubic eminence It measures 12 cm DIAMETERS IF PELVIC INLET
III.Transverse diameter: It is the distance between the two farthest points on the pelvic brim over the iliopectineal lines. It measures 13 cm DIAMETERS IF PELVIC CAVITY Cavity is the segment of the pelvis bounded above by the inlet and below by plane of least pelvic dimensions. Antero-posterior diameter (12 cm) : It measures from the mid-point on the posterior surface of the symphysis pubis to the junction of 2nd and 3rd sacral vertebrae Transverse diameter (12cm) : It cannot be precisely measured as the points lie over the soft tissues covering obturator foramen DIAMETERS OF PELVIC OUTLET
Divided into Two outlets: Obstetric outlet and anatomical outlet
Obstetric outlet: Its anterior wall is deficient at the pubic arch; its lateral walls are formed by ischial bones and the posterior wall includes whole of the coccyx. Anteroposterior diameter: It extends from the inferior border of the symphysis pubis to the tip of the sacrum .it measures about 11cm. Transverse diameter: It is the distance between the tip of two ischial spines.it measures about 10.5cm (bispineal) Anatomical outlet: It is otherwise known as bony outlet. It is bounded in front by the lower border of the symphysis pubis; laterally by the ischiopubic rami, ischial tuberosity and sacrotuberous ligament and posteriorly by the tip of coccyx Anteroposterior diameter: It extends from the lower border of the symphysis pubis to the tip of the coccyx. It measures 13 cm Transverse diameter: Inter tuberous .It measures between inner borders of ischial tuberosities by 11cm.
