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Female pelvis

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Sami Sambyal

This document provides an overview of the female pelvis from an obstetric perspective. It describes the bones that make up the pelvis, including the innominate bones, sacrum, and coccyx. It details the landmarks, joints, ligaments, diameters, and classifications of pelves. The key types discussed are the gynecoid, android, anthropic, and platypelloid pelves. Ideal pelvic characteristics for labor are outlined. The document serves as a comprehensive reference on the structure and features of the female pelvis relevant to obstetrics.

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FEMALE PELVIS By: Maj Saminder Malik MSc (N) Obs & Gyn
Female pelvis
INTRODUCTION important from obstetric point of view Forms passage for fetus to pass through the birth canal
Female pelvis
PELVIC BONES Female pelvis is formed by 04 pelvic bones 1. Innominate bones- 2 2. sacrum 1 3. Coccyx - 1
Female pelvis
INNOMINATE BONES Consists of 3 parts Ilium Ischium pubis
Female pelvis
Female pelvis
ILIUM o Large flared outer part o Iliac crest: it is the upper border of ilium and when we place hand on the hip it rest on the iliac crest o Iliac spine: the anterior side and posterior side of ilium consists of two bony projections each namely 1. anterior superior iliac spine 2. anterior inferior iliac spine 1. posterior superior iliac spine 2. posterior inferior iliac spine o Iliac fossa: The concave anterior surface of the ilium is the iliac fossa
ISHCHIUM It is the thick lower part of innominate bone Ishchial tuberosity: large prominence on which body rest while sitting Ishchial spine: an inward projection behind and above ishchial tuberosity. During labor station of head is estimated in relation to ishchial spine
PUBIC BONE Forms the anterior part of innominate bone Body of pubis: thick and flat part of pubic bone Ramii: two arm like projection - superior & inferior Symphysis pubis: the joint between two pubic bones Pubic arch: formed by the infusion of inferior ramii Obturator foramen: space enclosed by pubic ramii, pubic bone and ishchium Sciatic notch: curves on the lower border of innominate bones., for passage of great vessels Greater sciatic notch: extends from posterior inferior iliac spine to the ishchial spine Lesser sciatic notch: between ishchial spine and ishchial tuberosity Acetabulum: deep cup like structure to receive head of femur
Female pelvis
SACRUM Wedge shaped bone consisting 05 fused vertebrae Sacral promontory: Upper border of 1st sacral vertebra is known as sacral promontory Ala of sacrum: Lateral side of sacral promontory is known as ala of sacrum or wing of sacrum Halo of sacrum: There are two pairs of holes through which nerves are entering into the pelvic organs
COCCYX Vestigial tail Consists of 04 fused vertebral Forms a triangular bone
PELVIC JOINTS Sacroiliac Joints= 02 , strongest joints in body , connects sacrum with ilium Sacrococcygeal= 1, base of coccyx articulates with tip of sacrum. Movement of this joint during labor facilitates smooth passage of the baby Symphysis pubis: form at the junction of two pubic bones, united by a pad of cartilage
Female pelvis
PELVIC LIGAMENTS Each joint is held by the ligaments Sacroiliac ligament: medial surface of ilium to sacrum Sacrospinous ligament: Lateral aspect of the sacrum to ishchial spines Sacrotuberous ligament: Lateral aspect of sacrum to inner aspect of ishchial tuberosity Interpubic ligament: Between two pubic bones Iliolumbar ligament: iliac crest to lumbar vertebrae
Female pelvis
TYPE OF PELVIS False pelvis True pelvis
FALSE PELVIS No obstetric importance Above the pelvic brim / true pelvis Anterior: abdominal wall Posterior: lumbar vertebrae Lateral: iliac crest
TRUE PELVIS Bone defined tunnel through which baby has to pass during birth - pelvic brim - pelvic cavity - pelvic outlets
Female pelvis
PELVIC BRIM Almost round in shape except at the side of sacral promontory Poste: Ala or wings of sacrum, sacral promontory Lateral: iliac bones and its lateral borders Anterior : pubic bones Plane of brim is 55 to 60 above the horizontal plane
LANDMARKS OF INLET OR BRIM 1. Sacral promontory 2. Ala of sacrum 3. Sacroiliac joint 4. Iliopectineal line 5. Iliopubic eminence 6. Pectineal line 7. Pubic tubercle 8. Pubic crest 9. Symphysis pubis
PELVIC CAVITY Above: brim Below: outlet Anterior: pubic bone & pubic symphysis Posterior: curve of sacrum Measurement: 12 cm diameter
PELVIC OUTLET Lower part of true pelvis 1. anatomical outlet: Lower borders of each of the bone together with sacrotuberous ligament 2. Obstetrical outlet: diamond shaped AP diameter sacrococcygeal joint to lower border of symphysis pubis Transverse : between two ishchial spine and two ischial tuberosities
PELVIC MUSCLES Inner aspect of bony pelvis is covered with muscle Above the brim: iliac & psoas Side walls: obturator internus and its fascia Posterior: Pyriformis Pelvic floor: Levator Anii & Coccygenous
Female pelvis
PELVIC DIAMETERS (INLET) ANTEROPOSTERIOR True Conjugate: from tip of sacral promontory to upper border of symphysis pubis12cm Obstetric conjugate: from tip of sacral promontory to the most bulging point on the back of symphysis pubis (1cm below its upper border)10.5 cm Diagonal Conjugate: from tip of sacral promontory to lower border of symphysis pubis 12-12.5cm TRANSVERSE DIAMETER Two farthest points on iliopectineal lines (4cm from promontory & 7cm from symphysis pubis) largest diameter in pelvis 13cm OBLIQUE DIAMETER sacroiliac joint to iliopectineal eminence 12 cm (Rt and Lt)
PELVIC CAVITY Round All diameters are same 12 cm
Female pelvis
PELVIC OUTLET Obstetric AP: from tip of sacrum to lower border of symphysis pubis as coccyx moves backwards in 2nd stage of labor (13cm) Transverse: between ishchial spines (10.5 cm) Anatomical AP: from tip of coccyx to lower border of symphysis pubis Transverse: inner aspect of ishchial tuberosities
CLASSIFICATION OF PELVIS Gynecoid pelvis Android pelvis Anthropoid pelvis Platypelloid pelvis
Female pelvis
GYNAECOID PELVIS Female pelvis 50% females Rounded slightly oval inlet Straight pelvic sidewalls with roomy pelvic cavity Good sacral curve Ishchial spine not prominent Pubic arch is wide
ANDROID PELVIS Male pelvis Pelvic brim is heart shaped convergent sidewalls Narrow pubic arch Prominent spines
ANTHROPOID & PLATYPELLOID ANTHROPID Long and narrow pelvic canal AP diameter is more than transverse diameter Straight pelvis side walls PLATYPELLOID 3% women TD is much more than AP diameter Sacral promontory pushed forward
IDEAL OBSTETRIC PELVIS Brim: round or oval transversely No undue projection of sacral promontory AP: 12 cm TD: 13cm Plane of pelvic inlet 55degree Cavity: shallow with straight side walls, no great projections of ischial spines and smooth sacral curve Outlet: rounded pubic arch with suprapubic angle more than 80 Intertuberous diameter more than 10cm
FAVOURABLE PELVIS Sacral promontory cannot be felt Ischial spine not prominent Suprapubic arch accept 2 fingers Intertuberous diameter accepts 4 knuckles on pelvic exam
PELVIC DEFORMITIES
PELVIC DEFORMITIES

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Female pelvis

  • 1. FEMALE PELVIS By: Maj Saminder Malik MSc (N) Obs & Gyn
  • 3. INTRODUCTION important from obstetric point of view Forms passage for fetus to pass through the birth canal
  • 5. PELVIC BONES Female pelvis is formed by 04 pelvic bones 1. Innominate bones- 2 2. sacrum 1 3. Coccyx - 1
  • 7. INNOMINATE BONES Consists of 3 parts Ilium Ischium pubis
  • 10. ILIUM o Large flared outer part o Iliac crest: it is the upper border of ilium and when we place hand on the hip it rest on the iliac crest o Iliac spine: the anterior side and posterior side of ilium consists of two bony projections each namely 1. anterior superior iliac spine 2. anterior inferior iliac spine 1. posterior superior iliac spine 2. posterior inferior iliac spine o Iliac fossa: The concave anterior surface of the ilium is the iliac fossa
  • 11. ISHCHIUM It is the thick lower part of innominate bone Ishchial tuberosity: large prominence on which body rest while sitting Ishchial spine: an inward projection behind and above ishchial tuberosity. During labor station of head is estimated in relation to ishchial spine
  • 12. PUBIC BONE Forms the anterior part of innominate bone Body of pubis: thick and flat part of pubic bone Ramii: two arm like projection - superior & inferior Symphysis pubis: the joint between two pubic bones Pubic arch: formed by the infusion of inferior ramii Obturator foramen: space enclosed by pubic ramii, pubic bone and ishchium Sciatic notch: curves on the lower border of innominate bones., for passage of great vessels Greater sciatic notch: extends from posterior inferior iliac spine to the ishchial spine Lesser sciatic notch: between ishchial spine and ishchial tuberosity Acetabulum: deep cup like structure to receive head of femur
  • 14. SACRUM Wedge shaped bone consisting 05 fused vertebrae Sacral promontory: Upper border of 1st sacral vertebra is known as sacral promontory Ala of sacrum: Lateral side of sacral promontory is known as ala of sacrum or wing of sacrum Halo of sacrum: There are two pairs of holes through which nerves are entering into the pelvic organs
  • 15. COCCYX Vestigial tail Consists of 04 fused vertebral Forms a triangular bone
  • 16. PELVIC JOINTS Sacroiliac Joints= 02 , strongest joints in body , connects sacrum with ilium Sacrococcygeal= 1, base of coccyx articulates with tip of sacrum. Movement of this joint during labor facilitates smooth passage of the baby Symphysis pubis: form at the junction of two pubic bones, united by a pad of cartilage
  • 18. PELVIC LIGAMENTS Each joint is held by the ligaments Sacroiliac ligament: medial surface of ilium to sacrum Sacrospinous ligament: Lateral aspect of the sacrum to ishchial spines Sacrotuberous ligament: Lateral aspect of sacrum to inner aspect of ishchial tuberosity Interpubic ligament: Between two pubic bones Iliolumbar ligament: iliac crest to lumbar vertebrae
  • 20. TYPE OF PELVIS False pelvis True pelvis
  • 21. FALSE PELVIS No obstetric importance Above the pelvic brim / true pelvis Anterior: abdominal wall Posterior: lumbar vertebrae Lateral: iliac crest
  • 22. TRUE PELVIS Bone defined tunnel through which baby has to pass during birth - pelvic brim - pelvic cavity - pelvic outlets
  • 24. PELVIC BRIM Almost round in shape except at the side of sacral promontory Poste: Ala or wings of sacrum, sacral promontory Lateral: iliac bones and its lateral borders Anterior : pubic bones Plane of brim is 55 to 60 above the horizontal plane
  • 25. LANDMARKS OF INLET OR BRIM 1. Sacral promontory 2. Ala of sacrum 3. Sacroiliac joint 4. Iliopectineal line 5. Iliopubic eminence 6. Pectineal line 7. Pubic tubercle 8. Pubic crest 9. Symphysis pubis
  • 26. PELVIC CAVITY Above: brim Below: outlet Anterior: pubic bone & pubic symphysis Posterior: curve of sacrum Measurement: 12 cm diameter
  • 27. PELVIC OUTLET Lower part of true pelvis 1. anatomical outlet: Lower borders of each of the bone together with sacrotuberous ligament 2. Obstetrical outlet: diamond shaped AP diameter sacrococcygeal joint to lower border of symphysis pubis Transverse : between two ishchial spine and two ischial tuberosities
  • 28. PELVIC MUSCLES Inner aspect of bony pelvis is covered with muscle Above the brim: iliac & psoas Side walls: obturator internus and its fascia Posterior: Pyriformis Pelvic floor: Levator Anii & Coccygenous
  • 30. PELVIC DIAMETERS (INLET) ANTEROPOSTERIOR True Conjugate: from tip of sacral promontory to upper border of symphysis pubis12cm Obstetric conjugate: from tip of sacral promontory to the most bulging point on the back of symphysis pubis (1cm below its upper border)10.5 cm Diagonal Conjugate: from tip of sacral promontory to lower border of symphysis pubis 12-12.5cm TRANSVERSE DIAMETER Two farthest points on iliopectineal lines (4cm from promontory & 7cm from symphysis pubis) largest diameter in pelvis 13cm OBLIQUE DIAMETER sacroiliac joint to iliopectineal eminence 12 cm (Rt and Lt)
  • 33. PELVIC OUTLET Obstetric AP: from tip of sacrum to lower border of symphysis pubis as coccyx moves backwards in 2nd stage of labor (13cm) Transverse: between ishchial spines (10.5 cm) Anatomical AP: from tip of coccyx to lower border of symphysis pubis Transverse: inner aspect of ishchial tuberosities
  • 34. CLASSIFICATION OF PELVIS Gynecoid pelvis Android pelvis Anthropoid pelvis Platypelloid pelvis
  • 36. GYNAECOID PELVIS Female pelvis 50% females Rounded slightly oval inlet Straight pelvic sidewalls with roomy pelvic cavity Good sacral curve Ishchial spine not prominent Pubic arch is wide
  • 37. ANDROID PELVIS Male pelvis Pelvic brim is heart shaped convergent sidewalls Narrow pubic arch Prominent spines
  • 38. ANTHROPOID & PLATYPELLOID ANTHROPID Long and narrow pelvic canal AP diameter is more than transverse diameter Straight pelvis side walls PLATYPELLOID 3% women TD is much more than AP diameter Sacral promontory pushed forward
  • 39. IDEAL OBSTETRIC PELVIS Brim: round or oval transversely No undue projection of sacral promontory AP: 12 cm TD: 13cm Plane of pelvic inlet 55degree Cavity: shallow with straight side walls, no great projections of ischial spines and smooth sacral curve Outlet: rounded pubic arch with suprapubic angle more than 80 Intertuberous diameter more than 10cm
  • 40. FAVOURABLE PELVIS Sacral promontory cannot be felt Ischial spine not prominent Suprapubic arch accept 2 fingers Intertuberous diameter accepts 4 knuckles on pelvic exam