2. INTRODUCTION
• The female pelvis is basin shape
like structured, connects the spine to
the lower limbs, because of its
characteristics its aids in childbirth.
• The bony pelvis in normal standing
posture transmits the body weight of
head, trunk and the upper
extremities.
• In female it is adapted for child
bearing.
3.
4. FUNCTIONS OF PELVIS
• Female pelvis is skeletal ring, because of it,s characteristics, aids in childbirth.
Obstetrical Function:
1. Adapted for childbearing in comparison to male pelvis, brim is rounder and wider.
2. It support gravid uterus.
3. It gives passage way to fetus.
General Function:
1. Primary function to allow movement to body.
2. Helps in walking, sitting, running.
3. Pelvis contain and protect reproductive organs along with bladder and rectum.
4. Sitting weight of body is taken up by the ischial tuberosity.
5. Helps in transmitting weight of body to legs.
5. BONES OF PELVIS
There are 4 bones:
- Two Hip bones (Innominate or nameless)
- One Sacrum
- One Coccyx
6.
7. ILIUM
• It is the largest flarred out part present on the superior aspect of female
pelvis.
• Its superior border on which our hand is rest is known as Iliac crest.
• It has two bony projections anteriorly and posteriorly.
• The bony projection felt at the front of iliac crest known as anterior superior
iliac spine, just below it there is anterior inferior iliac spine.
• At opposite end of iliac crest similar prominence are present which are
named as Posterior superior and posterior inferior iliac spine.
• The concave anterior surface of the ilium is the Iliac Fossa.
8. ISCHIUM
• The ischium is the thick lower part of the hip bone.
• Ischial tuberosity the largest bony prominence. In sitting position body rest
on Ischial tuberosity.
• Behind and a little above the tuberosity is an inward projection, the Ischial
Spine.
- In labor, station of fetal head estimated in relation to ischial spine.
- Internal rotation of fetal head occur here.
• Greater sciatic notch – extends from sacroiliac joint to ischial spine
• Lesser sciatic notch – extends from ischial spine to ischial tuberosity.
9. PUBIC BONE
• The two pubic bone form the anterior part of the hip bone.
• It has body and two oar like projection known as Superior ramus & Inferior
Ramus.
• The two pubic bone meet at Symphysis Pubis.
• Two inferior rami form pubic arch.
• Space enclosed by body of the pubic bone, ramus, and ischium is called as
Obturator foramen.
• The innominate has a deep cup to receive the head of femur, termed as
Acetabulum.
10. SACRUM
• The sacrum is a wedge shaped bone consisting of five fused
vertebrae.
• The prominent upper boarder of the first sacral vertebra is
known as 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
• The posterior surface is roughened to receive attachments of
muscles.
11. COCCYX
• The coccyx is a vestigial tail. It consist of four fused
vertebra forming a small triangular bone.
• During labor it moves backward, to enlarge the pelvic
outlet allowing more space for passage of fetus called
Nodding.
12. PELVIC JOINTS
• Four pelvic joints-
1. Sacroiliac joints (2)-
- Slightly movable joint.
- Formed where ilium join first 2 sacral vertebrae on either side.
- Strongest joint of body.
2. Symphysis Pubis (1)-
- Cartilagenous fibrous joint between 2 pubic bones.
3. Sacro-coccygeal (1)-
- Hinge join between sacrum and coccyx. During pregnancy due to softening of
ligament, provide more space for fetal head to pass through pelvis.
13. 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 midwifery
The sacro-tuberous ligament
The sacro-spinous ligament
14. STRUCTURE OF PELVIS
• The pelvis is broadly divided into true and false pelvis.
False pelvis: It is formed by the upper flared out portion of the ilium. It
protects the abdominal organs. It has no obstetrical importance except that it
provides certain landmarks for external pelvimetry.
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. It has three parts:
- Brim
- Cavity
- Outlet
16. LANDMARKS OF PELVIC INLET/BRIM
1. Symphysis pubis
2. Pubic crest
3. Pubic tubercle
4. Pectineal line
5. Ilio-pectineal eminence
6. Ileopectineal line
7. Sacroiliac joint
8. Anterior border of ala of sacrum
9. Sacral promontory
17. DIAMETERS OF PELVIC BRIM
1. Anterior-posterior diameter of Inlet-
a) Anatomical conjugate(11cm)- Distance between midpoint of sacral
promontory to inner margin of upper border of symphysis pubis. It measures
about 11cm.
b) Obstetric conjugate(10cm)- Distance between midpoint of sacral
promontory to midline of inner surface of symphysis pubis. Shortest
diameter of inlet, measures about 10cm.
c) Diagonal conjugate(12cm)- Distance between lower border of
symphysis pubis to midpoint of sacral promontory. Measures by bimanual
examination. It measures about 12cm.
18. 2. Transverse diameter of inlet:
Distance between two farthest point on pelvic brim over Iliopectineal lines.
Measures about 13cm
3. Oblique diameter of inlet:
There are two oblique diameter right & left. Each extends from one sacro-iliac
joint to opposite iliopectineal eminence. Measures about 12cm.
19. THE PELVIC CAVITY
• The cavity extends from the brim above to the outlet below.
• Shape: its shape is almost rounded. It consist of
- Anterior border – Symphysis pubis
- Posterior border – Sacral hollow
- Lateral border – Soft tissues
• All diameters measures 12cm
20. THE PELVIC OUTLET
• Describes as anatomical and obstetrical outlet.
• Obstetrical outlet has practical value, through which fetus has to pass outlet only.
• The oblique diameter cannot be measured exacly due to presence of soft tissues, roughly measured
about 12cm.
Anatomical outlet-
- Anterio-Posterio diameter extends from lower border of symphysis pubis to tip of coccyx, measures
about 13cm.
- Transverse diameter is inter tuberous diameter, is the distance between inner border of 2 ischial
tuberosity, measures about 11cm.
Obstetrical outlet-
- Narrow through which fetus has to pass.
- Anterio-Posterio diameter extends from inferior border of symphysis pubis to tip of the sacrum,
measures about 11cm.
- Transverse diameter is bispinous diameter. It is distance between tip of two ischial spine, measures
about 10.5cm.