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07 female bony pelvis and fetal skull isam

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female bony pelvis

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07 female bony pelvis and fetal skull isam

  1. 1. Dr Isameldin Elamin MD DOWH MBBS Assistant professor Obstetrics & Gynaecology Department
  2. 2.  The bony pelvis is made up of four bones: ◦ Sacrum. ◦ Coccyx. ◦ Two innominate bone.  Innominate bone composed of:  Ilium.  Ischium.  Pubis.
  3. 3.  They are held by three joints:  Sacroiliac joints.  Symphysis pubis.  Sacrococcygeal joint.  Union with the vertebral column lead to: ◦ Stabilizes the pelvis. ◦ Transmit weight to lower extremities.
  4. 4.  The sacrum: ◦ Five fused vertebrae.  Promontory: ◦ Edge of the first sacral vertebra. ◦ Protrudes into the cavity of the pelvis.
  5. 5.  The sacrum articulates with: ◦ Ilium. ◦ Coccyx. ◦ Sacrospinous ligaments. ◦ Sacrotuberous ligaments.  The coccyx: ◦ Three to five rudimentary vertebrae. ◦ Articulates with the sacrum.
  6. 6.  The pelvis is divided into:  False pelvis. ◦ Bordered by:  The lumbar vertebrae.  Iliac fossa.  Abdominal wall. ◦ It supports the pregnant uterus.
  7. 7.  True pelvis. ◦ Bony canal formed by:  Sacrum  Coccyx ischium  Pubis. ◦ It is the area of concern to the obstetrician.
  8. 8.  The pelvic brim or inlet bounded by: ◦ Symphysis pubis. ◦ Upper margin of the pubic bone. ◦ Ileopectineal line and the Ala of the sacrum. ◦ Promontory of the sacrum.
  9. 9.  Transverse diameter is 13.5 cm.  Anterior–posterior (AP) diameter 11 cm.  The angle of the inlet is normally 60º. (Inclination angle).  In some women it may be as much as 90º.
  10. 10.  The pelvic mid-cavity bounded by: ◦ Middle of the symphysis pubis. ◦ Pubic bone. ◦ Obturator fascia . ◦ Ischial bone and spines. ◦ The junction of the second and third sections of the sacrum. ◦ The cavity is almost round. ◦ Transverse and anterior diameters are similar at 12 cm.  The ischial spines: ◦ Palpable vaginally. ◦ Used to assess the descent of the head. (Station). ◦ Used as landmarks to the pudendal block.
  11. 11.  The pelvic outlet is bounded by: ◦ Lower margin of the symphysis pubis. ◦ Descending ramus of the pubic bone. ◦ Ischial tuberosity. ◦ Sacrotuberous ligament. ◦ Last piece of the sacrum.  AP diameter is 13.5 cm.  Transverse diameter is 11 cm.
  12. 12.  Measurements related to: ◦ Maternal stature. ◦ Previous pelvic fractures. ◦ Metabolic bone disease, such as rickets.  Pelvic ligaments become more flexible towards labour.  X-rays or CT scans now uncommon to be used for predicting the outcome of labour.
  13. 13.  Caldwell and Moloy classification: ◦ Gynaecoid pelvis. ◦ Android pelvis. ◦ Anthropoid pelvis. ◦ Platypelloid pelvis.
  14. 14.  The gynaecoid pelvis: ◦ Most favourable for labour. ◦ Most common.  An android pelvis: ◦ Deep transverse arrest.  The anthropoid: ◦ The antero-posterior diameter is larger than the transverse ◦ Occipito-posterior (OP) position common.  A platypelloid pelvis: ◦ Obstructed labour.
  15. 15.  Formed by the two levator-Ani muscles with their fascia.
  16. 16.  The perineal body: ◦ Found between the vagina and the anus. ◦ It is a condensation of fibro muscular tissue. ◦ It receives attachments of:  Bulbo-cavernous muscles.  The superficial and deep transverse perineal muscles.  External anal sphincter. ◦ It is involved in a second-degree perineal tear and an episiotomy.
  17. 17.  Formed by: ◦ Bones, sutures and fontanelles.  Fetal skull is made up of: ◦ The vault. ◦ The face and the base. ◦ The sutures are formed where the bones meet.
  18. 18.  The vault are formed by: ◦ The parietal bones. ◦ Part of occipital bones. ◦ Part of frontal bones. ◦ Part of temporal bones.  There are four sutures: ◦ The sagittal. ◦ Frontal. ◦ Coronal. ◦ Lambdoidal sutures.
  19. 19.  Fontanelles are the junctions of the various sutures.  There are 2 fontanelles: ◦ The anterior fontanelle, or bregma: ◦ Diamond shaped. ◦ At the junction of:  The sagittal suture.  Frontal suture. Coronal sutures.
  20. 20.  The posterior fontanelle: ◦ Triangular shaped. ◦ At the junction of: ◦ The sagittal suture. ◦ The lambdoidal sutures. ◦ Between:  The two parietal bones.  The occipital bone.
  21. 21.  Clinical importance sutures and fontanelles : ◦ Overlap during labour. ◦ Bones are compressible. ◦ Moulding occur easily. ◦ Severe moulding is a sign of cephalo-pelvic disproportion. CPD.  The ‘vertex’ is the area bounded by the two parietal eminences and the anterior and posterior fontanelles.
  22. 22.  The attitude is the degree of flexion and extension.  There are different longitudinal diameters:  Suboccipito-bregmatic diameter. ◦ Well-flexed fetal head. ◦ It measures 9.5 cm. ◦ From suboccipital region to anterior fontanelle (bregma).  Suboccipito-frontal diameter: ◦ Less well flexed. ◦ Found in the OP position. ◦ From the suboccipital region to the prominence of the forehead. ◦ It measures 10 cm.
  23. 23.  Occipitofrontal diameter: ◦ Further extension of the head. ◦ Measured from the root of the nose to the posterior fontanelle. it measures 11.5 cm.  Mento-vertical diameter: ◦ It is the greatest diameter. ◦ From chin to vertex and ◦ Measures 13 cm. ◦ Known as a brow presentation. ◦ Too large to pass through the normal pelvis.  Submentobregmatic diameter: ◦ Measured from below the chin to the anterior fontanelle. ◦ It is 9.5 cm. ◦ It is the face presentation.
  24. 24.  The true conjugate (anatomic conjugate): ◦ From the middle of the sacral promontory to the superior surface of the pubic symphysis.  The obstetric conjugate: ◦ From the middle of the sacral promontory to the closest point on the convex posterior surface of the symphysis pubis. ◦ The shortest distance between the sacral promontory and the symphysis pubis
  25. 25.  The diagonal conjugate: ◦ From the lower border of the pubis to the sacral promontory .  The obstetric conjugate is then estimated by subtracting 1.5 to 2 cm from diagonal conjugate.  Obstetric conjugate is adequate when: ◦ Middle finger cannot reach the sacral promontory. ◦ If the diagonal conjugate is greater than or equal to 11.5 cm.
  26. 26.  Obstetrics by ten teachers 19 editions.  Essential of obstetrics and gynaecology.  Hacker & Moore, fifth edition  http://www.uptodate.com.

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