Obstetric Anatomy

1. THE PELVIS
¼L=h Jksf.k½
Stree Roga Class 2nd
DR. RAMVEER SHARMA
M.D. Ayu.(PT&SR)
PROF.& H.O.D.
Prasuti Tantra & Stree Roga Dep't.
M.M.M .Govt. Ayu. College Udaipur
Mob. 9414757932
Email. ramveersharma1960@gmail.com
Dr. Ram Veer Sharma

2. The Pelvis
Point - Shroni with Asthi Sandhi & Peshi.
 (Normal & abnormal soft and bony pelvis)
 Shroni mapan (Pelvimetry) , its obstetrical importance.
Anatomy -
Stree Roga Class 2nd
 The anatomy of the female is same as male, but has some
peculiarities specially of reproductive system then the male.
 Because of anatomical differences, this is essential for the
Gynaecologist and Obstetrician , must learn the special
anatomy of the female reproductive system.
Dr. Ram Veer Sharma

3. THE PELVIS
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 The female genital organs are situated in the pelvic cavity.
 Hence the pelvis is a important part of the body
Gynaecologically as well as Obstetrically.
Stree Roga Class 2nd
Bones 4 Joints 4
Hip bones -2 Sacroiliac joints Rt. Lt. - 2.
(Ilium Ischium Pubis) Sacro coccygeal joint - 1.
Sacrum – 1
Coccyx - 1 Symphysis pubis - 1
Dr. Ram Veer Sharma

4. (4) Bones: -
 The pelvis is constructed by four bones; according to Ayurveda
it is made from five bones namely -
 One Gudasthi (Coccyx),
 One Bhagasthi (Pubic bone),
Stree Roga Class 2nd
 Two Nitambasthi (Hip bones) and
 One Trikasthi (Sacrum).

Dr. Ram Veer Sharma

5.  Two innominate bone (Ilium, Ischium, and Pubis).
 3 - Sacrum
 4 - Coccyx
(b)
Stree Roga Class 2nd
(c)
:- The pelvic bones are flat (Kapalasthi) bones.


Dr. Ram Veer Sharma

6. • Peculiarities of The Bones:- Bones of the female pelvis are -
 Flat in shape,
 Light in weight,
 Soft, Hollow,
 Shallow, and
Stree Roga Class 2nd
 Joints are wide angles.
Joints: - (4) are Four
 Three:-
•
Dr. Ram Veer Sharma

7. Types of Joints: -
•
•
•
•
Stree Roga Class 2nd
Parts :-
 Clinically the pelvis is devised by the brim of the pelvis
(boundary line) - in two parts
(a) False pelvis (b) True pelvis.
Dr. Ram Veer Sharma

8. LAND MARK
Backward -
 Sacral promontory
 Anterior border of ala of sacrum
 Sacro iliac articulation
 Iliac crest
Stree Roga Class 2nd
 Iliac crest
Forward-
 Ilio pubic eminence
 Pectineal line
 Pubic tubercle
 Pubic crest
 Symphysis pubis Dr. Ram Veer Sharma

9. (A) FALSE PELVIS
 It has got little obstetrical significance (importance), It can be
estimating (certain external measurments)
 The size of true pelvis by its measurements:-
• Boundaries are-
Stree Roga Class 2nd
 Posterior ---- Lumbar vertebrae
 Lateral ------- Iliac fossa
 Anteriorly --- Anterior abdominal wall.
Dr. Ram Veer Sharma

10. Stree Roga Class 2nd
(A)False Pelvis
Measurements (1)
a. Inter Cristal - 10"-11" - 25-28cm
b. Inter-spinous- 9"-10" - 22-25cm
c. External conjugate -7.5" – 19cm
{Last lumbar vertebrae to anterior of symphysis pubis}
Dr. Ram Veer Sharma

11. Functions of False Pelvis -
1. Support of the enlarged uterus during pregnancy
2. Funnel function during delivery
3. Estimation of the true pelvis by measurements.
Stree Roga Class 2nd
Dr. Ram Veer Sharma

12. (B) TRUE PELVIS
 This is chiefly concerned to the obstetricians
Shape - Canal type through which the foetus has to pass out.
Size -
In front - it is shallow 4cm = 1.5" {formed by Pubis Symphysis}
Stree Roga Class 2nd
In posterior - deep 11.5cm = 4.5 " {formed by Sacrum & coccyx}
Laterally - deep 9cm = 3.5 " {formed by Ischium and sacro sciatic
ligament}.
Dr. Ram Veer Sharma

13. Parts:- 3 Obstetrically it is divided in three parts -
(1) Inlet -
• The brim of the pelvis is boundary of bony Landmark between
two parts of the pelvis.
Shape: - Almost round (oval) - AP Diameter, being the shortest.
Stree Roga Class 2nd
Shape: - Almost round (oval) - AP Diameter, being the shortest.
Plane: - It is an imaginary surface, late bounded by the brim. as
often referred to as superior strait.
Dr. Ram Veer Sharma

14. Inclination: - In the erect posture - it is tilted forward
 Angle with horizontal posture with plane of inlet =55ºs
 Angle with inlet and front of the body of the 5th lumbar
vertebrae = 135º
 If angle is increase due to fusion of 5thlumber vertebrae with
Stree Roga Class 2nd
sacrum Sacrolization called high inclination.
 High inclination has obstetrical insignificance as –
 Delayed engagement
 Uterine axis fails to co inside with the inlet.
• Favours to Occipito posterior position.
• Difficulty in descend of the head - because of False sacrum.
Dr. Ram Veer Sharma

15. Angle - Plane of inlet with body of first sacral vertebrae - 90º
 If this angle is of less degree, Suggests Funneling of the
pelvis.
Axis:-
 Its direction is down wards and forwards,
Stree Roga Class 2nd
 The line passes through the umbilicus to coccyx -
 Its direction is downwards and backwards.
 The uterine axis should coincide with axis of inlet so face of
uterus well spread in right direction to expel the foetus.
Dr. Ram Veer Sharma

16. Measurements of true Pelvis :-
(i) Inlet -
(A) Anterio - Posterior A.P.-
(a)True conjugate - Anatomical conjugate :-
 Mid point of sacral promontory
Stree Roga Class 2nd
To 4" or 10 -11 cm.(1-2 cm.)
 Mid point of upper border of symphysis pubis
(b) Obstetrical conjugate:-
 Mid point of the sacral promontory
To 10 cm. Shortest AP.
 Inner surface of the symphysis pubis Dr. Ram Veer Sharma

17. (c) Diagonal conjugate:-
 Mid point of the sacral promontory
To - 12cm.
 Lower border of the symphysis promontory.
Stree Roga Class 2nd
Dr. Ram Veer Sharma

18. Method of measurement of diagonal conjugate,
 By P.V. examination.
a. Insert the finger deeply in side the vagina.
b. Make a point on the gloved thumb at the level of the lower
border of the symphysis pubis,
Stree Roga Class 2nd
border of the symphysis pubis,
c. Withdrawal the finger,
d. Measure the distance of point of the thumb to tip of the middle
finger - 12 cm normal.
Dr. Ram Veer Sharma

19. Method of measurement of diagonal conjugate,
 By P.V. examination.
 If the middle finger fails to reach the promontory or touch with
difficulty.
 The conjugate is adequate for an average size head to pass
Stree Roga Class 2nd
 The conjugate is adequate for an average size head to pass
through it.
Dr. Ram Veer Sharma

20. Stree Roga Class 2nd
Dr. Ram Veer Sharma

21. (B) Transverse :-
 The diameter is measure between two farthest points on the
brim.
 Over the Ilio Pectineal line - 13.2cm.
 The diameter line divides the brim in the anterior and posterior
Stree Roga Class 2nd
segment.
(C) Oblique :- Both Rt. & Lt.
 Sacro iliac joint
To - 12cm.
 Ilio - pubic eminence
Dr. Ram Veer Sharma

22. (d) Sacro – Cotyloid -
 Mid sacral promontory
To - 9.5 cm.
 Ilio pubic eminence.
Stree Roga Class 2nd
Dr. Ram Veer Sharma

23. (ii) The Cavity
 This segment of the pelvis is bounded -
 Above by the inlet Below by the plane of least pelvis
dimension.
 Shape - Almost rounded
Stree Roga Class 2nd
 Shape - Almost rounded
 Plane - Mid point of the posterior surface of the symphysis
pubis To the Junction of the 2nd and 3rd sacral vertebrae
 It is greatest pelvic dimensions and most roomy.
Dr. Ram Veer Sharma

24. Axis :-
 It is directed almost down wards.
 Boundaries - It is bounded by
a. Behind - Sacrum and Coccyx 11.2 cm- 4.5” deep.
b. Front - Symphysis pubis 2.5cm. - 1”deep.
Stree Roga Class 2nd
c. Laterally - Ischium and sacro sciatic ligament 9cm -3.5"deep.
Dr. Ram Veer Sharma

25. Measurements -
Antero-Posterior -
 Mid point of the symphysis pubis to 2nd and 3rd sacral vertebral
joint 12cm.
Oblique 12cm.
Stree Roga Class 2nd
Transverse - It can not be practically measured.
 Sacro sciatic notches to opposite obturature foramina = 12cm.
Dr. Ram Veer Sharma

26. (3) Out Let :- It is bounded by -
Above - The plane of least pelvic dimensions.
Below - By anatomical out let.
 Anterior wall - is deficient at the pubic arch.
 Lateral walls - are formed by Ischial bones.
Stree Roga Class 2nd
 Posterior wall - by include whole coccyx.
Shape :- Anterio – Posterior ovular – diamond shape.
Dr. Ram Veer Sharma

27. Plane -
 It is narrowest plane and formed by -
 Anteriorly - lower border of symphysis pubis to
 Laterally the tip of Ischial spine and
 Posteriorly to meet the tip of the 5th sacral vertebrae.
Stree Roga Class 2nd
Dr. Ram Veer Sharma

28.  Measurements:-
Antero posterior -
 Lower border of the symphysis pubis.
To 11cm (4.25")
 Tip of the sacrum.
Stree Roga Class 2nd
Transverse -
 Between two Ischial spines - 10.5cm (4.25").
 Posterior Sagital - Mid point of the TDO to tip of the sacrum
- 5cm (2")
• Dr. Ram Veer Sharma

29.  Anatomical out let- Diameters -
 A.P. - with coccyx pushed = 13cm.
 Transverse - Inter Ischial spines = 11cm.
 Posterior Sagital - Sacro coccyxgeal joint to mid point of the
TDO (Anterior margin of the anus) = 8.5cm.
Stree Roga Class 2nd
Angles:-
 Supra pubic angle - 85 - 90º
 Pubic arch is rounded - 6cm. In between pubic ramie at the
level of 2cm behind the apex of the sub pubic arch.
 Measured clinically - Placing three fingers side by side.
Dr. Ram Veer Sharma

30. Joints :- 4
(a) Symphysis Pubis – 1.
 This is covered with hyaline cartilage.
 It is a secondary fibro cartilaginous joint.
 It has no capsule and synovial fluid cavity.
Stree Roga Class 2nd
(b) Sacro iliac articulation- 2.
 It is an articulation between articulation surface of the Ilium
and sacrum.
 It is a synovial joint has capsule and synovial cavity.
(c) Sacro lumber joint -1.
Dr. Ram Veer Sharma

31. Normal Measurements
Stree Roga Class 2nd
From To Inlet Cavity Out Let
Antero Posterior 10.8 – 11CM. 12CM. 13 – 13.2 CM.
Transverse 13 CM. 12 CM. 11 CM.
Oblique 12 CM. 12 CM. 12 CM.
Dr. Ram Veer Sharma
Oblique 12 CM. 12 CM. 12 CM.

32. Changes During Pregnancy?
 The Radiological evidence shows –
 An increase in width and mobility in all joints - due to effects
of the Relaxing hormones during pregnancy.
 And returns to normal following delivery.
Stree Roga Class 2nd
 Symphysis pubis Increase in width and mobility and
gliding movement present near term.
 Sacro iliac joints Increase the A.P. diameter of inlet during
labour by raotatory movement. In dorsal or Lithotomy position
• A.P. diameter may be increase by 1.5 -2 cm.
Dr. Ram Veer Sharma

33. Types of the Female Pelvis
(i)Gynaecoid (Normal) Pelvis -50%
Specialty -
a. Brim – more or less rounded or oval and Roomy,
b. Posterior segment Specious,
Stree Roga Class 2nd
c. Fore pelvis Wide,
d. Sacrum Well curved 90º,
e. Sacro sciatic notch Wide,
f. Lateral pelvic wall Are parallel,
g. Ischial spines Not projected,
Dr. Ram Veer Sharma

34. Types of the Female Pelvis
(i)Gynaecoid (Normal) Pelvis -50%
Specialty -
f. Supra pubic angle Wide - 85-90º,
g. Bones are felt light,
Stree Roga Class 2nd
h. Measurements Are normal.
 Per Vaginal examination Sacral promontory - can not be
reached.
 Sacrum Curves are show concave curve in both
longitudinally and transversely.
Dr. Ram Veer Sharma

35. Externally -
 A.P. diameter - Sacro coccygeal joint to - lower border of the
symphysis pubis = 4.5" = 12cm.
Type of the pelvis Shape Cavity or canal Shape of Sacrum
Gynaecoid 50% Rounded or oval Regular Curve is of 90º
Stree Roga Class 2nd
Anthropoid 25% Oval Small inlet - outlet
normal
Curve is more than
90º
Android 20% Triangle Funnel shape Curve is more than
90º
Platy pelloid 5%
Rickety -
Flat Flat regular Curve is less than 80º
acute curve
Dr. Ram Veer Sharma

36. Developmental or deformed Types
• There may be 14 types of developmental deformed pelvis either
in pure form or in combination.
Aetiology -
1. Sever mal nutrition (Minor variations ) Short stature women.
Stree Roga Class 2nd
2. Diseases or injuries (Major variations)
 Rackets, Oesteomalacia.
 Bone tuberculosis, Tubercular arthritis.
 Fractures of the pelvic or lower limb bones.
 Tumours, Polyomyltits.
Dr. Ram Veer Sharma

37. 3. Spinal - Kyphosis, Lordosis, Scoliosis.
 Spondylolestheasis,
 Coccygeal deformities.
4. Developmental - Hip joint diseases -
 Née gal's pelvis (Obliquely contracted) Arrested
Stree Roga Class 2nd
development of one ala of sacrum.
 Robert’s pelvis (Transversely contracted) Fusion of the ala
and sacrum.
• Higher or low assimilation of the pelvis
5. Lower limb deformities.
Dr. Ram Veer Sharma

38. Back Bone Deformities
Stree Roga Class 2nd
Dr. Ram Veer Sharma

39. Stree Roga Class 2nd
Types of Pelvis
Dr. Ram Veer Sharma

40. Pelvic Deformities.
Née gal's pelvis Robert’s pelvis
Stree Roga Class 2nd
Dr. Ram Veer Sharma

41. Diagnosis:-
 The pelvic anatomical pathology can be detected b the help of
clinical history and exam of the patient.
(i) Pat history (P./H.) - Any pelvic effective disease or pathology
like wise spine or lower limb fracture, Oesteomalacia, bone
Stree Roga Class 2nd
tuberculosis.
(ii) Obstetric history (O./H.) - Nature and results of the previous
labour .
 H/O Cesarean section
 Craniotomy For Cephalo -Pelvic disproportion.
 Difficult forceps delivery Dr. Ram Veer Sharma

42. (iii) General appearance -
 Height – shorter – less then 5’.
 Evidence of the rickets,
 Deformities of the spine and lower limbs,
 Dystocia dystrophia - Male type female.
Stree Roga Class 2nd
.
Dr. Ram Veer Sharma

43. Dystocia dystrophia - Diagnosis Male type female
Body configuration - Starkly built -
a. Bull neck,
b. Broad shoulder,
c. Short thighs,
Stree Roga Class 2nd
d. Obese,
e. Male type hair distribution,
f. Sub - Infertility,
g. Menstrual disorders - Oligomenorrhoea, Irregular menses and
Dysmenorrhoea
h. H./O. – Pre eclampsia, Lactation failure. Dr. Ram Veer Sharma

44. (iv) Per abdomen examination (P.A.):-
a) Pendulous belly - Primi Gravida,
b) Non engaged head at term (till before 3weeks of E.D.D.)
 Find out by Standing test –
 The women stand in erect position and doctor palpate the head
Stree Roga Class 2nd
above the symphysis pubis and note for its descent in to the
pelvis.
c) Mal presentation in primi.
Dr. Ram Veer Sharma

45. (v) Clinical Pelvimetry -
 Externally by measurements of the false pelvis.
 Internally (Manual or by P. / V.)
 Time - 37 weeks beyond to beginning to of labour.
 The internal examination should be gentle through methodical
Stree Roga Class 2nd
and purposeful.
 The points to be specially noted -
Dr. Ram Veer Sharma

46.  Sacral curve - Transversely and longitudinally?
 The approach to the sacral promontory?
 Sacro sciatic notch condition?
 Lateral pelvic wall?
 Ischial spines for its eminence?
Stree Roga Class 2nd
 Ischial spines for its eminence?
For pelvic,
 Sub pubic angle,
 Diagonal conjugate T.D.O.
(vi) Radiology - C.T. Scan and M.R.I.
Dr. Ram Veer Sharma

47. Stree Roga Class 2nd
Dr. Ram Veer Sharma