Learn what is "fetal attitude", "fetal lie", different types of fetal presentation (cephalic, breech, compound, shoulder), how to determine fetal position, and how to do Leopold's maneuvers
Learn what is "fetal attitude", "fetal lie", different types of fetal presentation (cephalic, breech, compound, shoulder), how to determine fetal position, and how to do Leopold's maneuvers
Cervical ripening is the preparation of the cervix for labour and delivery. The Bishop score is the commonest used methodology to assess it. For more like this visit my page on YouTube https://www.youtube.com/@mudiagaakpoghene2243
Cervical ripening is the preparation of the cervix for labour and delivery. The Bishop score is the commonest used methodology to assess it. For more like this visit my page on YouTube https://www.youtube.com/@mudiagaakpoghene2243
The female pelvis is ideal for childbearing. Complete knowledge on it helps a obstetrician or midwife to conduct normal labour as well as detect any abnormalities related to abnormal pelvis.
This topic includes difference between female and male pelvis, various pelvis types, general description of pelvis bones, division of pelvis, landmarks of pelvis, plane, axis, sacral angle, diameters of inlet, cavity and outlet.
Operation “Blue Star” is the only event in the history of Independent India where the state went into war with its own people. Even after about 40 years it is not clear if it was culmination of states anger over people of the region, a political game of power or start of dictatorial chapter in the democratic setup.
The people of Punjab felt alienated from main stream due to denial of their just demands during a long democratic struggle since independence. As it happen all over the word, it led to militant struggle with great loss of lives of military, police and civilian personnel. Killing of Indira Gandhi and massacre of innocent Sikhs in Delhi and other India cities was also associated with this movement.
The Roman Empire A Historical Colossus.pdfkaushalkr1407
The Roman Empire, a vast and enduring power, stands as one of history's most remarkable civilizations, leaving an indelible imprint on the world. It emerged from the Roman Republic, transitioning into an imperial powerhouse under the leadership of Augustus Caesar in 27 BCE. This transformation marked the beginning of an era defined by unprecedented territorial expansion, architectural marvels, and profound cultural influence.
The empire's roots lie in the city of Rome, founded, according to legend, by Romulus in 753 BCE. Over centuries, Rome evolved from a small settlement to a formidable republic, characterized by a complex political system with elected officials and checks on power. However, internal strife, class conflicts, and military ambitions paved the way for the end of the Republic. Julius Caesar’s dictatorship and subsequent assassination in 44 BCE created a power vacuum, leading to a civil war. Octavian, later Augustus, emerged victorious, heralding the Roman Empire’s birth.
Under Augustus, the empire experienced the Pax Romana, a 200-year period of relative peace and stability. Augustus reformed the military, established efficient administrative systems, and initiated grand construction projects. The empire's borders expanded, encompassing territories from Britain to Egypt and from Spain to the Euphrates. Roman legions, renowned for their discipline and engineering prowess, secured and maintained these vast territories, building roads, fortifications, and cities that facilitated control and integration.
The Roman Empire’s society was hierarchical, with a rigid class system. At the top were the patricians, wealthy elites who held significant political power. Below them were the plebeians, free citizens with limited political influence, and the vast numbers of slaves who formed the backbone of the economy. The family unit was central, governed by the paterfamilias, the male head who held absolute authority.
Culturally, the Romans were eclectic, absorbing and adapting elements from the civilizations they encountered, particularly the Greeks. Roman art, literature, and philosophy reflected this synthesis, creating a rich cultural tapestry. Latin, the Roman language, became the lingua franca of the Western world, influencing numerous modern languages.
Roman architecture and engineering achievements were monumental. They perfected the arch, vault, and dome, constructing enduring structures like the Colosseum, Pantheon, and aqueducts. These engineering marvels not only showcased Roman ingenuity but also served practical purposes, from public entertainment to water supply.
June 3, 2024 Anti-Semitism Letter Sent to MIT President Kornbluth and MIT Cor...Levi Shapiro
Letter from the Congress of the United States regarding Anti-Semitism sent June 3rd to MIT President Sally Kornbluth, MIT Corp Chair, Mark Gorenberg
Dear Dr. Kornbluth and Mr. Gorenberg,
The US House of Representatives is deeply concerned by ongoing and pervasive acts of antisemitic
harassment and intimidation at the Massachusetts Institute of Technology (MIT). Failing to act decisively to ensure a safe learning environment for all students would be a grave dereliction of your responsibilities as President of MIT and Chair of the MIT Corporation.
This Congress will not stand idly by and allow an environment hostile to Jewish students to persist. The House believes that your institution is in violation of Title VI of the Civil Rights Act, and the inability or
unwillingness to rectify this violation through action requires accountability.
Postsecondary education is a unique opportunity for students to learn and have their ideas and beliefs challenged. However, universities receiving hundreds of millions of federal funds annually have denied
students that opportunity and have been hijacked to become venues for the promotion of terrorism, antisemitic harassment and intimidation, unlawful encampments, and in some cases, assaults and riots.
The House of Representatives will not countenance the use of federal funds to indoctrinate students into hateful, antisemitic, anti-American supporters of terrorism. Investigations into campus antisemitism by the Committee on Education and the Workforce and the Committee on Ways and Means have been expanded into a Congress-wide probe across all relevant jurisdictions to address this national crisis. The undersigned Committees will conduct oversight into the use of federal funds at MIT and its learning environment under authorities granted to each Committee.
• The Committee on Education and the Workforce has been investigating your institution since December 7, 2023. The Committee has broad jurisdiction over postsecondary education, including its compliance with Title VI of the Civil Rights Act, campus safety concerns over disruptions to the learning environment, and the awarding of federal student aid under the Higher Education Act.
• The Committee on Oversight and Accountability is investigating the sources of funding and other support flowing to groups espousing pro-Hamas propaganda and engaged in antisemitic harassment and intimidation of students. The Committee on Oversight and Accountability is the principal oversight committee of the US House of Representatives and has broad authority to investigate “any matter” at “any time” under House Rule X.
• The Committee on Ways and Means has been investigating several universities since November 15, 2023, when the Committee held a hearing entitled From Ivory Towers to Dark Corners: Investigating the Nexus Between Antisemitism, Tax-Exempt Universities, and Terror Financing. The Committee followed the hearing with letters to those institutions on January 10, 202
Macroeconomics- Movie Location
This will be used as part of your Personal Professional Portfolio once graded.
Objective:
Prepare a presentation or a paper using research, basic comparative analysis, data organization and application of economic information. You will make an informed assessment of an economic climate outside of the United States to accomplish an entertainment industry objective.
The French Revolution, which began in 1789, was a period of radical social and political upheaval in France. It marked the decline of absolute monarchies, the rise of secular and democratic republics, and the eventual rise of Napoleon Bonaparte. This revolutionary period is crucial in understanding the transition from feudalism to modernity in Europe.
For more information, visit-www.vavaclasses.com
Acetabularia Information For Class 9 .docxvaibhavrinwa19
Acetabularia acetabulum is a single-celled green alga that in its vegetative state is morphologically differentiated into a basal rhizoid and an axially elongated stalk, which bears whorls of branching hairs. The single diploid nucleus resides in the rhizoid.
2024.06.01 Introducing a competency framework for languag learning materials ...Sandy Millin
http://sandymillin.wordpress.com/iateflwebinar2024
Published classroom materials form the basis of syllabuses, drive teacher professional development, and have a potentially huge influence on learners, teachers and education systems. All teachers also create their own materials, whether a few sentences on a blackboard, a highly-structured fully-realised online course, or anything in between. Despite this, the knowledge and skills needed to create effective language learning materials are rarely part of teacher training, and are mostly learnt by trial and error.
Knowledge and skills frameworks, generally called competency frameworks, for ELT teachers, trainers and managers have existed for a few years now. However, until I created one for my MA dissertation, there wasn’t one drawing together what we need to know and do to be able to effectively produce language learning materials.
This webinar will introduce you to my framework, highlighting the key competencies I identified from my research. It will also show how anybody involved in language teaching (any language, not just English!), teacher training, managing schools or developing language learning materials can benefit from using the framework.
Adversarial Attention Modeling for Multi-dimensional Emotion Regression.pdf
Evaluation of the pelvis
1. EVALUATION OF THE
PELVIS
Ina S. Irabon, MD, FPOGS, FPSRM, FPSGE
Obstetrics and Gynecology
Reproductive Endocrinology and Infertility
Laparoscopy and Hysteroscopy
2. TO DOWNLOAD THIS LECTURE DECK:
• www.slideshare.net à type “Ina Irabon” in
SEARCH bar
• www.wordpress.com
6. COMPOSITION OF THE BONY PELVIS
nctioning
muscle is
l layer. In
e replaced
muscular
ntractions
arian hor-
ar epithe-
n a sparse
ying myo-
fimbriated
e patches.
e two cell
mucosa is
vely more
n is occu-
The current
of flow is
y cilia and
ant factor
blood ves-
e tubes is
tion. This
Anterior superior
iliac spine
Ilium
Pubis
Symphysis pubis
Greater sciatic
foramen
Sacrospinous
ligament
Ischial spine
Lesser sciatic
foramen
SacrotuberousS
ligament
Ischium
Obturator
foramen
FIGURE 2-16 Sagittal view of the pelvic bones.
linea terminalis serves as the superior
border, whereas the pelvic outlet is the inferior margin. The
posterior boundary is the anterior surface of the sacrum, and
the lateral limits are formed by the inner surface of the ischial
bones and the sacrosciatic notches and ligaments. In front,
7. PELVIC ANATOMY
1. False (Greater) pelvis
• Above linea terminalis
• Posterior: lumbar vertebra
• Lateral: iliac fossae
• Front: lower anterior abdominal wall
2. True (Lesser) Pelvis
• Below linea terminalis
• Superior: linea terminalis
• Posterior: promontory and alae of the
sacrum
• Anterior: upper margin of pubic
bones, ascending superior rami of the
ischial bones and obturator foramina
• Inferior: pelvic outlet
• Lateral: inner surface of ischial bones
and sacrosciatic notches and
ligaments
32 Maternal Anatomy and Physiology
SECTION2
TTTT
APAPAPAP
True
Pelvis
FFFaFaFaFallslslsseee
PPPPellele viiv sss
PPPPPPPPPososssososossososotetetetetettriiiririiirirrrorrororrorooo
sasaasasaasaaasasgigigigiigggttttttttttttalalalaa
Anterior
sagittttttttttttttlalalalalalaaaaa
FIGURE 2-17 Anteroposterior view of a normal female pelvis.
Anteroposterior (AP) and transverse (T) diameters of the pelvic
• C unningham FG , Leveno KJ, Bloom SL, Spong C Y, D ashe JS, Hoffm an
BL, C asey BM , Sheffield JS (eds).W illiam ’s O bstetrics 24
th
edition
(20140; chapter 2 M aternal anatom y
• Sum paico W W , O cam po-Andres IS, Blanco-C apito LR, D iam ante An,
G am illa ZN. (eds). Textbook of O bstetrics 3rd edition. C hapter 23 The
Passages
8. PELVIC ANATOMY
32 Maternal Anatomy and Physiology
outle
to ro
force
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ver o
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have
ting
squa
the p
obser
birth
■ P
TTTT
APAPAPAP
True
Pelvis
FFFaFaFaFallslslsseee
PPPPellele viiv sss
PPPPPPPPPososssososossososotetetetetettriiiririiirirrrorrororrorooo
sasaasasaasaaasasgigigigiigggttttttttttttalalalaa
Anterior
sagittttttttttttttlalalalalalaaaaa
9. OBSTETRIC PLANES AND DIAMETERS
• the pelvis is described as having four imaginary
planes:
• 1. plane of the pelvic inlet—the superior strait.
2. plane of the pelvic outlet—the inferior strait.
3. plane of the midpelvis—the least pelvic
dimensions.
4. plane of greatest pelvic dimension—of no
obstetrical significance.
• C unningham FG , Leveno KJ, Bloom SL, Spong C Y, D ashe JS, Hoffm an
BL, C asey BM , Sheffield JS (eds).W illiam ’s O bstetrics 24
th
edition
(20140; chapter 2 M aternal anatom y
• Sum paico W W , O cam po-Andres IS, Blanco-C apito LR, D iam ante An,
G am illa ZN. (eds). Textbook of O bstetrics 3rd edition. C hapter 23 The
Passages
10. OBSTETRIC PLANES AND DIAMETERS
3 important
planes:
1. Pelvic inlet
2. Midpelvis
3. Pelvic outlet
• C unningham FG , Leveno KJ, Bloom SL, Spong C Y, D ashe JS, Hoffm an
BL, C asey BM , Sheffield JS (eds).W illiam ’s O bstetrics 24
th
edition
(20140; chapter 2 M aternal anatom y
• Sum paico W W , O cam po-Andres IS, Blanco-C apito LR, D iam ante An,
G am illa ZN. (eds). Textbook of O bstetrics 3rd edition. C hapter 23 The
Passages
11. 1. PELVIC INLET
• Forms the brim of the true
pelvis
• Also called the superior strait
• the pelvic inlet is also the
superior plane of the true
pelvis
• Has 4 diameters:
1. Anteroposterior (AP)
a) Diagonal conjugate
b) True conjugate
c) Obstetric conjugate
2. Transverse
3. Obliques (2)
• C unningham FG , Leveno KJ, Bloom SL, Spong C Y, D ashe JS, Hoffm an
BL, C asey BM , Sheffield JS (eds).W illiam ’s O bstetrics 24th edition
(20140; chapter 2 M aternal anatom y
• Sum paico W W , O cam po-Andres IS, Blanco-C apito LR, D iam ante An,
G am illa ZN. (eds). Textbook of O bstetrics 3rd edition. C hapter 23 The
Passages
12. PELVIC INLET:
ANTEROPOSTERIOR DIAMETER
1. Diagonal conjugate:
• distance between lower
border of symphysis pubis to
midpoint of sacral
promontory
• measures approx 12 cm
• The only AP diameter that
can be measured clinically
• C unningham FG , Leveno KJ, Bloom SL, Spong C Y, D ashe JS, Hoffm an
BL, C asey BM , Sheffield JS (eds).W illiam ’s O bstetrics 24
th
edition
(20140; chapter 2 M aternal anatom y
• Sum paico W W , O cam po-Andres IS, Blanco-C apito LR, D iam ante An,
G am illa ZN. (eds). Textbook of O bstetrics 3rd edition. C hapter 23 The
Passages
14. PELVIC INLET:
ANTEROPOSTERIOR DIAMETER
2. True or anatomic
conjugate
• distance between upper
margin of symphysis pubis to
midpoint of sacral promontory
• measures approx 11 cm
• Measured indirectly by
subtracting 1.2 cms from the
diagonal conjugate
• C unningham FG , Leveno KJ, Bloom SL, Spong C Y, D ashe JS, Hoffm an
BL, C asey BM , Sheffield JS (eds).W illiam ’s O bstetrics 24th edition
(20140; chapter 2 M aternal anatom y
• Sum paico W W , O cam po-Andres IS, Blanco-C apito LR, D iam ante An,
G am illa ZN. (eds). Textbook of O bstetrics 3
rd
edition. C hapter 23 The
Passages
15. PELVIC INLET:
ANTEROPOSTERIOR DIAMETER
3. Obstetric conjugate
• distance between midpoint of inner
surface of symphysis pubis to
midpoint of sacral promontory
• This clinically important obstetrical
conjugate is the shortest distance
between the sacral promontory and
the symphysis pubis.
• measures approx 10 cm
• Measured indirectly by subtracting
1.5 to 2 cms from the diagonal
conjugate
• C unningham FG , Leveno KJ, Bloom SL, Spong C Y, D ashe JS,
Hoffm an BL, C asey BM , Sheffield JS (eds).W illiam ’s O bstetrics
24
th
edition (20140; chapter 2 M aternal anatom y
• Sum paico W W , O cam po-Andres IS, Blanco-C apito LR,
D iam ante An, G am illa ZN. (eds). Textbook of O bstetrics 3
rd
edition. C hapter 23 The Passages
16. PELVIC INLET:
TRANSVERSE DIAMETER
• constructed at right
angles to the obstetrical
conjugate and represents
the greatest distance
between the linea
terminalis on either side.
• It usually intersects the
obstetrical conjugate at
a point approximately 5
cm in front of the
promontory
• Average: 13 cm
• Divides the inlet into
anterior and posterior
segments
Posterior sagittal
diameter
• C unningham FG , Leveno KJ, Bloom SL, Spong C Y, D ashe JS, Hoffm an
BL, C asey BM , Sheffield JS (eds).W illiam ’s O bstetrics 24th edition
(20140; chapter 2 M aternal anatom y
• Sum paico W W , O cam po-Andres IS, Blanco-C apito LR, D iam ante An,
G am illa ZN. (eds). Textbook of O bstetrics 3rd edition. C hapter 23 The
Passages
17. PELVIC INLET:
OBLIQUE DIAMETERS
• Extend from the
sacroiliac joints to
the opposite
iliopubic eminence
• Measures <13 cm
• C unningham FG , Leveno KJ, Bloom SL, Spong C Y, D ashe JS, Hoffm an
BL, C asey BM , Sheffield JS (eds).W illiam ’s O bstetrics 24
th
edition
(20140; chapter 2 M aternal anatom y
• Sum paico W W , O cam po-Andres IS, Blanco-C apito LR, D iam ante An,
G am illa ZN. (eds). Textbook of O bstetrics 3rd edition. C hapter 23 The
Passages
18. PLANE OF THE GREATEST PELVIC
DIAMETER
• Corresponds to the
roomiest plane of the
pelvis
• Posterior: 3rd to 4th sacral
vertebrae
• Lateral: ischial bones
• Anterior: middle surface of
symphysis pubis
• Its AP diameter and
transverse diameters
average 12.5cm
• C unningham FG , Leveno KJ, Bloom SL, Spong C Y, D ashe JS, Hoffm an
BL, C asey BM , Sheffield JS (eds).W illiam ’s O bstetrics 24
th
edition
(20140; chapter 2 M aternal anatom y
• Sum paico W W , O cam po-Andres IS, Blanco-C apito LR, D iam ante An,
G am illa ZN. (eds). Textbook of O bstetrics 3rd edition. C hapter 23 The
Passages
19. MIDPELVIS
• Measured at the level of the
ischial spines
• also called the midplane or
plane of least pelvic dimensions
• During labor, the degree of
fetal head descent into the true
pelvis may be described by
station, and the midpelvis and
ischial spines serve to mark zero
station.
• The anteroposterior diameter
through the level of the ischial
spines normally measures at
least 11.5 cm.
the true pelvis may be described by station, and the midpelvis
and ischial spines serve to mark zero station. The interspinous
diameter is 10 cm or slightly greater, is usually the smallest
pelvicdiameter,and,incasesofobstructedlabor,isparticularly
b
tu
in
an
w
th
tr
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n
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Th
th
in
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an
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Interspinous = 10 cmInterspinous = 10 cm
Transverse of inlet = 13.5 cm
Obstetrical
Conj=10.5cm
FIGURE 2-19 Adult female pelvis demonstrating the interspinous
diameter of the midpelvis. The anteroposterior and transverse
diameters of the pelvic inlet are also shown.
• C unningham FG , Leveno KJ, Bloom SL, Spong C Y, D ashe JS, Hoffm an
BL, C asey BM , Sheffield JS (eds).W illiam ’s O bstetrics 24
th
edition
(20140; chapter 2 M aternal anatom y
• Sum paico W W , O cam po-Andres IS, Blanco-C apito LR, D iam ante An,
G am illa ZN. (eds). Textbook of O bstetrics 3rd edition. C hapter 23 The
Passages
20. 2. MIDPELVIS
• Extends from the lower margin of
the symphysis pubis, through the
level of the ischial spines, up to
the tip of the sacrum
• Transverse diameter: distance
between the 2 ischial spines (10.5
cm)à interspinous diameter
• The interspinous diameter (station
0, when the BPD of fetal head
passes this diameter) is 10 cm or
slightly greater, is usually the
smallest pelvic diameter,
is a minor elevation that marks the union site of the ilium and
pubis. These oblique diameters average less than 13 cm.
Midpelvis and Pelvic Outlet
The midpelvis is measured at the level of the ischial spines,
also called the midplane or plane of least pelvic dimensions
(Fig. 2-19). During labor, the degree of fetal head descent into
the true pelvis may be described by station, and the midpelvis
and ischial spines serve to mark zero station. The interspinous
diameter is 10 cm or slightly greater, is usually the smallest
pelvic diameter, and, in cases of obstructed labor, is particularly
Interspinous = 10 cmInterspinous = 10 cm
Transverse of inlet = 13.5 cm
Obstetrical
Conj=10.5cm
• C unningham FG , Leveno KJ, Bloom SL, Spong C Y, D ashe JS, Hoffm an
BL, C asey BM , Sheffield JS (eds).W illiam ’s O bstetrics 24th edition
(20140; chapter 2 M aternal anatom y
• Sum paico W W , O cam po-Andres IS, Blanco-C apito LR, D iam ante An,
G am illa ZN. (eds). Textbook of O bstetrics 3
rd
edition. C hapter 23 The
Passages
21. MIDPELVIS
• Suspicion of midpelvis contraction
is possible with the following:
1. Prominence of the ischial spines
2. Pelvic sidewalls are convergent
3. Concavity of the sacrum is
shallow
4. Bi-ischial diameter of the outlet is
< 8cm
• C unningham FG , Leveno KJ, Bloom SL, Spong C Y, D ashe JS, Hoffm an
BL, C asey BM , Sheffield JS (eds).W illiam ’s O bstetrics 24
th
edition
(20140; chapter 2 M aternal anatom y
• Sum paico W W , O cam po-Andres IS, Blanco-C apito LR, D iam ante An,
G am illa ZN. (eds). Textbook of O bstetrics 3rd edition. C hapter 23 The
Passages
22. 3. PELVIC OUTLET
• Outlet is bounded anteriorly
by the pubic arch, laterally
by the ischiopubic rami,
ischial tuberosity, and
sacrotuberous ligament and
posteriorly by the tip of the
coccyx
• Intertuberous (or bituberous)
diameter: 11cm
• AP diameter: 9.5-11.5cm
• C unningham FG , Leveno KJ, Bloom SL, Spong C Y, D ashe JS, Hoffm an
BL, C asey BM , Sheffield JS (eds).W illiam ’s O bstetrics 24
th
edition
(20140; chapter 2 M aternal anatom y
• Sum paico W W , O cam po-Andres IS, Blanco-C apito LR, D iam ante An,
G am illa ZN. (eds). Textbook of O bstetrics 3rd edition. C hapter 23 The
Passages
23. PELVIC OUTLET
• The pelvic outlet consists of two
approximately triangular areas.
• Posterior triangle
• Anterior triangle
• They have a common base, which
is a line drawn between the two
ischial tuberosities.
• Clinically, three diameters of the
pelvic outlet usually are
described—the anteroposterior,
transverse, and posterior sagittal.
• C unningham FG , Leveno KJ, Bloom SL, Spong C Y, D ashe JS,
Hoffm an BL, C asey BM , Sheffield JS (eds).W illiam ’s O bstetrics
24th edition (20140; chapter 2 M aternal anatom y
• Sum paico W W , O cam po-Andres IS, Blanco-C apito LR,
D iam ante An, G am illa ZN. (eds). Textbook of O bstetrics 3rd
edition. C hapter 23 The Passages
24. PELVIC OUTLET
• Intertuberous diameter may
be measured by placing a
closed fist against the
perineum at the level of the
tuberosities
• Thom’s rule: when
transverse diameter + PSD >
15cm (xray pelvimetry) à
outlet adequate
• C unningham FG , Leveno KJ, Bloom SL, Spong C Y, D ashe JS, Hoffm an
BL, C asey BM , Sheffield JS (eds).W illiam ’s O bstetrics 24
th
edition
(20140; chapter 2 M aternal anatom y
• Sum paico W W , O cam po-Andres IS, Blanco-C apito LR, D iam ante An,
G am illa ZN. (eds). Textbook of O bstetrics 3rd edition. C hapter 23 The
Passages
25. CALDWELL-MOLOY ANATOMICAL
CLASSIFICATION OF THE PELVIS
• based on pelvic
shape
• its concepts aid
an understanding
of labor
mechanisms.
34 Maternal Anatomy and Physiology
SECTION2
FIGURE 2-20 The four parent pelvic types of the Caldwell–Moloy classification. A line passing through the widest transverse diameter
divides the inlets into posterior (P) and anterior (A) segments.
• C unningham FG , Leveno KJ, Bloom SL, Spong C Y, D ashe JS, Hoffm an
BL, C asey BM , Sheffield JS (eds).W illiam ’s O bstetrics 24
th
edition
(20140; chapter 2 M aternal anatom y
• Sum paico W W , O cam po-Andres IS, Blanco-C apito LR, D iam ante An,
G am illa ZN. (eds). Textbook of O bstetrics 3rd edition. C hapter 23 The
Passages
26. • the greatest transverse diameter of the inlet and its
division into anterior and posterior segments are used to
classify the pelvis as gynecoid, anthropoid, android, or
platypelloid.
• The posterior segment determines the type of pelvis,
whereas the anterior segment determines the tendency.
• For example: a gynecoid pelvis with an android
tendency à posterior pelvis is gynecoid and the anterior
pelvis is android shaped.
PELVIC SHAPES
(CALDWELL-MOLOY CLASSIFICATION)
• C unningham FG , Leveno KJ, Bloom SL, Spong C Y,
D ashe JS, Hoffm an BL, C asey BM , Sheffield JS
(eds).W illiam ’s O bstetrics 24th edition (20140; chapter 2
M aternal anatom y
• Sum paico W W , O cam po-Andres IS, Blanco-C apito LR,
D iam ante An, G am illa ZN. (eds). Textbook of
O bstetrics 3rd edition. C hapter 23 The Passages
27. PELVIC SHAPES
(CALDWELL-MOLOY CLASSIFICATION)
Maternal Anatomy and Physiology
Corton MM: Anatomy of the pelvis: how the pelvis is built for support. Clin
FIGURE 2-20 The four parent pelvic types of the Caldwell–Moloy classification. A line passing through the widest transverse diameter
divides the inlets into posterior (P) and anterior (A) segments.
28.
29.
30. CALDWELL MOLOY CLASSIFICATION
• many pelves are not pure but are of mixed types.
• For example, a gynecoid pelvis with an android
tendency means that the posterior pelvis is
gynecoid and the anterior pelvis is android shaped.
• C unningham FG , Leveno KJ, Bloom SL, Spong C Y, D ashe JS, Hoffm an
BL, C asey BM , Sheffield JS (eds).W illiam ’s O bstetrics 24
th
edition
(20140; chapter 2 M aternal anatom y
• Sum paico W W , O cam po-Andres IS, Blanco-C apito LR, D iam ante An,
G am illa ZN. (eds). Textbook of O bstetrics 3rd edition. C hapter 23 The
Passages
31. SOFT PARTS OF THE PELVIS
• Pelvic floor: muscular
partition that separates
pelvic cavity from
perineum
• 3 sets of muscles
1. Pubococcygeus
(pubovisceral)
2. Iliococcygeus
3. puborectalis
àCollectively known as
LEVATOR ANI
• C unningham FG , Leveno KJ, Bloom SL, Spong C Y, D ashe JS, Hoffm an
BL, C asey BM , Sheffield JS (eds).W illiam ’s O bstetrics 24
th
edition
(20140; chapter 2 M aternal anatom y
• Sum paico W W , O cam po-Andres IS, Blanco-C apito LR, D iam ante An,
G am illa ZN. (eds). Textbook of O bstetrics 3rd edition. C hapter 23 The
Passages
32. SOFT PARTS OF THE PELVIS
• Vaginal birth conveys significant risk for damage to
the levator ani or to its innervation
• Of these muscles, the pubococcygeus muscle is
more commonly damaged
• Evidence supports that these injuries may
predispose women to greater risk of pelvic organ
prolapse or urinary incontinence
• C unningham FG , Leveno KJ, Bloom SL, Spong C Y, D ashe JS, Hoffm an
BL, C asey BM , Sheffield JS (eds).W illiam ’s O bstetrics 24
th
edition
(20140; chapter 2 M aternal anatom y
• Sum paico W W , O cam po-Andres IS, Blanco-C apito LR, D iam ante An,
G am illa ZN. (eds). Textbook of O bstetrics 3rd edition. C hapter 23 The
Passages
33. SOFT PARTS OF THE PELVIS
Pelvic diaphragm
• Levator ani +
coccygeus muscles +
fascial covering
• C unningham FG , Leveno KJ, Bloom SL, Spong C Y, D ashe JS, Hoffm an
BL, C asey BM , Sheffield JS (eds).W illiam ’s O bstetrics 24
th
edition
(20140; chapter 2 M aternal anatom y
• Sum paico W W , O cam po-Andres IS, Blanco-C apito LR, D iam ante An,
G am illa ZN. (eds). Textbook of O bstetrics 3rd edition. C hapter 23 The
Passages
35. SOFT PARTS OF THE PELVIS
• Pelvic diaphragm: 2 parts
1. Urogenital triangle (anterior)
2. Anal triangle (posterior)
• Nerve supply: S4, inferior rectal
nerve, perineal branch of the
pudendal nerve
• Supports pelvic organs
• Control of external anal sphincter
• Stabilize sacroiliac and
sacrococcygeal joints • C unningham FG , Leveno KJ, Bloom SL, Spong C Y, D ashe JS, Hoffm an
BL, C asey BM , Sheffield JS (eds).W illiam ’s O bstetrics 24
th
edition
(20140; chapter 2 M aternal anatom y
• Sum paico W W , O cam po-Andres IS, Blanco-C apito LR, D iam ante An,
G am illa ZN. (eds). Textbook of O bstetrics 3rd edition. C hapter 23 The
Passages
36. ANTERIOR TRIANGLE
• Contains portions of urethra and vagina, certain
portions of internal pudendal artery branches, and
the compressor urethrae and urethrovaginal
sphincter muscles, which comprise part of the
striated urogenital sphincter complex.
• C unningham FG , Leveno KJ, Bloom SL, Spong C Y, D ashe JS, Hoffm an
BL, C asey BM , Sheffield JS (eds).W illiam ’s O bstetrics 24
th
edition
(20140; chapter 2 M aternal anatom y
• Sum paico W W , O cam po-Andres IS, Blanco-C apito LR, D iam ante An,
G am illa ZN. (eds). Textbook of O bstetrics 3rd edition. C hapter 23 The
Passages
37. ANAL/ POSTERIOR TRIANGLE
• This triangle contains the
ischioanal fossae, anal
canal, and anal sphincter
complex, which consists of
the internal anal sphincter,
external anal sphincter, and
puborectalis muscle.
• Branches of the pudendal
nerve and internal pudendal
vessels are also found within
this triangle.
• C unningham FG , Leveno KJ, Bloom SL, Spong C Y, D ashe JS, Hoffm an
BL, C asey BM , Sheffield JS (eds).W illiam ’s O bstetrics 24
th
edition
(20140; chapter 2 M aternal anatom y
• Sum paico W W , O cam po-Andres IS, Blanco-C apito LR, D iam ante An,
G am illa ZN. (eds). Textbook of O bstetrics 3rd edition. C hapter 23 The
Passages
38. PUDENDAL NERVE
• formed from the anterior rami of S2–4 spinal nerves.
• It courses between the piriformis and coccygeus
muscles and exits through the greater sciatic
foramen at a location posterior to the sacrospinous
ligament and just medial to the ischial spine
• thus, when injecting local anesthetic for a pudendal
nerve block, the ischial spine serves as an
identifiable landmark
• C unningham FG , Leveno KJ, Bloom SL, Spong C Y, D ashe JS, Hoffm an
BL, C asey BM , Sheffield JS (eds).W illiam ’s O bstetrics 24
th
edition
(20140; chapter 2 M aternal anatom y
• Sum paico W W , O cam po-Andres IS, Blanco-C apito LR, D iam ante An,
G am illa ZN. (eds). Textbook of O bstetrics 3rd edition. C hapter 23 The
Passages
39. ANAL SPHINCTER COMPLEX: IAS
• Two sphincters surround the anal canal to provide fecal
continence—the external and internal anal sphincters.
• Both lie proximate to the vagina, and one or both may
be torn during vaginal delivery.
• Internal Anal Sphincter (IAS) is a distal continuation of
the rectal circular smooth muscle layer. It receives
predominantly parasympathetic fibers, which pass
through the pelvic splanchnic nerves.
• this sphincter is supplied by the superior, middle, and inferior
rectal arteries.
• IAS contributes the bulk of anal canal resting pressure for fecal
continence and relaxes prior to defecation.
• C unningham FG , Leveno KJ, Bloom SL, Spong C Y, D ashe JS, Hoffm an
BL, C asey BM , Sheffield JS (eds).W illiam ’s O bstetrics 24
th
edition
(20140; chapter 2 M aternal anatom y
• Sum paico W W , O cam po-Andres IS, Blanco-C apito LR, D iam ante An,
G am illa ZN. (eds). Textbook of O bstetrics 3rd edition. C hapter 23 The
40. ANAL SPHINCTER COMPLEX: EAS
• External Anal Sphincter (EAS) is a striated muscle ring
that anteriorly attaches to the perineal body and that
posteriorly connects to the coccyx via the
anococcygeal ligament.
• EAS maintains a constant resting contraction to aid
continence, provides additional squeeze pressure when
continence is threatened, yet relaxes for defecation.
• Receives blood supply from the inferior rectal artery,
which is a branch of the internal pudendal artery.
• C unningham FG , Leveno KJ, Bloom SL, Spong C Y, D ashe JS, Hoffm an
BL, C asey BM , Sheffield JS (eds).W illiam ’s O bstetrics 24
th
edition
(20140; chapter 2 M aternal anatom y
• Sum paico W W , O cam po-Andres IS, Blanco-C apito LR, D iam ante An,
G am illa ZN. (eds). Textbook of O bstetrics 3rd edition. C hapter 23 The
Passages
41. SUMMARY/REVIEW
1. Composition of the bony pelvis
2. Pelvic anatomy
true pelvis
false pelvis
3. Planes of the bony pelvis
inlet
midpelvis
outlet
4. Pelvic shapes
gynecoid, android, anthropoid, platypelloid
5. Soft parts of the pelvis
levator ani
pelvic diaphragm
