Anatomy & Physiology of

Female Pelvic bone

Yared H. (MS/MRH)
Department of Nursing
Adigrat University

Monday, March 18, 2019 By; Yared H., ADU 1

Introduction
 Female Pelvis:
Differs from the male pelvis, being broader
with a rounded brim that is conducive to its
specific role in childbearing.
Function
As a protective structure for the uterus ,
ovaries, bladder, rectum and, to a much lesser
extent, the organs in the lower abdomen.

Monday, March 18, 2019 By; Yared H., ADU 2

Female Pelvic Bones con..
 It serves as a bridge between the two femur
bones and helps distribute the upper body
weight.
 Involves in sitting and motion.
 It is well adapted to childbearing & delivery

Monday, March 18, 2019 By; Yared H., ADU 3

Female Pelvic Bones con..
Has four bones
 Two Innominate or hip bones
 The ilium
ilium--
Large flared upper outer part
 The ischium
ischium-- Thick lower part.
 The pubis - forms the anterior part.

 Sacrum
 Coccyx

Monday, March 18, 2019 By; Yared H., ADU 4

Monday, March 18, 2019 By; Yared H., ADU 5
Female Pelvic Bones con..

Monday, March 18, 2019 By; Yared H., ADU 6

Monday, March 18, 2019 By; Yared H., ADU 7
Female Pelvis
 Gynacoid pelvis - regarded as true female
pelvis
 Android pelvis -resembles male pelvis
 Anthropoid pelvis -has longer anterior
posterior diameter
 Platypelloid pelvis
pelvis--has large transverse
diameter

Monday, March 18, 2019 By; Yared H., ADU 8

Female Pelvic Bones con..

Monday, March 18, 2019 By; Yared H., ADU 9

Female Pelvic Bones con..

Monday, March 18, 2019 By; Yared H., ADU 10

 Female Pelvic Bones con..
1-Gynecoid
• Is found in 50% of women
• Rounded—
Rounded—slightly oval inlet
• Straight pelvic sidewalls with roomy pelvic cavity
• Good sacral curve
• Ischial spines are not prominent
• Pubic arch is wide

Monday, March 18, 2019 By; Yared H., ADU 11

The Gynaecoid pelvis

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Female Pelvic Bones con..
2-Android
• found in 20% women
• Pelvic brim is heart shaped
• Pelvis funnels from above downwards
(convergent sidewalls)
• Narrow pubic arch
• Prominent spines

Monday, March 18, 2019 By; Yared H., ADU 13

Android

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Female Pelvic Bones con..
3-Anthropoid
• Pelvic brim APD > TD
• Long & narrow pelvic canal with long sacrum
• Straight pelvic sidewalls
4-Platypelloid
• 5% of women
• Pelvic brim TD >>>APD , kidney shape
• Sacral promontory pushed forwards

Monday, March 18, 2019 By; Yared H., ADU 15

The anthropoid pelvis

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The plathypeloid pelvis

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Female Pelvic Bones con..
Gynecoid Pelvis: Composed of four bones
Innominate (hip) bones: one on each side
 Sacrum: wedge shaped, consisting of 5 fused
vertebrae
 Sacral promontory which is the body of S1
 Coccyx: vestigial tail

Monday, March 18, 2019 By; Yared H., ADU 18

Female Pelvic Bones con..
Each innominate bone has three parts:
 Ilium: large flared out part
 Ischium
Ischium:: thick lower part with Large
prominence: ischial tuberosities
 Behind and a little above the tuberosities is an
inward projection---
projection---ischial
ischial spines
 Pubic bone: with the obturator foramen

Monday, March 18, 2019 By; Yared H., ADU 19

Female Pelvic Bones con..
Illium
 It is large flared out & thinner bone
 The outer part of illium is called iliac crest
 Its concave shape & centeral portion of the
illium is called iliac fossa

Monday, March 18, 2019 By; Yared H., ADU 20

Female Pelvic Bones con..
 In front of the iliac crest can be felt two bony
prominences which are called
anterior superior iliac spine & just below called
anterior inferior iliac spine.
 The same thing on the back of the iliac crust
again two bony prominence that is
posterior superior iliac spine & posterior
inferior iliac spine can be felt.
Monday, March 18, 2019 By; Yared H., ADU 21
Female Pelvic Bones con..
Ischium
 It is small & thicker part
 Consistes of one obturater foramen &
acetabulum
 Acetabulum is formed:2/5th of ischium
ischium,, 2/5th
of ilium & 1/5th of symphysis pubis

Monday, March 18, 2019 By; Yared H., ADU 22

Female Pelvic Bones con..
Sciatic notch: Divided into two
1. Large sciatic notch - it starts from posterior
inferior iliac spine to ischial spine
spine--Goes
through pelvic outlet
2. Small sciatic notch - It starts from ischial
spine to ischial tuberosisty
tuberosisty--Goes through
obtrutor foramen

Monday, March 18, 2019 By; Yared H., ADU 23

Female Pelvic Bones con..
Symphysis pubis: Consists of two pubic bones.
This contains;
- 90o angles.
- Superior & inferior ramus
- Upper & lower border of symphysis pubis

Monday, March 18, 2019 By; Yared H., ADU 24

False pelvis Vs.True pelvis
False pelvis –lies above the pelvis brim
 Formed by the iliac portion of the innominate
bone & is limited above the iliac crest
 Its obstetrics function is to support the
enlarged uterus during pregnancy.
Its bounderies are
• posteriorly-lumbar vertebrae
posteriorly-
• Laterally - iliac fossa
• Anteriorly - Anterior abdominal wall.
Monday, March 18, 2019 By; Yared H., ADU 25
The True Pelvis
The ‘true pelvis’ refers to the bony canal that
the fetus needs to pass through during the
normal mechanism of childbirth.
• It comprises a brim, cavity and an outlet.

Monday, March 18, 2019 By; Yared H., ADU 26

The pelvic cavity
This extends from the pelvic brim to the
pelvic outlet. Parts of pelvic cavity
 Inlet (pelvic brim)
 Middle
 Outlet

Monday, March 18, 2019 By; Yared H., ADU 27

 Land marks of female pelvis
A. The pelvic brim
 The pelvic brim separates the ‘false’ pelvis
from the ‘true’ pelvis .
 Is a round shape, with the exception of the
sacral promontory which protrudes into it
posteriorly..
posteriorly
 Formed by pubic bones anteriorly
anteriorly;; the iliac
bones laterally and the posterior border is
formed by the promontory and the sacral alae.
Monday, March 18, 2019 By; Yared H., ADU 28
Land marks…
B. Mid pelvis
• Ischial spine
C. Out let
• Ischial tuberosity laterally
• Inferior border of symphsis pubis anteriorly
anteriorly..
• Sacrotuberous and sacrospinous ligaments
ligaments--
postero -laterally

Monday, March 18, 2019 By; Yared H., ADU 29

Diameters of the pelvis
1. Pelivic brim
1.1 Anterior - Posterior diameter
A.True conjugate
 From the promontory of the sacrum to the
centre of the upper surface of the symphysis
pubis
 It measures 12cm
 Can not be estimated, directly

Monday, March 18, 2019 By; Yared H., ADU 30

Diameters of the pelvis con’t
B. Obsterics conjugate
 A line from the sacral promontory to the thick
inner upper part of symphysis pubis
 It measures 11cm
C. Diagonal conjugate
 It is the distance b/n lower border of
symphysis pubis to the mid point of the sacral
promonatry..
promonatry
 It measures 13cm
Monday, March 18, 2019 By; Yared H., ADU 31
Diameters of the pelvis con’t


Monday, March 18, 2019 By; Yared H., ADU 32

Diameters of the pelvis con’t
1.2. Oblique diameter
- There are two oblique diameters
- Right oblique diameter
- Left oblique diameter
- Each one extends from one sacro iliac joint
to the opposite iliopectineal eminence &
measures 12cm

Monday, March 18, 2019 By; Yared H., ADU 33

Diameters of the pelvis con’t
1.3.Transverse diameter
- It is the distance b/n the two furthest points
on the
pelvis brim over the iliopectineal lines
- It measures 13cm
- Measurement: Pelvimetery

Monday, March 18, 2019 By; Yared H., ADU 34

Diameters of the pelvis con’t

2.. Mid cavity

 Interspinous diameter
diameter--a line between the
two ischial spines and measures 12 centimeters.

Monday, March 18, 2019 By; Yared H., ADU 35

Diameters of the pelvis con’t
2.1 Antero - posterior diameters:
diameters
 Anatomical antero
antero--posterior diameter =11cm-
=11cm-
from the tip of the coccyx to the lower border
of symphysis pubis.
 Obstetric antero
antero--posterior diameter = 13 cm-
cm-
from the tip of the sacrum to the lower border
of symphysis pubis as the coccyx moves
backwards during the second stage of labour
labour..
Monday, March 18, 2019 By; Yared H., ADU 36
Diameters of the pelvis con’t
2.2 Transverse diameters:
diameters:
 Bituberous diameter = 11 cm-
cm-between the
inner aspects of the ischial tuberosities
tuberosities..
 Bispinous diameter = 10.5 cm-
cm-between the
tips of ischial spines
2.3 Oblique diameter
 Extends from obturater formaen to sacro
spinous ligament
 It measures 12cm
Monday, March 18, 2019 By; Yared H., ADU 37
3. Diameters of the Obstetrical outlet
3.1 The anteroposterior diameter
diameter:: is the line
from the lower boarder of the symphysis
pubis to the Sacrococcygeal joint. It is 13 cm.
3.2 The oblique diameter:
diameter: measurement b/n
the obturator foramen and the sacrospinous
ligament. It measures 12 cm
3.3 The transverse diameter:
diameter: is a line b/n the
two ischial spines intraspinous diameter. It
measures 10 – 11 cm.
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Measurements of gynacoid pelvis

Monday, March 18, 2019 By; Yared H., ADU 39

Measurements of gynacoid pelvis

Monday, March 18, 2019 By; Yared H., ADU 40

Pelvic joints
 Joints are the point at which two or more
bones are connected
The female pelvis is connected by four joints:
 two sacroiliac joints - is the strongest joint in
body
 One sacro coccygeal joints
 One symphysis pubis

Monday, March 18, 2019 By; Yared H., ADU 41

Pelvic Ligaments
 Ligaments are a tough bonds of white fibrous
connective tissue that links two bones
together at a joint
 Also connects two muscle together
 The female pelvis is connected by eight
ligaments .

Monday, March 18, 2019 By; Yared H., ADU 42

Pelvic Ligaments
Each pelvic joint is held together by ligaments:
 Interpubic ligament at the symphysis pubis (1)
 Sacro iliac ligaments (2)
 Sacro coccygeal ligaments (1)
 Sacro tuberous ligament (2)
 Sacro spinous ligament (2)

Monday, March 18, 2019 By; Yared H., ADU 43

Monday, March 18, 2019 By; Yared H., ADU 44
Pelvic floor Or Pelvic diaphragm
 Is a muscular floor that demarcates the pelvic
cavity and perineum.
Functions:: -
Functions
 It supports abdominal and pelvic organs
 The muscles are responsible for the voluntary
control of micturation and defecation
 It influences the passive movement of the
fetus through the birth canal and relaxes to
allow its exit from the pelvis.
Monday, March 18, 2019 By; Yared H., ADU 45
Fetal skull
 The skull is formed of the face , the vault &
the base
 The bones of the face & base are heavy &
fused
 The bones of the vault are 2 temporal,2
frontal,2 parietal & 1 occipital
 The bones of the vault are not joined,
Thus, changes in the shape of the fetal head
during labor can occur due to moulding
Monday, March 18, 2019 By; Yared H., ADU 46
Monday, March 18, 2019 By; Yared H., ADU 47
Fetal skull definitions
 Bregma; Anterior fontanelle
Bregma;
 Brow; lies between bregma & root of the nose
 Face; lies between root of the nose &
suborbital ridges
 Occiput
Occiput;; boney prominence behind post
fontanelle
 Vertex; diamond shaped area between ant &
post fontanelles & parietal eminences
Monday, March 18, 2019 By; Yared H., ADU 48
Monday, March 18, 2019 By; Yared H., ADU 49
Fetal skull sutures
 Frontal suture between 2 frontal bones
 Sagittal suture between 2 parietal bones
 Coronal suture between parietal & frontal
 Lambdoid suture between parietal &
occipital
 Temporal suture between inferior margin of
the parietal & temporal

Monday, March 18, 2019 By; Yared H., ADU 50

Fetal skull fontanelles
 Anterior fontanelle diamond shaped space
between coronal & sagittal suture
 Post fontanel triangle shaped space
between sagittal & lambdoid suture

Monday, March 18, 2019 By; Yared H., ADU 51

Fetal skull diameters
 Biparietal diameter 9.5 cm. between parietal
eminences--The greatest transverse diameter
eminences
 Sub occipito bregmatic 9.5 cm. middle of
the bregma to undersurface of the occipital
bone at the neck
The presenting diameter of the well flexed
head in labour

Monday, March 18, 2019 By; Yared H., ADU 52

Fetal skull diameters
 Sub occipito frontal 10 - 10.5cm root of the
nose to undersurface of the occipital bone at
the neck
The presenting diameter of the partially flexed
head
 Occipitofrontal 11.5 cm Root of the noose
to the most prominent point of the occiput
A deflexed head presents with this diameter
Monday, March 18, 2019 By; Yared H., ADU 53
Fetal skull diameters
 Mento vertical 13-
13-14 cm Chin to most
prominent point of the occiput
The presenting diameter in brow presentation
The largest diameter of the fetal head
 Sub mentobregmatic 9.5 cm Chin to middle
of bregma
The presenting diameter in face presentation

Monday, March 18, 2019 By; Yared H., ADU 54

Monday, March 18, 2019 By; Yared H., ADU 55
Monday, March 18, 2019 By; Yared H., ADU 56
Moulding of the head
 Occurs with descent of the fetal head into the
pelvis to reduce the head circumference
 Frontal bones slip under parietal bones
 Parietal bones override each other
 Parietal bones slip under the occipital bone

Monday, March 18, 2019 By; Yared H., ADU 57

Molding of the head
Degree of moulding
Assessed vaginally
• 0 Suture lines are separate
• +1 Suture lines meet
• +2 Suture lines overlap but can be
reduced by gentle digital pressure
• +3 Overlap irreducible

Monday, March 18, 2019 By; Yared H., ADU 58

 Thank You

Monday, March 18, 2019 By; Yared H., ADU 59