Sie sind auf Seite 1von 41

Anatomy of pelvis in relation to

obstetrics and of the fetal skull


Dr Mu Mu Win
Senior Lecturer
Faculty of Medicine
UiTM

The bony pelvis


Bones forming the pelvis:
1.hip bones, left and right
a.pubic
b.ilium
c.ischium
2.sacrum
3.coccyx

Aspects of pelvic architecture


In a normal pelvis:

Anterior superior iliac spines and the


pubic symphysis are in the same
coronal plane

The bony pelvis


Anatomical position of the pelvis
Longitudinal axix of the
symphysis is parallel to
sacrum

Tip of the coccyx and the


upper margin of the pubic
symphysis lie in the horizontal
plane

The pelvic inclination

Angle that any pelvic plane


makes with the horizontal line

Plane of the pelvic inlet(brim)

Forms an angle of about 60


degrees with the horizontal
plane
In negros , this angle may
approach 90 degrees and the
fetal head may be slow to
engage during labour

of
ne
Pla
t
inle

Is directed downward and


forward from the sacral
promontry to the pubic
symphysis
Plane
of outle
t

Horizontal plane

Vertical plane

The pelvic inclination

of

inclined about 25 degrees


to the horizontal line

ne
Pla
t
inle

Plane
of outle
t

Horizontal plane

Vertical plane

Plane of the plevic outlet

The pelvic axis


Axis of the pelvic cavity(Axis of the
birth canal)
The axis of the birth canal is the
path followed by the fetal head in
its course through the pelvic
cavity
It extends downward and
backward in the axis of the inlet
(ie. at a right angle to the plane
of the inlet ) as far as the ischial
spine
The axis turns downward and
forward ,at a right angle and
parallel to the plane of the inlet

The bony pelvis

Joints of the pelvis:


I .Lumbo-sacral joints
ii. Sacro-iliac joints
iiii.Sacro-coccygeal joints
Iv.Pubic symphysis

The bony pelvis


Divisions of the pelvis:
1. Pelvis major (False pelvis ,
Greater pelvis)
i. Ala of the sacrum
ii. Iliac fossa
2. Pelvis minor (True pelvis ,
Lesser pelvis )
i. an upper pelvic apature
(pelvic inlet)
ii. a cavity ( pelvic cavity)
iii.a lower pelvic aparture
( pelvic outlet)

Planes and diameters of the pelvis

True pelvis has three planes


of obstetrics significance

Plane
of outle
t

Horizontal plane

Vertical plane

The pelvic cavity extends from


the inlet to the outlet

of

The inlet
Planes of least dimensions
or the mid plane
The outlet

ne
Pla
t
inle

Planes and diameters of the pelvis


Pelvic inlet
Pelvic brim is the boundary line
between the pelvic major and the
pelvic minor (ie. The boundary line
between the abdominal and pelvic
cavities)
The pelvic cavity is composed of:
a. promontry of sacrum
b. anterior border of ala of sacrum
c. arcuate line of ilium
d. pectinial line of pubis
e. pubic crest
f. upper end of pubic symphysis

Planes and diameter of the pelvis


Diameter of the pelvic inlet
6 diameters of the inlet are
customarily described
a. Anatomical conjugate (true
conjugate,)

Antero-posterior diameter
extending from middle of
sacrum promontry to middle of
the upper margin of the
symphysis pubis
Normally 11 cm, of no obstetric
significance

Planes and diameter of the pelvis


b. Obstetric Conjugate
Obstetrically important antero
posterior diameter
Shortest distance from the sacral
promontry and the symphysis
pubis
Generally drawn from the middle
of the sacral promontry to the
closest point on the convest
posterior surface of the
symphysis pubis
Approx; 11 cm
Represent the actual space
available to the fetus in
negiotiating the pelvic inlet
If OC less than 10 cm, it is
considered contracted pelvis

Planes and Diameter of the Pelvis


C. Diagonal Conjugate

Extend from the midpoint of


sacral promontory to the
midpoint of the inferior margin
of the symphysis pubis

Approx 12.5 cm

It is the only diameter of the


inlet that can be measured
clinically

By subtracting 1.5 cm from


the DC, approx length of the
OC can be obtained

Diagonal conjugate

Planes and diameter of the pelvis


d. Transverse diameter

Widest distance between the


iliopectineal line which is
perpendicular to the AP diameter
Approx; 13.5 cm

Transverse
diameter

e. Oblique diameter
Oblique diameter

Extend from one sacroiliac joint


to opposite iliopectineal
eminence
Designated right or left according
to the sacroiliac joint from which
it originates
Approx; 12.75 cm

Anteroposterior
diameter

Planes and diameter of the pelvis


Midplane (plane of the least
dimensions)
Bounded;

A. anterior middle of the


symphysis pubis

B. lateral- pubic bone,


obturator fascia, inner aspect
of the ischial bones and
spines

C. posterior- junction of the


2nd and 3rd sections of the
sacrum

Planes and diameter of the pelvis


Midplane
A.Transverse diameter
B. anterioposterior diameter

Distances similar at 12 cm
Ischial spines are palpable
vaginally

Assessing descent of the fetal head by


vaginal examination

Planes and diameter of the pelvis


Pelvic outlet
Boundaries of the pelvic outlet:
Lower margin of the symphysis
pubis,
on each side by the descending
ramus of the pubic bone, the
ischial tuberosity and the
sacrotuberous ligament,
Last piece of the sacrum

Planes and diameter of the pelvis


Pelvic oulet
Anterioposterior diameter of
the outlet_ measures from
inferior margin of the
symphysis pubis to last piece
of the sacrum.
Approxi; 13.5 cm
Because the coccyx is usually
pushed out of the way by the
advancing presenting part ,its
not included in measurements
of the outlet for obstetrics
purpose
Bituberous diameter distance
between inner aspects of the
ischial tuberosities
Transverse diameter is 11 cm

Classification of the pelvic type


Based on the shape of the
pelvic inlet

A. Anthropoid

B. Platypelloid

C. Android

D. Gynaecoid

Classification of pelvic type


A. Gynaecoid(50%)

Normal female pelvis and ideal for


childbearing
Has a round or transverse oval
inlet
Transverse diameter is greater
than anterioposterior diameter
13.5 cm > 11 cm
Forepelvis is wide and round
Side walls are straight

Sacraum usually well curve


Wide sacrosciatic notch
Ischial spines are everted (blunt)
Pubic arch is wide
Engagement occurs in the transverse or oblique anterior position followed by
descend, anterior rotation and spontaneous vaginal delivery

B. Android (20%)

Typical male type pelvis


Bone structure is heavy in comparison with other 3 pelvic types
Inlet is heart shaped or wedge- shape with a narrow and angulated
forepelvis
Prominent sacral promontry
Sacrum bone is long, flat and inclined forward

Side walls are convergent producing a funnel pelvis


Sacrosciatic notch is narrow
Ischial spines are inverted and prominent
Pubic arch is narrow
Engagement usually occurs in transverse or posterior postion
Frequent outcome is deep transverse arrest or arrest as an occipitoposterior
with failure of rotation

Deep transverse arrest

Differences between Gynaecoid and Android Type

C. Anthropoid (25%)

Inlet is oval, with the AP diameter is much longer than transverse diameter
All the AP diameters are longer and all transverse diameters are shorter than in
comparison with the average gynaecoid pelvis
Forepelvis is oval and more narrow than in gynaecoid pelvis
Side walls are generally straight
Ischial spines are usually not encroaching
Pubic arch is normal or relatively narrow but well shaped

sacrum has an average curvature with a wide sacrosciatic notch ,thus creating an
increased space in the post pelvis
Engagement usually occurs in the anterioposterior or oblique diameter and
occipitoposterior are common
Fetuses in OP usually descend and deliver without rotating
Progress is good for spontaneous vaginal delivery with increased frequency of OP
deliveries

D. Platypelloid type (<3%)

Flat pelvis _ rare


Inlet is transverse oval (transverse diameter is longer than AP diameter)
Characteristics of this pelvis are those of a gynaecoid pelvis that has been
compressed in the anteriorposterior direction
All the transverse diameters are long and all AP diameters are short

If engagement occour ,it is transverse position , often with marked acyclinism


Frequently there is associated with an increased risk of obstructed labour (eg;
Brown presentation)

Clinical pelvimetry
Pelvimetry:
Measurement of the dimensions and
capacity of the pelvis
more accurate accomplished by
radiographic pelvimetry, however
risks of radiation to fetus

Clinical pelvimetry entails using


hands to measure :
certain pelvic diameter
Pelvic architecture
Predict the adequacy of the
pelvis for a particular fetus

Diagonal
Conjugate

Fetal skull bone

Fetal relationship

Engagement the fetal is engaged if the widest leading part


(typically the widest circumference of the head) is negotiating the
inlet.

Station Relationship of the leading bony part of the fetus to the


maternal ischial spines. If at the level of spines, it is at zero 0
station, if it passed it by 2 cm, it is at +2 station.

Attitude Relationship of the fetal head to spine,flexed, neutral


(military) or extended attitudes are possible.

Position Relationship of the presenting part to maternal pelvis, ie.


ROP=Rt occiput posterior, LOA=Lt occiput anterior

Fetal relationship
Presentation Relationship between the leading fetal
part and the pelvic inlet; cephalic, breech or shoulder
presentation
Lie Relationship between the longitudinal axis of fetus
and mother; longitudinal , oblique and transverse
Caput or Caput succedaneum: edema typically formed
by the tissue overlying the fetal skull during the vaginal
delivery process.

Different positions of the fetal head