female pelvis

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female pelvis, parts , bones, diameters, landmarks, joints and ligaments

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Female pelvis:

Female pelvis Jayadeepa J

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The female pelvis because of its characteristics, aids in child birth. The bony pelvis in normal standing posture transmits the body weight of head, trunk and the upper extremities to the lower extremities. In female it is adapted for child bearing. The obstetrical anatomy of a typical female pelvis is best considered as one unit.

FUNCTIONS OF FEMALE PELVIS:

FUNCTIONS OF FEMALE PELVIS The primary function of the pelvic girdle is to allow movement of the body, especially walking and running. It permits the person to sit and kneel. The women pelvis is adapted for child bearing, and because of its increased width and rounded brim women are less speedy than men. The pelvis transmits the weight of the trunk to the legs, acting as a bridge between the femur. This makes it necessary for the sacro -iliac joint to the immensely strong and virtually immobile. The pelvis also takes the weight of the sitting body on to the ischial tuberosities . The pelvis affords protection to the pelvic organs and, to a lesser extent, to the abdominal contents. The sacrum transmits the cauda equina and distributes the nerves to the various parts of the pelvis.

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The normal female pelvis The female pelvis because of its characteristics, gives rise to no difficulties in child birth, providing the fetus is of normal size. Knowledge of pelvic anatomy is needed for the conduction of labour as one of the ways to estimate the progress is made by assessing the relationship of the fetus to certain pelvic landmarks. A midwife must be competent to recognize a normal pelvis in order to be able to detect deviations from normal and refer them to the obstetrician.

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Pelvic bones There are four pelvic bones Two innominate ( nameless) or hip bones One sacrum One coccyx

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Innominate bones: each innominate bone is composed of three parts Ilium Ischium Pubic bones The ilium - ilium is the larger flared out part. When the hand is placed on the hip it rests on the iliac crest, which is the upper border. At the front of the iliac crest can be felt a bony prominence known as the anterior superior iliac spine . A short distance below it is the anterior inferior iliac spine. There are two similar points at the other end of the iliac crest, namely the posterior superior and the posterior inferior iliac spines. The concave anterior surface of the ilium is the iliac fossa .

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The ischium - ischium is the thick lower part. It has a large prominence known as the ischium tuberosity , on which the body rests when sitting. Behind and a little above the tuberosity is an inward projection, the ischial spine . in labour the station of the fetal head is estimated in relation to the ischial spines.

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The pubic bone- this bone forms the anterior part. It has a body and two oar like projections, the superior ramus and the inferior ramus . The two pubic bones meet at the symphysis pubis and the two inferior rami from the pubic arch, merging into a similar ramus and the ischium . The space enclosed by the body of the pubic bone, the rami and the ischium is called the obturator foramen.

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The innominate bone contains a deep cup to articulate with the head of the femur. This is termed as Acetabulum . all three parts of the bone contribute to the acetabulum in the following proportions: 2/5 th ilium , 2/5 th ischium and 1/5 th pubic bone. On the lower border of the innominate bone are found two curves. One extends from the posterior inferior iliac spine up to the ischial spine and is called the greater sciatic notch. It is wide and rounded. The other lies between the ischial spine and the ischial tuberosity and is the lesser sciatic notch.

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Sacrum: the sacrum is a wedge shaped bone consisting of five fused vertebrae. The upper border of the first sacral vertebra juts forward and id known as the sacral promontory. The anterior surface of the sacrum is concave and is referred to as the hollow of sacrum. Laterally the sacrum extends into a wing or ala. Four pairs of holes or foramina pierce the sacrum and through these, nerves from the Cauda Equina emerge to supply the pelvic organs. The posterior surface is roughened to receive attachments of muscles.

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Coccyx: the coccyx is a vestigial tail. It consists of four fused vertebra forming a small triangular bone. With its base uppermost articulating with the lower end of the sacrum. During labour it moves backward, having more space for the delivery of the fetus this is called nodding.

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Pelvic joints There are four pelvic joints One symphysis pubis Two sacroiliac joints One sacro-coccygeal joint

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The symphysis pubis is formed at the junction of the two pubic bones, which are united by a pad of cartilage. The sacroiliac joints – these are the strongest joints in the body. They join the sacrum to the ilium and thus connect the spine to the pelvis. The sacro coccygeal joint – this joint is formed where the base of the coccyx articulate with the tip of the sacrum.

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In the non-pregnant state there is very little movement in these joints, but during pregnancy endocrine activity causes the ligaments to soften, which allows the joints to give. This may provide more room for the fetal head as it passes through the pelvis. The symphysis pubis may separate slightly in later pregnancy. If it widens appreciably, the degree of movement permitted may give rise to pain on walking. The sacro-coccygeal joint permits coccyx to the deflected backward during the birth of the head.

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Pelvic ligaments Each of the pelvic joints is held together by ligaments Interpubic ligaments at the symphysis pubis Sacro -iliac ligaments Sacro-coccygeal ligaments There are two other ligaments important in midwifery The sacro -tuberous ligament The sacro-spinous ligament

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The sacro -tuberous ligament runs from the sacrum to the ischial tuberosity and the sacro-spinous ligament from the sacrum to the ischial spine. These two ligaments cross the sciatic notch and from the posterior wall of the pelvic outlet.

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The pelvis is broadly divided into true pelvis and false pelvis. The false pelvis: is divided by the linea terminalis into the false pelvis above this demarcation and the true pelvis below it. The false pelvis is the portion above the pelvic brim. It has no obstetric significance relevant to the passage of the fetus through the pelvis. The true pelvis: the true pelvis constitutes the bony passage through which the fetus must pass through to be born vaginally. Therefore, its construction planes and diameters are of utmost interest in obstetrics.

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Boundaries of true pelvis; The true pelvis has the following as its boundaries Superiorly it is bounded by the sacral promonitory , linea terminalis and the upper margin of pubic bones. Inferiorly it is bounded by the inferior margins of the ischial tuberosities and the tip of the coccyx. Laterally it has sacroiliac notches and ligaments, and inner surface of ischial bones Anteriorly by the obturator foramina an dthe posterior surface of the symphysis pubis, pubic bones and the ascending rami of ischial bones. Posteriorly bounded by the anterior surface of sacrum and coccyx.

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The true pelvis has three parts namely brim, a cavity and an outlet The brim or inlet – its boundaries are the sacral promontory and wings of the sacrum behind the iliac bones in the front. The shape of the pelvic inlet is transversely oval, with a slight posterior indentation caused by the sacral promontory.

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Land marks of the brim: the inlet has the landmarks, these are the fixed anatomical points on the brim. Sacral promontory Sacral wing or sacral ala Sacro -iliac joint The ileo-pectineal line- the edge formed at the inward aspect of the ilium The ilio-pectineal eminence- a roughened area where the superior ramus of the pubic bone meets the ilium Superior ramus of the pubic bone Upper inner border of the body of pubic bone. Upper inner border of the symphysis pubis.

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The pelvic cavity This extends from the pelvic brim to the pelvic outlet. It forms the curve of Carus , which the fetus has to navigate in order to be born and has no specific landmarks. The pelvic outlet This is either an ovoid or diamond-shaped space; its perimeter is partially comprised of ligaments. The landmarks of the pelvic outlet are as follows: _ Lower border of the symphysis pubis _ Pubic arch _ Ischial spines and ischial tuberosities _ Sacrotuberous and sacrospinous ligaments _ Lower aspect of the sacrum and the coccyx

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The diameters of the pelvis The major obstetric interest in the female bony pelvis is that it is not distensible, with only minor degrees of movement being possible at the symphysis pubis and sacroiliac joints. The various dimensions of the pelvis are therefore particularly significant in the context of childbirth and the successful passage of the fetus through the bony pelvic structure. The most common type of female pelvis ( gynaecoid ) is considered to be the optimal shape and size for childbirth; this is providing the fetus isn’t above average size and the pelvis isn’t smaller than average, or where there is a combination of both factors.

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The pelvic brim There are three diameters that are measured and, as a midwifery student, you will frequently hear these being referred to: _ Anterior-posterior diameter _ Oblique diameter (left and right) _ Transverse diameter The diagrams presented here show the points from where these measurements are taken and the associated Table gives a clear format for the measurement of the pelvic canal in centimetres .

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