Anatomy of the  pelvis- obstetrics and gynaecology
Submitted To: Submitted By:
Dr.Mrs.M.Gandhimathi,M.Sc.(N), Ph.D Abisha.M R
Professor of O&G Nursing M.Sc.(N) O&G - I Year
Govt. College of Nursing Govt. College of Nursing
Cuddalore Cuddalore
SEMINAR ON PELVIS
INTRODUCTION:
Competence is recognizing the anatomy of a normal pelvis is key
to midwifery practice as the one of way to estimate a women’s progress
in labor is by assessing the relationship of the fetus to certain pelvic
landmark. Knowledge of pelvic anatomy is also needed in order to be
able to detect deviations from normal.
PELVIS:
The pelvis is basin shaped cavity, is a bony ring between the movable
vertebrae of the vertebral column which it support and the lower limbs that is
rest on. The bony pelvis, which connects the spine to the lower limbs.
Pelvis contains and protect the female reproductive organs and other structures.
1) The reproductive organs, namely the vagina, the uterus, the fallobian tubes
and other ovaries.
2) The bladder and urethra.
3) The pelvic colon, the rectum and the analcanal.
CLASSICIFICATION OF PELVIS:
Classically pelvis have been .described “Caldwell - Moley Classification”.
ANDRIOD
PELVIS
GYNAECOID
PELVIS
ANTHROPOID
PELVIS
PLATTY
PELLOID
PELVIS
I. The Gynaecoid Pelvis:
A. The normal female pelvis is gynaecoid in shape. The brim of the true
pelvis is round or almost oval in shape. When the patient is standing, the
pelvis inlet or the brim is inclined at an angle of 50-60 degree to the
horizontal.
B. Effect on labor the foetal head often engages in the transverse diameter of
the brim in a anterior position. The course and mechanism of labor or
normal.
• Therefore the gynaecoid pelvis is the best for child bearing.
II. The Android Pelvis: This is the male type pelvis, the
brim is triangular or heart shaped and is more roomy
posteriorly.
THE ANTHROPOID PELVIS :
This type of pelvis resembles the pelvis of
the ape. The brim is oval in shape with an increase in the anterio-
posterior diameter and a corresponding decrease in
the transverse diameter.
The Plattypelloid Pelvis:
The corresponds to the simple flat pelvis. The anterio posterior
diameter is short
but transverse diameter is wide.
STRUCTURE OF PELVIS:
The false pelvis is the part of the pelvis
situated above the pelvis brim.
Its boundaries are,
• Posteriorly - Lumbar Vertebrae
• Laterally - Illiac Fossa
• Anteriorly - Anterior Abdominal Wall
Its only obstetric function is to support
the enlarged uterus during pregnancy.
The true pelvis is the most
important part of the pelvis in
obstetrics.
The true pelvis is the bony canal
through which the fetus must pass
during birth.
FALSE
PELVIS
TRUE
PELVIS
THE TRUE PELVIS MADE UP TO THREE PARTS,
THE PELVIS
INLET OR
THE BRIM
THE
CAVITY
THE
OUTLET
I). The Pelvis inlet or the Brim:
a) The brim is the area bounded infront by the upper border of the symphysis
pubis and the upper border of the pubis rami, posteriorly by the sacral
promontory and the ala of the sacrum and laterally by illio - pectenial lines.
b) The brim determines the shape of the pelvis.
c) Landmarks of true pelvis constitutes the plane of the brim and it will be
round.
The landmarks are,
Landmarks
Sacral
Promontory
Sacro Iliac
Joint
Superior
ramus of the
pubis bone
Illio
Pectineal
line
Sacral ala
or wing Upper inner
border of the
symphysis
pubis
Illio
Pectineal
Eminence
Upper inner
border of the
pubic bone
The Pelvic Cavity:
The cavity lies between the inlet and the outlet.
 The Anterior wall is formed by the pubic bones and symphysis pubis and is
depth is 4 cm.
 The Posterior wall is formed by the curve of the sacrum, which is 12 cm
length.
 Laterally - the bodies of the ischium and the part of the illium, the greater
sciatic notches and the obdurater foramina.
 The cavity contains the pelvic colon, rectum, bladder and some of the
reproductive organs.
The Pelvic Outlet:
The lower circumference of the true pelvis is very regular, the space is enclosed by
it is called outlet.
The outlet are described,
Anatomical
Outlet
Obstetrical
Outlet
Anatomic Outlet,
is formed by the lower borders of each bones together with the
sacrotuberous ligament.
Obstetrical Outlet,
is the space between the narrow pelvic strait and anatomical
outlet.
Bone of Pelvis:
The pelvic girdle, which is stronger and more massively constructed
than the wall of the cranial or thoracic cavities, is composed of four bones.
i. Two Innominate Bone - Laterally
ii. One Sacrum - Anteriorly
iii. One Coccyx - Posteriorly
Innominate Bone:
Each innominate bone is made up of three bones and that have fused
together.
The illium, ischium and the pubis.
The illium:
The illium is the large 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 illiac crest can be felt a bony prominence as the Anterior
superior iliac spine.
A short distance below it is anterior inferior iliac spine. There are two similar
points at other end of the iliac crest, namely the Posterior superior and the
Posterior inferior iliac spine. The concave anterior surface of the illium is the
iliac fossa.
The Ischium:
I. The ischium is the thick lower part. It is large prominence known as the
ischial tuberosity, on which the body rests when sitting.
II. Behind the 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 spine.
III. The pubis forms the anterior part, it has a body and two oar like projections,
the superior ramus and the inferior ramus.
IV. The two pubic bones meet at the symphysis pubis and the two inferior ramus
from the Pubic arch, merging in to a similar ramus on the ischium.
V. The space enclosed by the part of the pubic bone, the rami and the ischium
is called the obturator foramen.
VI. The innominate bone contains a deep cup to receive the head of the femur
termed the acetabulum, which is composed of three fused bones in the
following proportions.
Two - fifths illium
Two - fifths ischium and
Two - fifth pubis
VII. On the lower border of the innominate bones are found two curves.
VIII. One curves extend from the posterior inferior illiac spine up to the
ischial spine and is called grater sciatic notch.
IX. The other curve lies between the ischial spine and the ischial ischial
tuberosity and is known as the lessor sciatic notch.
The Sacrum:
A. The sacrum is a wedge shaped bone consisting of the fused vertebrae.
B. The upper part of the first sacral vertebrae, with just forward is known as the
sacral promontory.
C. The anterior surface of the sacrum is concave and is referred as the hollow of
the sacrum.
D. Laterally the sacrum extends in to a wing or ala.
E. Four pairs of holes or foramina pierce the sacrum and through these, nerves
from the cauda equine emerge to supply the pelvic organs.
F. The posterior surface is rough ended to receive attachments of pelvis.
The Coccyx:
 The coccyx is a vestigial tail.
 It consists of four fused vertebrae, forming a small triangular bone, which
articulates with the fifth sacral segment.
Joint of Pelvis:
Symphysis Pubis
Two Sacroiliac Joint
One Sacrococcygeal Joint
1. Symphysis Pubis:
I. The symphysis pubis is the midline cartilaginous joint uniting the rami of
the left and right pubis bones.
II. The articular surfaces are covered with hyaline cartilage. Due to softening
of the ligaments during pregnancy, there is considerable among the gliding
movement.
2. Sacroilliac Joint:
a) Sacroiliac joints are strong, weight bearing synovial joints with irregular
elevations and depressions that producing interlocking of the bone. They
join the sacrum to the illium and as a result connect that spine to pelvis.
b) Engagement to diagnose, it is better to palpate gently with two hands facing
down over the abdomen, than to prod around with pawlik’s grip, which in
non - experienced hand is painful.
(3). One Sacrococcygeal Joint:
I. Sacrococcxygeal joint is formed where the base of the coccyx articulates
with the tip of the sacrum.
II. It allow both flexion and extension.
III. Extension increases anterio - posterior diameter of the outlet, it permits the
coccyx to be deflected backwards during the birth of the fetal head.
Muscle of the Pelvis:
Pubo
Coccygenous
Muscles
Illio
Coccyges
Muscles
Coccygens
Muscles
Puborectails
Muscles
It is a hammock like muscle, found in the both sexes, that stretches from
the pubis bone to the coccyx (tail bone) forming the floor of the pelvic cavity and
supporting the pelvic organs.
Iliococcyges is a thin sheet of muscle that transverse the pelvic canal from
the tendinous arch of the levator ani to the midline illio coccygeal raphe, where it
joints with the muscle of the other side and connects with the superior surface of
the sacrum and coccyx.
I. Pubo Coccygenous Muscles:
II. Iliococcyges Muscles:
Coccygues also known as ischio coccygeus is a triangular shaped sheet of
muscle located posterior to the levator ani muscle in the pelvic floor. The
coccygeus together with the levator ani, from the pelvic diaphragm.
The puborectails muscle forms a sling around the lower rectum when it
meets the fiber from the opposite site.
III. Coccyx Muscles:
IV. Puborectails Muscles:
Ligaments of Pelvis:
 The pelvic, joints are held together by very strong ligaments that are
designed not to allow movements however, during pregnancy the hormones
relaxin gradually loosens all the pelvic ligaments allowing slight pelvic
movement proving more room for the fetal head as it passes through the
pelvis.
 A widening of 2-3 mm at the symphysis pubis during pregnancy above the
normal gap of 4-5 mm is normal but if it widens significantly, the degree of
movement permitted may give rise to pain or walking.
The ligaments connecting the bones of the pelvis with
each other can be divided in to four groups.
The Sacroiliac Joint Ligaments: Those connecting the sacrum and ilium.
The Sacro tuberous ligaments & The sacro spinous ligaments: Those passing
between the sacrum sacrum and ischium.
The Sacro - coccygeal ligaments: Those uniting the sacrum and coccyx.
The inner pubic ligaments: Those between the two pubis bones.
The ligaments that are important to midwifery practice are the sacro
tuberous and the sacro spinous ligaments as they from the posterior wall of the
pelvic outlet
Nerve of
Pelvis
Sacral
Plexus
Lumbar
Plexus
Autonomic
Nerve
Somatic
Nerve
 Lumbar Plexus:
 Illio hypogastric nerve
 Genito femoral nerve
 Lateral femoral cutaneous nerve
 Femoral nerve
 Obturator nerve
 Sacral Plexus:
 Nerve to pyriformis
 Posterior femoral cutaneous nerve
 Pudendal nerve
 Sciatic nerve
Somatic Nerve:-
Lumbar plexus is formed with in the substance od psoas muscle. It is
formed by the anterior primary rami of the first three lumbar nerves and part
of the forth nerve and a contribution from the 12th thoracic nerve.
II). Iliohygogastric Nerve:
The former gives branches to the buttock which the later supplies the
skin of the Mons pubis and the surrounding vulva.
I). Lumbar Plexus:
III). Genito Femoral Nerve:
Femoral branch supplies the thigh and the genital branch
supplies the skin of the labia majus.
IV). Lateral Femoral Cutaneous Nerve:
The nerve is purely sensory and supplies the peritoneum of the illiac
fossa and to the lateral side of the thigh down to the knee.
V). Femoral Nerve:
This is the largest branch and descends in the groove between
the psoas and iliacus muscle and enters the thigh deep to the
inguinal ligaments.
VI). Obturator Nerve:
The obturator nerve arises from the lumbar plexus and it lies with in the
substance of psoas major. It is formed from the anterior divisions of the
anterior lami of second, third, fourth lumbar nerves.
Sacral Plexus:
Sacral plexus from the out of the lumbosacral trunk and the upper four sacral
rami.
Nerve to pyriformis: This is as follows,
Perforating Cutaneous Nerve:
It perforates the sacrotuberous ligament and the fibers of gluteal maximus. It
supplies the medical side of the buttock.
Posterior Femoral Cutaneous Nerve: It supplies the lateral part of the posterior
two third of labia majus.
Pudental Nerve:
It is nerve of the pelvic floor and the perineum. It leaves the pelvis between
pyriformis and coccygeas and curls around the ischial spine to enter the pudental
canal through the lesser sciatic foramen.
Sciatic Nerve:
It is the largest branch of the sacral plexus. It is formed at the lower
margin of pyriformis by the union of the component nerves.
Autonomic Nerve:
I. The pelvic organ are supplied by the sympathetic and para sympathetic
nerve system.
II. The sympathetic components are derived from the superior hypogastric
plexus via the hypogastric nerve and from the sacral sympathetic ganglion.
III. The para sympathetic nerves enter the pelvis through the pelvic splanchnic
nerves.
Landmarks of Pelvis:
There are 9 landmarks in inlet.
Symphysis
Pubis
Pubic
Crest
Pectineal
Line
Illio
Pectineal
Eminence
Pubic
Tubercle
Sacral
Promontory
Ala of the
Sacrum
Sacro
Iliac Joint
Illio
Pectineal
Line
Diameter of the Pelvis:
Diameters of the brim or Inlet:
The brim has three principles diameter:
Anterior Posterior Diameter:-
 It extents from the mid point of the sacral promontory to the inner margin
symphysis pubis. It measures 11 cm.
 The true conjugate cannot be estimated directly. However, its measurement
is inferred by subtracting 1.2 cm from the diagonal conjugate.
Obstetric Conjugate:
It is the distance between the midpoint of the sacral promontory to prominent
bony projection in the midline on the inner surface of the symphysis pubis. it
measure 10 cm.
Diagonal Conjugate:
 It is the distance between the lower border of symphysis pubis to the midpoint of
the sacral promontory, it measure 12 cm .
 Obstetric conjugate is computed by subtracting 1.5-2 cm from the diagonal
conjugate depending upon the height, thickness and inclination of the symphysis
pubis.
Transverse Diameter:
 It is the distance between the two farthest points on the pelvic brim over the
illio pectineal lines. It measures 13cm.
Oblique Diameter:
 On extends from one sacro iliac joint to the opposite ilio pubic eminence and
measure 12cm.
Diameter of Cavity:
Anteroposterior Transverse Diameter
 It measure from the midpoint of the
posterior surface of the symphysis
pubis to the junction of second and
third sacral vertebrae.
 It cannot be precisely measured as
the points lie over the sift tissue
covering the sacro sciatic notches
and obturator foramen.
 It measure 12 cm.  It measure 12 cm.
Diameter of Outlet:-
Anatomical Outlet:
It is otherwise known as bony outlet.
It is bounded infront by the lower border of the symphysis pubis, laterally by
the ischio pubic rami, ischial tuberosity and sacrotuberous ligament and
pastorally tip of coccyx. It is Diamond shape.
Antero Posterior Diameter:
It extends from the lower border of the symphysis pubis to the tip of the coccyx. It
measures 13cm.
Transverse Diameter:
It measures between inner border of ischial tuberosity.
It measures 11cm.
Posterior Sagittal Diameter:
It is clinically measured by the distance between the sacro coccygeal joint
anterior margin of the anus.
The diameter is 8.5 cm.
Obstetrical of Outlet:-
It is anteroposterior oval shape.
Anteroposterior: It extends from the inferior border of the symphysis pubis to the
tip of the sacrum.
 It measure 11cm.
Transverse Diameter: It is the distance between the tip of the ischial spine.
It measure 10.5cm.
Posterior Sagittal Diameter: It is the distance between the tip of the sacrum and
mid point of the spinous.
 It measures 5cm.
Midpelvis:
Midpelvis is the segment of the pelvis bounded above by the place of the greatest
pelvic dimensions and below by a plane known as midpelvic plane.
Antero Posterior Diameter:
It extends from the lower border of the symphysis pubis to the point on the sacrum
at which the pelvic plane meets.
It measure 11.5cm.
Transverse Diameter:
It measure between the two ischial spine.
It measure 11.5cm.
Posterior Sagittal Diameter:
It extends from the midpoint of the bispinous diameter to the point on the
sacrum at which the midpelvic plane meets.
It measure 4.5cm.
Functional of Pelvis:-
Obstetrical Function:
 Adopted for child bearing in comparison to male pelvis, brim is rounded and
wider.
 It supports gravid uterus.
 It gives passage way to fetus.
General Function:
 Primary function to allow movement to body.
 Helps in walking, sitting and running.
 Pelvic contain and protect reproductive organs along with the bladder and
rectum.
 Sitting weight of the body is taken up by the ischial tuberosity.
 Helps in transmitting weight of body to legs.
Summary:
So far we discussed about introduction of pelvis, definition, classification,
structures, bones, joints muscle, ligaments, nerves, landmarks diameters and
functions of the pelvis.
Conclusion:
Through this seminar I have learned about this pelvis. I would like to thank
our O&G faculty,
Dr.Mrs.M.Ganthimathi,M.Sc.(N).,P.hD.(N)., Professor
for given this golden opportunity.
Theory Application:
General System Theory
Input
The students lack of
knowledge regarding
“Pelvis”.
Output
The studies gained
knowledge
regarding “Pelvis”.
Throughput
Taking seminaron
“Pelvis”.
Feed back
Bibliography:
1) D.C.Dutta, (2019), “Textbook of Obstetrics,” 9th Edition, New Delhi, Jaypee
Brothers Medical Publishers (P) Ltd, P.No: 79,80,81.
2) David Mckay Flart, Janenorman, (2000), “Gynecology illustrated,” Fifth edition,
Harcaut Publishers Limited, Page No: 19,20,21.
3) Oaojo, Enang Bassey Briggs, (2016) “ A textbook fro Midwifes in the topics”
Second edition, Jaypee Brothers Medical Publishers (P) Ltd, P.No: 56
4) Srinish S Sheth, (2014), “ Essentials of Obstetrics” First edition, Jaypee Brothers
Medical Publishers (P) Ltd, P.No: 25,31,32.
Net Source:
I. https://www.ncbi.nlm.nin.gov
II. https://techmeanatomy.info
Anatomy of the  pelvis- obstetrics and gynaecology

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Anatomy of the pelvis- obstetrics and gynaecology

  • 2. Submitted To: Submitted By: Dr.Mrs.M.Gandhimathi,M.Sc.(N), Ph.D Abisha.M R Professor of O&G Nursing M.Sc.(N) O&G - I Year Govt. College of Nursing Govt. College of Nursing Cuddalore Cuddalore SEMINAR ON PELVIS
  • 3. INTRODUCTION: Competence is recognizing the anatomy of a normal pelvis is key to midwifery practice as the one of way to estimate a women’s progress in labor is by assessing the relationship of the fetus to certain pelvic landmark. Knowledge of pelvic anatomy is also needed in order to be able to detect deviations from normal.
  • 4. PELVIS: The pelvis is basin shaped cavity, is a bony ring between the movable vertebrae of the vertebral column which it support and the lower limbs that is rest on. The bony pelvis, which connects the spine to the lower limbs. Pelvis contains and protect the female reproductive organs and other structures. 1) The reproductive organs, namely the vagina, the uterus, the fallobian tubes and other ovaries. 2) The bladder and urethra. 3) The pelvic colon, the rectum and the analcanal.
  • 5. CLASSICIFICATION OF PELVIS: Classically pelvis have been .described “Caldwell - Moley Classification”. ANDRIOD PELVIS GYNAECOID PELVIS ANTHROPOID PELVIS PLATTY PELLOID PELVIS
  • 6. I. The Gynaecoid Pelvis: A. The normal female pelvis is gynaecoid in shape. The brim of the true pelvis is round or almost oval in shape. When the patient is standing, the pelvis inlet or the brim is inclined at an angle of 50-60 degree to the horizontal. B. Effect on labor the foetal head often engages in the transverse diameter of the brim in a anterior position. The course and mechanism of labor or normal.
  • 7. • Therefore the gynaecoid pelvis is the best for child bearing.
  • 8. II. The Android Pelvis: This is the male type pelvis, the brim is triangular or heart shaped and is more roomy posteriorly.
  • 9. THE ANTHROPOID PELVIS : This type of pelvis resembles the pelvis of the ape. The brim is oval in shape with an increase in the anterio- posterior diameter and a corresponding decrease in the transverse diameter.
  • 10. The Plattypelloid Pelvis: The corresponds to the simple flat pelvis. The anterio posterior diameter is short but transverse diameter is wide.
  • 11. STRUCTURE OF PELVIS: The false pelvis is the part of the pelvis situated above the pelvis brim. Its boundaries are, • Posteriorly - Lumbar Vertebrae • Laterally - Illiac Fossa • Anteriorly - Anterior Abdominal Wall Its only obstetric function is to support the enlarged uterus during pregnancy. The true pelvis is the most important part of the pelvis in obstetrics. The true pelvis is the bony canal through which the fetus must pass during birth. FALSE PELVIS TRUE PELVIS
  • 12. THE TRUE PELVIS MADE UP TO THREE PARTS, THE PELVIS INLET OR THE BRIM THE CAVITY THE OUTLET
  • 13. I). The Pelvis inlet or the Brim: a) The brim is the area bounded infront by the upper border of the symphysis pubis and the upper border of the pubis rami, posteriorly by the sacral promontory and the ala of the sacrum and laterally by illio - pectenial lines. b) The brim determines the shape of the pelvis. c) Landmarks of true pelvis constitutes the plane of the brim and it will be round.
  • 14. The landmarks are, Landmarks Sacral Promontory Sacro Iliac Joint Superior ramus of the pubis bone Illio Pectineal line Sacral ala or wing Upper inner border of the symphysis pubis Illio Pectineal Eminence Upper inner border of the pubic bone
  • 15. The Pelvic Cavity: The cavity lies between the inlet and the outlet.  The Anterior wall is formed by the pubic bones and symphysis pubis and is depth is 4 cm.  The Posterior wall is formed by the curve of the sacrum, which is 12 cm length.  Laterally - the bodies of the ischium and the part of the illium, the greater sciatic notches and the obdurater foramina.  The cavity contains the pelvic colon, rectum, bladder and some of the reproductive organs.
  • 16. The Pelvic Outlet: The lower circumference of the true pelvis is very regular, the space is enclosed by it is called outlet. The outlet are described, Anatomical Outlet Obstetrical Outlet
  • 17. Anatomic Outlet, is formed by the lower borders of each bones together with the sacrotuberous ligament. Obstetrical Outlet, is the space between the narrow pelvic strait and anatomical outlet.
  • 18. Bone of Pelvis: The pelvic girdle, which is stronger and more massively constructed than the wall of the cranial or thoracic cavities, is composed of four bones. i. Two Innominate Bone - Laterally ii. One Sacrum - Anteriorly iii. One Coccyx - Posteriorly
  • 19. Innominate Bone: Each innominate bone is made up of three bones and that have fused together. The illium, ischium and the pubis. The illium: The illium is the large 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 illiac crest can be felt a bony prominence as the Anterior superior iliac spine.
  • 20. A short distance below it is anterior inferior iliac spine. There are two similar points at other end of the iliac crest, namely the Posterior superior and the Posterior inferior iliac spine. The concave anterior surface of the illium is the iliac fossa.
  • 21. The Ischium: I. The ischium is the thick lower part. It is large prominence known as the ischial tuberosity, on which the body rests when sitting. II. Behind the 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 spine. III. The pubis forms the anterior part, it has a body and two oar like projections, the superior ramus and the inferior ramus. IV. The two pubic bones meet at the symphysis pubis and the two inferior ramus from the Pubic arch, merging in to a similar ramus on the ischium.
  • 22. V. The space enclosed by the part of the pubic bone, the rami and the ischium is called the obturator foramen. VI. The innominate bone contains a deep cup to receive the head of the femur termed the acetabulum, which is composed of three fused bones in the following proportions. Two - fifths illium Two - fifths ischium and Two - fifth pubis VII. On the lower border of the innominate bones are found two curves.
  • 23. VIII. One curves extend from the posterior inferior illiac spine up to the ischial spine and is called grater sciatic notch. IX. The other curve lies between the ischial spine and the ischial ischial tuberosity and is known as the lessor sciatic notch.
  • 24. The Sacrum: A. The sacrum is a wedge shaped bone consisting of the fused vertebrae. B. The upper part of the first sacral vertebrae, with just forward is known as the sacral promontory. C. The anterior surface of the sacrum is concave and is referred as the hollow of the sacrum. D. Laterally the sacrum extends in to a wing or ala. E. Four pairs of holes or foramina pierce the sacrum and through these, nerves from the cauda equine emerge to supply the pelvic organs. F. The posterior surface is rough ended to receive attachments of pelvis.
  • 25. The Coccyx:  The coccyx is a vestigial tail.  It consists of four fused vertebrae, forming a small triangular bone, which articulates with the fifth sacral segment.
  • 26. Joint of Pelvis: Symphysis Pubis Two Sacroiliac Joint One Sacrococcygeal Joint
  • 27. 1. Symphysis Pubis: I. The symphysis pubis is the midline cartilaginous joint uniting the rami of the left and right pubis bones. II. The articular surfaces are covered with hyaline cartilage. Due to softening of the ligaments during pregnancy, there is considerable among the gliding movement.
  • 28. 2. Sacroilliac Joint: a) Sacroiliac joints are strong, weight bearing synovial joints with irregular elevations and depressions that producing interlocking of the bone. They join the sacrum to the illium and as a result connect that spine to pelvis. b) Engagement to diagnose, it is better to palpate gently with two hands facing down over the abdomen, than to prod around with pawlik’s grip, which in non - experienced hand is painful.
  • 29. (3). One Sacrococcygeal Joint: I. Sacrococcxygeal joint is formed where the base of the coccyx articulates with the tip of the sacrum. II. It allow both flexion and extension. III. Extension increases anterio - posterior diameter of the outlet, it permits the coccyx to be deflected backwards during the birth of the fetal head.
  • 30. Muscle of the Pelvis: Pubo Coccygenous Muscles Illio Coccyges Muscles Coccygens Muscles Puborectails Muscles
  • 31. It is a hammock like muscle, found in the both sexes, that stretches from the pubis bone to the coccyx (tail bone) forming the floor of the pelvic cavity and supporting the pelvic organs. Iliococcyges is a thin sheet of muscle that transverse the pelvic canal from the tendinous arch of the levator ani to the midline illio coccygeal raphe, where it joints with the muscle of the other side and connects with the superior surface of the sacrum and coccyx. I. Pubo Coccygenous Muscles: II. Iliococcyges Muscles:
  • 32. Coccygues also known as ischio coccygeus is a triangular shaped sheet of muscle located posterior to the levator ani muscle in the pelvic floor. The coccygeus together with the levator ani, from the pelvic diaphragm. The puborectails muscle forms a sling around the lower rectum when it meets the fiber from the opposite site. III. Coccyx Muscles: IV. Puborectails Muscles:
  • 33. Ligaments of Pelvis:  The pelvic, joints are held together by very strong ligaments that are designed not to allow movements however, during pregnancy the hormones relaxin gradually loosens all the pelvic ligaments allowing slight pelvic movement proving more room for the fetal head as it passes through the pelvis.  A widening of 2-3 mm at the symphysis pubis during pregnancy above the normal gap of 4-5 mm is normal but if it widens significantly, the degree of movement permitted may give rise to pain or walking.
  • 34. The ligaments connecting the bones of the pelvis with each other can be divided in to four groups. The Sacroiliac Joint Ligaments: Those connecting the sacrum and ilium. The Sacro tuberous ligaments & The sacro spinous ligaments: Those passing between the sacrum sacrum and ischium. The Sacro - coccygeal ligaments: Those uniting the sacrum and coccyx. The inner pubic ligaments: Those between the two pubis bones. The ligaments that are important to midwifery practice are the sacro tuberous and the sacro spinous ligaments as they from the posterior wall of the pelvic outlet
  • 36.  Lumbar Plexus:  Illio hypogastric nerve  Genito femoral nerve  Lateral femoral cutaneous nerve  Femoral nerve  Obturator nerve
  • 37.  Sacral Plexus:  Nerve to pyriformis  Posterior femoral cutaneous nerve  Pudendal nerve  Sciatic nerve
  • 38. Somatic Nerve:- Lumbar plexus is formed with in the substance od psoas muscle. It is formed by the anterior primary rami of the first three lumbar nerves and part of the forth nerve and a contribution from the 12th thoracic nerve. II). Iliohygogastric Nerve: The former gives branches to the buttock which the later supplies the skin of the Mons pubis and the surrounding vulva. I). Lumbar Plexus:
  • 39. III). Genito Femoral Nerve: Femoral branch supplies the thigh and the genital branch supplies the skin of the labia majus. IV). Lateral Femoral Cutaneous Nerve: The nerve is purely sensory and supplies the peritoneum of the illiac fossa and to the lateral side of the thigh down to the knee.
  • 40. V). Femoral Nerve: This is the largest branch and descends in the groove between the psoas and iliacus muscle and enters the thigh deep to the inguinal ligaments. VI). Obturator Nerve: The obturator nerve arises from the lumbar plexus and it lies with in the substance of psoas major. It is formed from the anterior divisions of the anterior lami of second, third, fourth lumbar nerves.
  • 41. Sacral Plexus: Sacral plexus from the out of the lumbosacral trunk and the upper four sacral rami. Nerve to pyriformis: This is as follows, Perforating Cutaneous Nerve: It perforates the sacrotuberous ligament and the fibers of gluteal maximus. It supplies the medical side of the buttock. Posterior Femoral Cutaneous Nerve: It supplies the lateral part of the posterior two third of labia majus.
  • 42. Pudental Nerve: It is nerve of the pelvic floor and the perineum. It leaves the pelvis between pyriformis and coccygeas and curls around the ischial spine to enter the pudental canal through the lesser sciatic foramen. Sciatic Nerve: It is the largest branch of the sacral plexus. It is formed at the lower margin of pyriformis by the union of the component nerves.
  • 43. Autonomic Nerve: I. The pelvic organ are supplied by the sympathetic and para sympathetic nerve system. II. The sympathetic components are derived from the superior hypogastric plexus via the hypogastric nerve and from the sacral sympathetic ganglion. III. The para sympathetic nerves enter the pelvis through the pelvic splanchnic nerves.
  • 44. Landmarks of Pelvis: There are 9 landmarks in inlet. Symphysis Pubis Pubic Crest Pectineal Line Illio Pectineal Eminence Pubic Tubercle Sacral Promontory Ala of the Sacrum Sacro Iliac Joint Illio Pectineal Line
  • 45. Diameter of the Pelvis: Diameters of the brim or Inlet: The brim has three principles diameter: Anterior Posterior Diameter:-  It extents from the mid point of the sacral promontory to the inner margin symphysis pubis. It measures 11 cm.  The true conjugate cannot be estimated directly. However, its measurement is inferred by subtracting 1.2 cm from the diagonal conjugate.
  • 46. Obstetric Conjugate: It is the distance between the midpoint of the sacral promontory to prominent bony projection in the midline on the inner surface of the symphysis pubis. it measure 10 cm. Diagonal Conjugate:  It is the distance between the lower border of symphysis pubis to the midpoint of the sacral promontory, it measure 12 cm .  Obstetric conjugate is computed by subtracting 1.5-2 cm from the diagonal conjugate depending upon the height, thickness and inclination of the symphysis pubis.
  • 47. Transverse Diameter:  It is the distance between the two farthest points on the pelvic brim over the illio pectineal lines. It measures 13cm. Oblique Diameter:  On extends from one sacro iliac joint to the opposite ilio pubic eminence and measure 12cm.
  • 48. Diameter of Cavity: Anteroposterior Transverse Diameter  It measure from the midpoint of the posterior surface of the symphysis pubis to the junction of second and third sacral vertebrae.  It cannot be precisely measured as the points lie over the sift tissue covering the sacro sciatic notches and obturator foramen.  It measure 12 cm.  It measure 12 cm.
  • 49. Diameter of Outlet:- Anatomical Outlet: It is otherwise known as bony outlet. It is bounded infront by the lower border of the symphysis pubis, laterally by the ischio pubic rami, ischial tuberosity and sacrotuberous ligament and pastorally tip of coccyx. It is Diamond shape. Antero Posterior Diameter: It extends from the lower border of the symphysis pubis to the tip of the coccyx. It measures 13cm.
  • 50. Transverse Diameter: It measures between inner border of ischial tuberosity. It measures 11cm. Posterior Sagittal Diameter: It is clinically measured by the distance between the sacro coccygeal joint anterior margin of the anus. The diameter is 8.5 cm.
  • 51. Obstetrical of Outlet:- It is anteroposterior oval shape. Anteroposterior: It extends from the inferior border of the symphysis pubis to the tip of the sacrum.  It measure 11cm. Transverse Diameter: It is the distance between the tip of the ischial spine. It measure 10.5cm. Posterior Sagittal Diameter: It is the distance between the tip of the sacrum and mid point of the spinous.  It measures 5cm.
  • 52. Midpelvis: Midpelvis is the segment of the pelvis bounded above by the place of the greatest pelvic dimensions and below by a plane known as midpelvic plane. Antero Posterior Diameter: It extends from the lower border of the symphysis pubis to the point on the sacrum at which the pelvic plane meets. It measure 11.5cm.
  • 53. Transverse Diameter: It measure between the two ischial spine. It measure 11.5cm. Posterior Sagittal Diameter: It extends from the midpoint of the bispinous diameter to the point on the sacrum at which the midpelvic plane meets. It measure 4.5cm.
  • 54. Functional of Pelvis:- Obstetrical Function:  Adopted for child bearing in comparison to male pelvis, brim is rounded and wider.  It supports gravid uterus.  It gives passage way to fetus.
  • 55. General Function:  Primary function to allow movement to body.  Helps in walking, sitting and running.  Pelvic contain and protect reproductive organs along with the bladder and rectum.  Sitting weight of the body is taken up by the ischial tuberosity.  Helps in transmitting weight of body to legs.
  • 56. Summary: So far we discussed about introduction of pelvis, definition, classification, structures, bones, joints muscle, ligaments, nerves, landmarks diameters and functions of the pelvis.
  • 57. Conclusion: Through this seminar I have learned about this pelvis. I would like to thank our O&G faculty, Dr.Mrs.M.Ganthimathi,M.Sc.(N).,P.hD.(N)., Professor for given this golden opportunity.
  • 58. Theory Application: General System Theory Input The students lack of knowledge regarding “Pelvis”. Output The studies gained knowledge regarding “Pelvis”. Throughput Taking seminaron “Pelvis”. Feed back
  • 59. Bibliography: 1) D.C.Dutta, (2019), “Textbook of Obstetrics,” 9th Edition, New Delhi, Jaypee Brothers Medical Publishers (P) Ltd, P.No: 79,80,81. 2) David Mckay Flart, Janenorman, (2000), “Gynecology illustrated,” Fifth edition, Harcaut Publishers Limited, Page No: 19,20,21. 3) Oaojo, Enang Bassey Briggs, (2016) “ A textbook fro Midwifes in the topics” Second edition, Jaypee Brothers Medical Publishers (P) Ltd, P.No: 56 4) Srinish S Sheth, (2014), “ Essentials of Obstetrics” First edition, Jaypee Brothers Medical Publishers (P) Ltd, P.No: 25,31,32.
  • 60. Net Source: I. https://www.ncbi.nlm.nin.gov II. https://techmeanatomy.info