female pelvis

Question 1

pelvis bone

Answer 1

• massive cup shaped ring of bone
• with the ligaments at lower end of the trunk, form the hip bone ( pubic bone, ileum, ischium ) on either side and in front of sacrum and coccyx posteriorly

Question 2

pelvis plans

Answer 2

• the pelvis is divided into 2 parts by the pelvic brim, which is formed by the sacral promontory behind, the iliopectineal line laterally and the symphysis pubis anteriorly
• above the brim is the false pelvis, which forms part of the abd cavity
• bounded:- posteriorly by lumbar vertebra
  laterally by iliac fossa
  anteriorly by lower portion of ant abd wall
• below the brim is the true pelvis
• bounded fr above by:-
  promontory
  ala of sacrum
  linea terminalis
  upper margin of pubic bone
• bounded fr below by pelvic outlet
• 4 plane
  1. pelvic plane of inlet
  2. wide pelvic plane
  3. narrow pelvic plane
  4. pelvic of outlet plane
  Outlet plane
• A-P diameter ( around 11.9cm ) extends fr lower margin of symphysis to the sacrococcygeal joint rather than the tip of coccyx
• Transverse or intertuberous diameter of the outlet is measured fr inner border of one ischial tuberosity to the other ( 10-11cm )

Mid plane
- Anterioposteriorly the greatest dimension is frm midsymphysis to the sacrum at the fused 2nd and 3rd vertebrae(12.75 or more)
- Extending frm the middle of post borders of ischial bones are ischial spines
- The distance bet spines(10.5) represents the shortest transverse diameter of true pelvic cavity
- Ischial spines can be reached during vaginal examination
- The ischial spines serve as landmarks in determining station, or the level to with the presenting part of the fetus has descended into the pelvic cavity
Inlet plane

• boundary r :
  antr border : upper margin of symphysis
  postr : promontory
  latr : linea terminalis n antr by horizontal pubic rami bones
• AP is 11cm, transverse 13.5cm
• Plane diameter is oblique ???

Question 3

pelviometry

Answer 3

• Diagonal conjugate
  ⮚ Distance from sacral promontory to symphysis pubis
  ⮚ Approximate length of fingers introitus to sacrum
  ⮚ Adequate diagonal conjugate > 11.5cm
• Intertuberous Diameter
  ⮚ Distance between Ischial tuberosities
  ⮚ Approximately width of fist
  ⮚ Adequate intertuberous diameter > 10 cm
• Intertrochanteric diameter
  ⮚ Distance btw the greater trochanter head of femur at both leg
  ⮚ Adequate intertrochanteric diameter ???
• Prominence of ischial spine
  ⮚ Distance btw inner surface of symphysis pubis slightly below its upper border and sacral promontory

Question 4

true conjugate

Answer 4

• also called conjugate vera
• measures up to 11cm ( AP inlet ) btwn promontory of sacrum n lower part of pubic symphysis
• may be calculated directly by radiographic, US
• indirect measurement by
  1. CE
• wrist index ( WI ) is taken into account ( N = 14-15 cm )
• if <14cm → minus 8cm fr CE
• if 14-15cm → minus 9cm
• if >15cm → minus 10cm
• formula => CV = CE – ( 8 or 9 or 10 )

2. CD
   - height of symphysis is taken into consideration ( N = 4-5cm )
   - if <4cm → minus 1.5cm
   - if 4-5.5cm → minus 2cm
   - if >5cm → minus 2.5cm
   - formula => CV = CD – ( 1.5 or 2 or 2.5 )

3 CL ( latr conjugate ) / Kerner-Gerter distance
- distance btwn antr supr spine n postr supr spine ( N = 14-15cm )
- if <13cm → CV <9cm
- if N → CV is N

4. Phrank distance ( N = 11cm )
   - distance btwn jugular notch n C7
   - wh is directly equal to CV
5. Michaelis Rhomboid
   - vertical diameter = CV
   - projection of sacrum at women’s back

Question 5

pelvic organs : the female reproductive system anatomy

Answer 5

● External genitalia (vulva)
Vulva includes mons veneris, labia majora, labia minora, clitoris, vestibule & perineum
These are all visible on external examination.
It’s bounded anteriorly by mons veneris,
Laterally by labia majora
Posteriorly by perineum

● Internal genitalia
Internal genitalia include vagina, uterus, Fallopian tubes & ovaries.

Vagina: fibromuscular-membranous sheath communicating uterine cavity with vulva

Anterior wall- upper one third related with Douglas pouch

Lower two third- urethra
Lower half is embedded with its wall

Posterior wall- upper one third related with Douglas pouch

Middle one third-anterior rectal wall, separated by rectovaginal septum
Lower one third- separated from anal canal by perineal body

Lateral walls- upper one third related with pelvic cellular tissue at base of broad ligament

Middle one third blended with levators ani
Lower one third related with bulbocavernosus muscles, vestibular bulbs &Bartholin’s gland

Uterus: hollow pyriform muscular organ between bladder (front) & rectum (behind)
Normal position- anteversion & anteflexion
Usually inclines to right
Parts- corpus(body), isthmus, cervix
Body consist of 3 layers: perimetrium, myometrium & endometrium
Fallopian tubes: paired structures, in medial three-fourth of upper free margin of broad ligament

Parts- interstitial, isthmus, ampulla, infundibulum

Layers- serous, muscular, mucous membrane

Ovaries: paired sex glands

Attached to posterior layer of broad ligament by mesovarium
To lateral pelvic wall by infundibulopelvic ligament
To uterus by ovarian ligament

Question 6

different conjugates

Answer 6

• 3 conjugates
  1. CV ( N = 11cm )
• btwn promontory of sacrum n upper part of symphysis
  2. CD ( N = 12.5cm )
• btwn promontory n lower part symphysis
  3. obstetrical conjugate ( N = 10cm )

Question 7

the gynecoid pelvis

Answer 7

• Shape of inlet: round
• Fore pelvic: wide
• A-P diameter: 12cm
• Transverse diameter: 13cm
• Brim index: 8-100
• Side walls: straight
• Ischial spine: not prominent
• Sciatic notch: wide
• Subpubic angle: wide
• Incidence: Asians > Europeans ( 80% > 50-70% )