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© Royal College of Obstetricians and Gynaecologists Anatomy of the female pelvis and vaginal birth.

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Presentation on theme: "© Royal College of Obstetricians and Gynaecologists Anatomy of the female pelvis and vaginal birth."— Presentation transcript:

1 © Royal College of Obstetricians and Gynaecologists Anatomy of the female pelvis and vaginal birth

2 © Royal College of Obstetricians and Gynaecologists Take a look at the bony pelvis you have been given. View it from the front. In the following slides, the bony landmarks will be described.

3 © Royal College of Obstetricians and Gynaecologists

4 Innominate bone

5 © Royal College of Obstetricians and Gynaecologists Sacrum

6 © Royal College of Obstetricians and Gynaecologists Coccyx

7 © Royal College of Obstetricians and Gynaecologists Sacroiliac joint

8 © Royal College of Obstetricians and Gynaecologists Sacrococcygeal joint

9 © Royal College of Obstetricians and Gynaecologists Symphysis pubis

10 © Royal College of Obstetricians and Gynaecologists Ischial spine

11 © Royal College of Obstetricians and Gynaecologists Ileopectineal line

12 © Royal College of Obstetricians and Gynaecologists Obturator foramen

13 © Royal College of Obstetricians and Gynaecologists Pubic arch

14 © Royal College of Obstetricians and Gynaecologists Sacral promontory

15 © Royal College of Obstetricians and Gynaecologists Anterior foramina

16 © Royal College of Obstetricians and Gynaecologists Now look at the pelvis from one side. In the following slides, more landmarks will be shown. You will also see how the pelvis is orientated when a woman is standing up straight.

17 © Royal College of Obstetricians and Gynaecologists Anterior superior iliac spine Symphysis pubis Vertical plane

18 © Royal College of Obstetricians and Gynaecologists Pubis Ileum Ischium

19 © Royal College of Obstetricians and Gynaecologists Obturator foramen Acetabulum

20 © Royal College of Obstetricians and Gynaecologists Look at the pelvis from the front again. In the following slides, you will be shown a little more anatomy. Look at the position of the sacrotuberous and sacrospinous ligaments.

21 © Royal College of Obstetricians and Gynaecologists Sacrotuberous ligament

22 © Royal College of Obstetricians and Gynaecologists Sacrospinous ligament

23 © Royal College of Obstetricians and Gynaecologists Look at the pelvis from behind. Look at the position of the sacrotuberous and sacrospinous ligaments. These delineate the greater and lesser sciatic foraminae.

24 © Royal College of Obstetricians and Gynaecologists

25 Sacrospinous ligament

26 © Royal College of Obstetricians and Gynaecologists Sacrotuberous ligament

27 © Royal College of Obstetricians and Gynaecologists Greater sciatic foramen Lesser sciatic foramen

28 © Royal College of Obstetricians and Gynaecologists We are now going to add in some muscles. You will see piriformis from front and back. You will see obturator internus from the back.

29 © Royal College of Obstetricians and Gynaecologists Piriformis

30 © Royal College of Obstetricians and Gynaecologists Piriformis

31 © Royal College of Obstetricians and Gynaecologists Obturator internus

32 © Royal College of Obstetricians and Gynaecologists We are now going to add in blood vessels and nerves. Look at the pelvis from the front again.

33 © Royal College of Obstetricians and Gynaecologists

34

35 Internal Iliac A Common Iliac A

36 © Royal College of Obstetricians and Gynaecologists External Iliac A

37 © Royal College of Obstetricians and Gynaecologists Internal Iliac V Common Iliac V

38 © Royal College of Obstetricians and Gynaecologists The Lumbosacral Plexus

39 © Royal College of Obstetricians and Gynaecologists Sciatic nerve

40 © Royal College of Obstetricians and Gynaecologists Pudendal nerve

41 © Royal College of Obstetricians and Gynaecologists Obturator nerve

42 © Royal College of Obstetricians and Gynaecologists Look at the pelvis from the side. We will look at the muscles and ligaments on the side wall of the pelvis. You will see where the levator ani muscles originate. You will also see the critical dimensions of the pelvis.

43 © Royal College of Obstetricians and Gynaecologists

44 Sacrotuberous ligament

45 © Royal College of Obstetricians and Gynaecologists Sacrospinous ligament

46 © Royal College of Obstetricians and Gynaecologists Obturator canal

47 © Royal College of Obstetricians and Gynaecologists Obturator internus Muscle Covered by Fascia

48 © Royal College of Obstetricians and Gynaecologists Pudendal canal

49 © Royal College of Obstetricians and Gynaecologists Line of attachment of levator ani

50 © Royal College of Obstetricians and Gynaecologists Pelvic inlet Critical pelvic dimensions

51 © Royal College of Obstetricians and Gynaecologists Pelvic midplane Critical pelvic dimensions

52 © Royal College of Obstetricians and Gynaecologists Pelvic outlet Critical pelvic dimensions

53 © Royal College of Obstetricians and Gynaecologists Pelvic outlet Pelvic inlet Pelvic cavity Pubic arch FemaleMale

54 © Royal College of Obstetricians and Gynaecologists Look at the pelvis from the front again. Imagine a ‘coronal’ plane through the middle of the pelvis. You will see the rectum coming through the pelvis. You will see where the levator ani muscles originate. You will see which structures form the pelvic diaphragm.

55 © Royal College of Obstetricians and Gynaecologists Iliac crest Pelvic brim Ischial tuberosity

56 © Royal College of Obstetricians and Gynaecologists Rectum

57 © Royal College of Obstetricians and Gynaecologists Obturator Internus With Fascia

58 © Royal College of Obstetricians and Gynaecologists Levator ani Plus coccygeus Makes Pelvic diaphragm

59 © Royal College of Obstetricians and Gynaecologists There are some structures above the pelvic diaphragm. There are some structures below the pelvic diaphragm.

60 © Royal College of Obstetricians and Gynaecologists Peritoneum

61 © Royal College of Obstetricians and Gynaecologists Subperitoneal space

62 © Royal College of Obstetricians and Gynaecologists Contains: Pubocervical Trans cervical Sacrocervical Ligaments

63 © Royal College of Obstetricians and Gynaecologists Perineum everything under pelvic diaphragm

64 © Royal College of Obstetricians and Gynaecologists Ischiorectal fossae

65 © Royal College of Obstetricians and Gynaecologists Now look at the pelvis from below. Look at the layout of the bones and the ligaments. They define the pelvic outlet.

66 © Royal College of Obstetricians and Gynaecologists Obturator membrane Obturator canal

67 © Royal College of Obstetricians and Gynaecologists Pubic arch Inferior pubic ramus Ischial ramus Symphysis pubis

68 © Royal College of Obstetricians and Gynaecologists Sacrotuberous ligament Sacrum / coccyx Ischial tuberosity

69 © Royal College of Obstetricians and Gynaecologists Pelvic outlet

70 © Royal College of Obstetricians and Gynaecologists Urogenital triangle Anal triangle

71 © Royal College of Obstetricians and Gynaecologists Keep looking at the pelvis from below. Imagine the anatomy above the pelvic diaphragm. The following slides show the structures encountered as you descend through the pelvis.

72 © Royal College of Obstetricians and Gynaecologists Rectum Cervix Bladder Above the Pelvic diaphragm

73 © Royal College of Obstetricians and Gynaecologists Pubocervical ligament Above the Pelvic diaphragm

74 © Royal College of Obstetricians and Gynaecologists Transverse cervical ligament Above the Pelvic diaphragm

75 © Royal College of Obstetricians and Gynaecologists Sacrocervical ligament Above the Pelvic diaphragm

76 © Royal College of Obstetricians and Gynaecologists Levator ani: Pubococcygeus Iliococcygeus Ischiococcygeus Pelvic diaphragm Coccygeus

77 © Royal College of Obstetricians and Gynaecologists Keep looking at the pelvis from below. Imagine the anatomy as you descend below the pelvic diaphragm. The following slides show the structures encountered as you continue to descend through the pelvis.

78 © Royal College of Obstetricians and Gynaecologists Superior layer of fascia Urogenital diaphragm

79 © Royal College of Obstetricians and Gynaecologists Sphincter urethrae Urogenital diaphragm Deep transverse peroneal muscles

80 © Royal College of Obstetricians and Gynaecologists Perineal membrane

81 © Royal College of Obstetricians and Gynaecologists Clitoris & crus Structures in Superficial pouch Bulb of vestibule Vestibular glands

82 © Royal College of Obstetricians and Gynaecologists Ischiocavernosus Muscles in Superficial pouch Bulbospongiosus Supl transverse peroneal muscles

83 © Royal College of Obstetricians and Gynaecologists Perineal body

84 © Royal College of Obstetricians and Gynaecologists Keep looking at the pelvis from below. You have now reached the most superficial level.

85 © Royal College of Obstetricians and Gynaecologists Labium minus Labium majus

86 © Royal College of Obstetricians and Gynaecologists Prepuce of clitoris Mons pubis Vestibule vagina Fourchette

87 © Royal College of Obstetricians and Gynaecologists Here is the female abdomen and pelvis viewed from one side. The structures shown should now be familiar to you.

88 © Royal College of Obstetricians and Gynaecologists

89 Peritoneum

90 © Royal College of Obstetricians and Gynaecologists Pubocervical ligament Sacrocervical ligament

91 © Royal College of Obstetricians and Gynaecologists Pelvic diaphragm

92 © Royal College of Obstetricians and Gynaecologists Urogenital diaphragm

93 © Royal College of Obstetricians and Gynaecologists Here is the rectum. Look at its anatomical relations.

94 © Royal College of Obstetricians and Gynaecologists Perineal body Sacrum Anococcygeal body Rectum

95 © Royal College of Obstetricians and Gynaecologists Puborectalis Deep Superficial Subcutaneous

96 © Royal College of Obstetricians and Gynaecologists Take your fetal skull and view it from above. Note the near central position of the anterior fontanelle.

97 © Royal College of Obstetricians and Gynaecologists occiput posterior fontanelle parietal eminence saggital suture anterior fontanelle frontal bones coronal sutures lambdoid sutures

98 © Royal College of Obstetricians and Gynaecologists The following slides will demonstrate the orientation of the fetal skull as it passes through the pelvis in normal labour.

99 © Royal College of Obstetricians and Gynaecologists passenger the head flexes as the uterus contracts the head descends and engages in the pelvis the leading part approaches the ischial spines

100 © Royal College of Obstetricians and Gynaecologists passenger the occiput starts to rotate anteriorly the occiput reaches the pelvic floor (levator ani) internal rotation continues to achieve an occipito-anterior position

101 © Royal College of Obstetricians and Gynaecologists passenger the occiput clears the symphysis pubis the head extends to deliver

102 © Royal College of Obstetricians and Gynaecologists passenger the head sits on the maternal perineum

103 © Royal College of Obstetricians and Gynaecologists passenger the fetal head realigns itself with the fetal shoulders - restitution

104 © Royal College of Obstetricians and Gynaecologists passenger the shoulders contact the pelvic floor and rotate so that the bisacromial diameter lies in an anteroposterior orientation the head therefore continues to rotate - external rotation


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