ANATOMY OF FEMALE PELVIC By: Tiyas K Airlangga University Department of Child-Maternity Nursing Nursing Faculty 2010

PELVIC Solid part : Pelvic bone Soft part : Pelvic ligament & muscle

A. PELVIC BONE 2 Innominate bone : Os illium Os ischium Os pubic Sacrum Coccyx

PELVIC BONE

PELVIC BONE

PELVIC BONE

Sacrum PELVIC BONE

Tulang Coccygis PELVIC BONE

Ischium Function Support body weight (tuber ischiadica)

Fungsi os Coccygis In labor this bone extent to posterior in order to wider the pelvic outlet

Pelvic Inlet/Pelvic brim Area bordered by: Promontorium Sacrum Linea inominata Ramus Superior ossis Pubis Uper border of Symphisis pubis

Pelvic outlet Ujung bawah Sacrum Tulang Tuber Ischiadica Area bordered by: Ujung bawah Sacrum Tulang Tuber Ischiadica Sacro-coccygeal Lower border of symphisis pubis

Normal pelvic measurement Distansia Cristarum Distansia Spinarum Distansia Cristarum: 28—29 cm Distansia Spinarum: 25—26 cm

Inside Pelvic measurement Conjugata Diagonalis = 12,5—13cm Conjugata Vera = CD – (1,5—2cm) Conjugata Obstetrika = terpendek

Hodge line Hodge I: imagination line drawn from promontorium to the upper border of symphisis pubis Hodge II: parallel with hodge I measured from lower border of symphisis Hodge III: parallel with hodge II, measured from spina ischiadica Hodge IV: parallel with hodge III, measured from coccyx tip

H I H II H III H IV

B. PELVIC LIGAMENT & MUSCLE LIGAMENT connect the pelvic joint Ligament interpubic pada symphysis pubis Ligament sacro iliaca Ligament sacro-coccygeal Ligament sacro-tuberous Ligament sacro spinosus

PELVIC MUSCLE The inner aspect of the bony pelvis is covered with muscles: Above the brim --- iliacus & psoas Sidewalls ---- obturator internus & its fascia Post wall ---- pyriformis Pelvic floor ---- lavator ani & coccygeus

PELVIC MUSCLE

Conjugata Vera

Sacral promontory Left sacro-iliac joint Iliopectineal line Sacrospinous ligament L4 Symphysis pubis Left sacro-iliac joint Sacrotuberous ligament Ischial spine Sacral promontory Ischial tuberosity 48 Sacral promontory Left sacro-iliac joint Iliopectineal line Sacrospinous ligament Sacrotuberous ligament Ischial spine Symphysis pubis Ischial tuberosity

PELVIC EXAMINATION X-Ray Jangka Panggul Distansia Cristarum Distansia Spinarum Conjugata eksterna/Bouldeloque: distance between upper border symphysis pubis with prosessus spinosus lumbal 5. the normal measurement 18—20 cm Vaginal Touché

Vaginal Touché Examintion Promontorium touched/not Conjugata Vera normal/not Spina Ischiadica prominent/not Arkus pubis wide/narrow Sakrum curve/not Note: Touched Promontory usually indicated narrow pelvic Height ≤145 cm also indicated narrow pelvic

Differentiation between female and male pelvic

Pelvic Shape

PELVIC SHAPE 1-GYNECOID Typical female pelvis found in 50% of women Rounded—slightly oval inlet Straight pelvic sidewalls with roomy pelvic cavity Good sacral curve Ischial spines are not prominent Pubic arch is wide

PELVIC SHAPE 2-ANDROID Typical male pelvis found in 1/3 white women 1/6 non-white Pelvic brim is heart shaped Pelvis funnels from above downwards (convergent sidewalls) Narrow pubic arch Prominent spines

PELVIC SHAPE 3-ANTHROPOID 25% white women & 50% nonwhite Pelvic brim APD > TD Long & narrow pelvic canal with long sacrum Straight pelvic sidewalls 4-PLATYPELLOID 3% of women Pelvic brim TD >>>APD  kidney shape Sacral promontory pushed forwards

Pelvic Shape Deviation Panggul Naegele Panggul Rakhitis Panggul Skoliosis Panggul Kifosis -”- dari Samping Panggul Osteomalasia Panggul Spondilolistesis Panggul Robert

Causes of pelvic deviation Congenital: Narrow palvic Simple flat Funnel (narrow outlet) Assimilation Disease : Rachitic Osteomalasia TBC Lordosis Skoliosis Kifosis Spondilosis

Deviation impact Prolonged labor CPD (Chepalo Pelvic Disproportion) Breech presentation Infertility

POST TEST Pelvic anatomy contains of what kind of part? What can you mention about Pelvic bone? What can you mention about Pelvic ligament? What can you mention about pelvic muscle? What do you know about pelvic shape? What would happen if the pelvic is not normal in measurement?

Daftar pustaka Wyknyosastro , S., (2002) Ilmu Kebidanan. Jakarta: Yayasan Bina Pustaka Sarwono Prawiroharjo Cunningham, H. et. al., (2005) Williams Obstetrics. 22nd. New York: McGRAW-HILL Bobak, LM. & Jensen, MD., (2005) Maternity & Gynecology Care: The Nurse and The Family. 5th Ed. St. Louis: Mosby company

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