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1 Xiu Xiu Jiang Ai Xia Liu Telephone (office): Women’s Hospital, School of Medicine, Zhejiang University
2 Anatomy of the Female Reproductive System Jiang Xiu XiuWomen’s hospital, School of Medicine, Zhejiang University
5 Pelvis A basin-shaped ring Latin word “basin” To bear the weight of the upper body when sitting and standingTo contain and protect the pelvic organs"Pelvis" is the Latin word for a "basin" and the pelvis thus got its name from its shape . Since pelvis is a bone structure, it is very strong and stable. Generally, its function is to bear the weight of the upper body when sitting and standing; to contain and protect the pelvic organs, for example, bladder, uterus and rectum.
8 Pelvis child-bearing and child-birth function in women. Female Male "Pelvis" is the Latin word for a "basin" and the pelvis thus got its name from its shape .In women the pelvis is wider and has a larger capacity than in men, a condition that reflects the child-bearing function in women.Female Male
9 Key factors of bony pelvis related to child-birthSizeShapeJoint (movement )Ligament (relaxation)
10 Anatomy of the Bony Pelvis BonesJointsLigamentsThree planes of the pelvisTypes of the female pelvis
16 Joints Symphysis pubis Greek word “growing together” Absorb shock during walking.Delivery of baby.gap of the symphysis pubisnon-pregnant: 4-5mmPregnant: less than 9mm
17 Joints Diastasis of the symphysis pubis symphysiotomy result from: rapid birth; forceps delivery; prenatal;symptom:pelvic girdle pain--- involving 45% of all pregnant women and 25% of all women postpartumprenatalsymphysiotomy
19 Ligaments Sacrospinous ligament Extend from the lateral border of the sacrum and coccyx to the ischial spineA thin, triangular ligamentWith sacrotuberous ligament, Closes off the greater sciatic notch to form the greater sciatic foramen and closes off the lesser sciatic notch to form the lesser sciatic foramenIts main function is to prevent posterior rotation of the ilium with respect to the sacrumWhen pelvic ligaments and connective tissue supports are severally attenuated or absent in women, the sacrospinous ligament provides a consistently strong site for fixation of the vaginal apex, so called sacrospinous ligament suspension, in which the vaginal apex is suspended posteriorly and laterally to the ligament on either side or both sides.
20 Ligaments Sacrospinous ligament sacrospinous ligament suspension Functionto prevent posterior rotation of the ilium with respect to the sacrumFixation site for pelvic organ prolapsesacrospinous ligament suspensionthe vaginal apex is suspended posteriorly and laterally to the ligament on either side or both sidesIts main function is to prevent posterior rotation of the ilium with respect to the sacrumWhen pelvic ligaments and connective tissue supports are severally attenuated or absent in women, the sacrospinous ligament provides a consistently strong site for fixation of the vaginal apex, so called sacrospinous ligament suspension, in which the vaginal apex is suspended posteriorly and laterally to the ligament on either side or both sides.
21 Ligaments Sacrotuberous ligament Extend from the posterior aspect of the lower 3 sacral vertebrae to the ischial tuberosityIt is flat, and triangular in form; narrower in the middle than at the ends.
22 Boundary of pelvis Border line posterior upper border of sacral promontorylateraliliopectineal lineanteriorupper border of pubis
23 Boundary of pelvis False pelvis ( pelvis major ) The female bony pelvis is divided into:False pelvis ( pelvis major )---above the border line and has no obstetric importance.True pelvis ( pelvis minor )---below the border line and related to the child -birthThe bone delivery canal of childbirth
25 Planes of True Pelvis pelvic inlet is heart-shape, . posteriorly bounded by. posteriorlyupper border of sacral promontory. laterally:iliopectineal line. anteriorly:upper border of pubisanteroposterior about 11cm.transverse about 13cmoblique about 12.75cm
26 Planes of True Pelvis Mid-cavity It is a segment, the boundaries of which are:the roof is the plane of pelvic inlet,the floor is the plane of the plane of pelvic outlet,anterior - the shorter symphysis pubis,posterior - the longer sacrum.Interspinous diameter = 10 cmbetween the tips of ischial spines.
27 Planes of True PelvisPelvic outlet: 2 triangular planes with 1 base which is the intertuberous diameterAnterior sagittal plane:apex - the lower border of the symphysis pubis.laterally: the ischiopubic archPosterior sagittal plane:apex - the tip of the coccyx.Laterally - sacrotuberous ligamentTwo intersecting triangle， It is lozenge-shaped
28 Diameters of pelvic outlet Planes of True PelvisDiameters of pelvic outletAntero-posterior diameter =11.5cmfrom Sacro-coccygeal joint to the lower border of symphysis pubis.Transverse diameters (Bituberous diameter) = 9 cmbetween the inner aspects of the ischial tuberosities.Anterior sagittal diameter = 6 cmfrom the lower border of the symphysis pubis to the centre of the bituberous diameter.Posterior sagittal diameter = 8.5 cmfrom Sacro-coccygeal joint to the centre of the bituberous diameter.
29 Caldwell- Moloy Classification of Pelvic Types (1933) Four types of female pelves were described. Actually, the majority of pelvis are mixed types.
30 Gynaecoid pelvis It is the normal female type. Inlet is slightly transverse oval.Sacrum is wide with average concavity and inclination.Side walls are straight with blunt ischial spines.Sacro-sciatic notch is wide.Subpubic angle is o.The gynaecoid pelvis is the so-called normal female pelvis. Its inlet is either slightly oval, with a greater transverse diameter, or round. The interior walls are straight, the subpubic arch wide, the sacrum shows an average to backward inclination, and the greater sciatic notch is well rounded. Because this type is spacious and well proportioned there is little or no difficulty in the birth process. Caldwell and his co-workers found gynaecoid pelves in about 50 per cent of specimens.Fig: White lines in the diagrams at right show the greatest diameters of the pelves at left.Ideal shape, best chances for normal vaginal delivery.
31 Anthropoid pelvis It is ape-like type. All anteroposterior diameters are long.All transverse diameters are short.Sacrum is long and narrow.Sacro-sciatic notch is wide.Subpubic angle is narrow (<900 )prominent ischial spinesis a female pelvis with masculine features, including a wedge or heart shaped inlet caused by a prominent sacrum and a triangular anterior segment. The reduced pelvis outlet often causes problems during child birth. In 1939 Caldwell found this type in one third of white women and one sixth in non-white women.
32 Android pelvis It is a male type. Inlet is triangular or heart-shaped with anterior narrow apex.Side walls are converging (funnel pelvis)Projecting ischial spines.Sacro-sciatic notch is narrow.Subpubic angle is narrow <90oThe anthropoid pelvis is characterized by an oval shape with a greater anteroposterior diameter. It has straight walls, a small subpubic arch, and large sacrosciatic notches. The sciatic spines are placed widely apart and the sacrum is usually straight resulting in deep non-obstructed pelvis. Caldwell found this type in one quarter of white women and almost half of non-white women.
33 Platypelloid pelvis It is a flat female type. All anteroposterior diameters are short.All transverse diameters are long.Sacro-sciatic notch is narrow.Subpubic angle is wideThe platypelloid pelvis has a transversally wide, flattened shape, is wide anteriorly, greater sciatic notches of male type, and has a short sacrum that curves inwards reducing the diameters of the lower pelvis. This is similar to the rachitic pelvis where the softened bones widen laterally because of the weight from the upper body resulting in a reduced anteroposterior diameter. Giving birth with this type of pelvis is associated with problems. Less than 3 per cent of women have this pelvis type.
35 Pelvic floorThe tissues closing down the pelvic outlet (muscles and fasciae)Function- providing support for pelvic organs, e.g. the bladder, rectum, the uterus.- maintenance of continenceAnterior part (urogenital triangle)urethra and vagina pass throughPosterior part (anal triangle)rectum pass through
37 Pelvic floor Inner layer (pelvic diaphragm 盆膈) the main support of the pelvic floorformed by the levator ani and coccygenus muscles and covering fasciae.Levator ani: （肛提肌)pubococcygenus (耻尾肌),iliococcygenus (髂尾肌),puborectalis (坐尾肌)
39 Levator ani Pubococcygenus (PC ) Iliococcygenus (IC) -a hammock-like muscle-stretches from the pubic bone to the coccyx (tail bone)-controls urine flow and position the baby's head during childbirth.Iliococcygenus (IC)- arises from the ischial spine, super ramus of the pubis, and is attached to the coccyx- Help for vaginal contractionPuborectalis (PR) sphincter ani externus- arise from the lower part of the symphysis pubis,and the superior fascia of the urogenital diaphragm , meet with the corresponding fibers of the opposite side around the lower part of the rectum, and form for it a strong sling.- Relaxation reduces the angle between rectum and anus, allowing defecation in conjunction with relaxation of the internal and external sphincters.
40 Pelvic floorPerineumgeneral conception: the tissues closing down the pelvic outletClinical conception: the tissues between vaginal and anus.- thickness: 3-4cm- the outlayer support for pelvic floor
41 SUMMARY Bones Joints Ligaments planes of the pelvis Types of the female pelvisPelvice floor