1. Ole Petter Ottersen Anatomy of the genital organs Jon Storm-Mathisen Department of Anatomy, Institute of Basic Medical Sciences & Centre for Molecular Biology and Neuroscience, University of Oslo, Norway jon.storm-mathisen@medisin.uio.no http://www.cmbn.no/group-storm-mathisen.html Per Brodal Undervisningsleder i anatomi

2. The Pelvic Region: Introduction to its Functional Anatomy Per Brodal Institutt for medisinske basalfag Universitetet i Oslo 9th Semester 2008

3. Anatomy 9th Semester  Lectures gross anatomy, histology (microscopic anatomy), embryology Intention: overviews, help to self-study  Practicals Histology assumes a certain level of theoretical knowledge (lecture given a few days in advance of the practical classes)  Gross Anatomy Demos three PBL-groups (20-25 students)

4. Demos, cont’d  Keep the group-size optimal: Meet at your scheduled time!  You are not allowed to switch to another group for convinience  Study the booklet for the Demos in advance (”Kompendium”, sold at the Akademika)

5. Assessment  Practical anatomy test (see page 41 in the Semester Booklet)  Modified OSCE - four anatomy stations Photomicrographs of histological sections Theoretical questions – functional anatomy: emphasis on clinically relevant topics

6. Some Advice About Learning Anatomy..  Always try to find the link between structure and function  You must know a fair number of names to able to communicate.. ..but don’t get lost in details  The real challenge is to establish ones own internal three-dimensional pictures  Therefore: spend ample time with prosected specimens, models and microscopic slides

7. Anatomic nomenclature used in this semester  Latin/greek – classical anatomical nomenclature  English based on latin/greek but modified grammatically  Norwegian terms  A mess??

8. Tasks of the Human Pelvis  Transition between the back and the lower extremities  Special requirements due to our upright, two-legged walking  Container of viscera – carrying some of the weight of the abdominal content  Birth channel

9. The Pelvic Girdle (bekkenet) Pelvis major (store bekken) Pelvis minor (lille bekken) Linea terminalis Iliosacral joint Symphysis Sacrum L5L5 Rauber/Kopsch: Anatomie des Menschen 1987

10. Os coxae (innominate bone, hip bone) Os ilium Lateral viewMedial view Os ischii Os pubis Foramen obturatum Facies auricularis (Iliosacral joint) Spina ischiadica Tuber ischiadicum (Ischial tuberosity) Incisura ischiadica major (greater ischiadic notch) Incisura ischiadica minor Spina ilaca posterior superior Spina iliaca anterior superior

11. 10 year Ossification of Os Coxae Wolf-Heidegger’s Atlas of Anatomy, Vol 1. Os ilium Os ischii Os pubis GROWTH ZONES CLOSE AT 16-18 YEARS Infant, 3 months

12. Ligaments and openings of the pelvis Ligamentum sacrotuberale Ligamentum sacrospinale Sacroiliac ligaments Foramen ischiadicum majus Foramen ischiadicum minus Promontorium Thieme, Atlas of Anatomy 2006

13. Landmarks – The Michaelis’ Rhomboid Spina iliaca posterior superior Spinous process of L4 Anal cleft (rima ani) Michaelis’ rhomboid Iliac crest Thieme, Atlas of Anatomy 2006

14. Characteristics of the female pelvis The female pelvis is ”designed” to give room for the exit of the ”passenger” Normal birth depends on: a)The expulsive forces b)The passages c)The passenger

15. Characteristics of the female pelvis, cont’d  Factors contributing to wider passages in the female : Larger diameters of pelvic inlet Less protruding promontory Wider subpubic angle Wider distance between the ischial tuberosities and the ischial spines Wider and lower symphysis The sacrum curves less than in the male

16. The Diameters of the Birth Canal Transverse diameter = 11 cm (intertubarvidden) Transverse diameter = 13 cm (Tverrvidden) Antero-posterior diameter = 12 cm (conjugata vera, likevidden) Antero-posterior diameter =12,5 cm (diameter recta, likevidden) Bispinous diameter = 10,5 cm (Interspinalvidden)

17. The Bony Passages Antero-posterior diameter = 12 cm (conjugata vera, likevidden) Antero-posterior diameter =12 cm (diameter recta, likevidden)

18. Pelvic Fracture? 18 Per Brodal 2008 Hamilton Bailey’s Physical Signs in Clinical Surgery

19. The fetal skull Anterior fontanelle (Bregma) Suboccipito- bregmatic diameter = 9,5 cm Biparietal diameter = 9,5 Moulding during labor Llewellyn-Jones 1999

20. Soft Parts of the Passages  Sheets of muscles and connective tissue  Several overlapping layers  Funnel-shaped  Stretched and pushed aside during childbirth  Subcutaneous and subperitoneal spaces with loose connective tissue, vessels, nerves and lymph nodes Pelvic floor muscles (levator ani) Peritoneum

21. Muscles of the pelvic floor Thieme, Atlas of Anatomy 2006 Levator ani muscle Urogenital diaphragm with sphincter muscles

22. Formation of the Birth Canal and Moulding of the Fetus During Labour Amniotic fluid Soft tissues Skeleton