Def-The Knowledge of pelvic anatomy is a great importance to the students of midwifery.

The

student should be competent enough to recognize a

normal pelvis in order to recognize deviation from normal and to refer for better management.

Function of pelvis

Adapted for child bearing

Allows movement of the body

Permits the person to site

Transmits the weight of the trunk to the leg Affords protection to pelvic organs and a lesser extent to the abdominal contents.

It is composed of four bones

Two innominate or hip bones One sacrum One coccyx

Innominate bones Each innominate bone is formed by fusion of three bones

The ilium The ischium The pubic bone

The three bones fussed at acetabulum

The ilium

It is the large flared out part of the innominate bone. Is made up of a relatively flat of bone above and part of acetabulum below. It has the following characteristics The external aspect is gently curved and has a roughened surface to which the glitter muscles of the buttock are attached. The greater part of the inner aspect is smooth and concave forming the iliac fossa. The ridge which surmounts these two surfaces is known as iliac crest, which serves for the attachment of the muscles of the abdominal wall.

 Anteriorly- the crest ends in the anterior superior iliac spine, a bony prominence which is palpable under the skin. Posteriorly- iliac crest ends in the posterior superior iliac spine. Below-the anterior superior iliac spine is another bony prominence; the anterior inferior iliac spine, while posteriorly, there is posterior inferior iliac spine. At its lower most part the illium forms the upper twofifth of the acetabulum, where it fuses with ischium and pubis.

The ischium The lowest constituent bones of the innominate bone Formed by the following parts The head forms the lowest two fifth of the acetabulum, where it fuses with the ilium and pubis. Below the acetebulum a thick buttress of bone pass down and terminates in ischial tuberosity the part which the weight of the body rest on when sitting. Passing up wards and in ward from the ischial tuberosity a small shaft of the ischium becomes continuous with the inferior ramus of the pubis so forming the public arch The ischium forms the lower boundery of the large foramen, the obturator foramen or foram ovale On its internal aspect the ischium forms the side wall of the true pelvis. Protruding in wards from its posterior edge, about 5cm above the tuberosity, is a conspicuous projection known as the ischial spine which is use to estimate the station of fetal head.

The pubis The smallest of the three bones forming the innominate bone and form the lower one fifth of the acetabulum. The right and left public bones unite with each other anteriorly at the squire shaped public bodies. They are fused by a pad of cartilage, the symphysis pubis. Below the body of the pubic, the inferior ramus passes downwards and out wards to join the ischium, so forming the upper part of pubic arch. The sacrum Is situated in the posterior part of the pelvis and consists of five fused sacral vertebrae

B. The sacrum Is situated in the posterior part of the pelvis and consists of five fused sacral vertebrae. The anterior surface is smooth, and is concave from above down wards and slightly so from side to side forming the hollow of the sacrum. The sacral alae are the widened out wings of bone on each side of the 1st sacral vertebra. Promontory of the sacrum is the center point of the upper border of the 1st sacral vertebrae which with the base of the 5th sacral vertebra, protrudes over the hollow of the sacrum. Sacral canal runs longitudinally through the center of the sacrum and opens at the level of the 5th sacral vertebra. The posterior surface for the sacrum is rough and irregular and serves for the attachment of the ligaments and muscles of the back. The sacrum articulates laterally with the ilium at sacroiliac joint and lower margin of it articulate with coccyx at sacro -coccygeal joint.

c. The coccex It is triangular in shape with its base uppermost. The 1st coccygeal vertebra articulates with lower end of the sacrum at the sacro coccygeal joint.

There are four pelvic joints

two sacro-iliac joints one symphysis pubis one sacro -coccugeel joints The sacro Iliac jonts

Are the strongest joint in the body. They join the sacrum to the ilium and thus connect the spine to the pelvis. Their main features are;The joint cavity is very small . The supporting ligaments pass from the sacrum and the fifth lumber vertebra to the ilium both anterior and posterior to the joint cavity.

Is formed at the junction of the pubic bones which are united by a pad of cartilages. It is reinforced by supporting ligaments which pass from one pubic bone to the other in front, behind, above and below the disc of cartilage.

The symphysis pubis

Is situated between the lower border of the sacrum and the upper border of the coccyx. Slight back ward and forward movement of the coccyx on the lower end of the sacrum occur normally. The back ward movement is greatly increased during labor at the time of the actual birth of the head.

The sacro- coccygeal joint

The pelvic ligaments Ligaments are the fibrous, slightly stretchy, connective tissues that hold various internal organs in place; they also bind one bone to another in joints. Each of the pelvic joints held together by ligaments. These are:pubic ligaments sacro-iliac ligament sacro-coccygeal ligaments sacro tuberous ligaments is a strong ligament passing from the posterior superior iliac spine and lateral borders of the sacrum and coccyx to the ischial tuberosity. It bridges across the greater and lesser sciatic notches

The sacro spinous ligament - passes from the side of the sacrum and coccyx across the greater sciatic notch to the ischial spine. It lies in front of the sacro- tuberous ligament. The inguinal ligament (paupers ligament) runs from the anterior superior iliac spine to the pubic tubercle forming the groin. The sacro- tuberous ligament and sacrospinous ligaments cross the sciatic notch and form the posterior wall of the pelvic out let.

The regions of the pelvis The brim of the pelvis divides the pelvis into two parts, the false and true pelvis. The false pelvis - lies above the pelvic brim and consists mainly of the iliac fossa. - It has little importance in midwifery. The true pelvis -included the pelvic brim and all the area that lies below it. - It consists of three constituent parts 1. The inlet or brim of the pelvis 2. The cavity 3. The out let The pelvic brim is round except where the sacral promontory projects in to it. It appears heart shaped because of shutting sacral prominence. It is wider transvers ely than in the anterior posterior dimension.

The regions of the pelvis The brim of the pelvis divides the pelvis into two parts, the false and true pelvis. The false pelvis - lies above the pelvic brim and consists mainly of the iliac fossa. - It has little importance in midwifery. The true pelvis -included the pelvic brim and all the area that lies below it. - It consists of three constituent parts 1. The inlet or brim of the pelvis 2. The cavity 3. The out let The pelvic brim is round except where the sacral promontory projects in to it. It appears heart shaped because of shutting sacral prominence. It is wider transvers ely than in the anterior posterior dimension.

brim is round except where the sacral promontory projects in to it. It appears heart shaped because of shutting sacral prominence. It is wider transvers ely than in the anterior posterior dimension. It is marked by 8 fixed land marks
The promontory of the sacrum the ala of the sacrum the sacro- iliac join ilio - pectineal line

The pelvic cavity Extends from the inlet above to the outlet below Formed by the hollow of the sacrum The posterior wall is deeply concave and approximately 12cm in length. The anterior wall is formed by symphysis pubis and is approximately 4cm long. The lateral walls comprise the greater sciatic notch, the internal surface of a small portion of the ilium the body the ischium and the foramen ovale.

The plane of the cavity of the pelvis is an imaginary surface which extends from the mid point of the symphis pubis in front to the junction of the 2nd and 3rd sacral vertebrae. The slope of pelvic cavity controls the speed of birth and therefore reduces sudden pressure changes on the fetal head. Ischial spine marks the mid plane of the pelvis Two outlet of the pelvis are described the anatomical and the obstetrical. The anatomical outlet

The plane of the cavity of the pelvis is an imaginary surface which extends from the mid point of the symphis pubis in front to the junction of the 2nd and 3rd sacral vertebrae. The slope of pelvic cavity controls the speed of birth and therefore reduces sudden pressure changes on the fetal head. Ischial spine marks the mid plane of the pelvis Two outlet of the pelvis are described the anatomical and the obstetrical. The anatomical outlet

The anatomy of the female Genital Organs Are made up of the external genitalia which comprise the structures of the valva, uterus, fallopian tubes and overies.

Internal genitally The vagina Is a tube (canal) which extends from the valva to the uterine cervix? It is longer in poster is wall (9cm) than anterior (7sm) The vault of the vagina is divided in to four fornices by the projection of the cervix: Anterior Posterior Two lateral fornices The posterior fornix is the largest The vaginal walls are pink in appearance and grown in to small folds known as rugae which allow the vaginal well to starch during intercourse and child birth. Structures

The Uterus Is a hollow, flattened, muscular peer- shaped organ situated between the bladder and rectum in non pregnant state. It is normally antiverted and antiflexed It measures 8 cm in length, 5cm width and 1.25cm thick. Its weight is approximately 57gm. It consists of the following parts Body or corpus comprises the upper 2/3 of the uterus Lies between the isthmus and the opening of the fallopian tubes. Cervix

- forms the lower third of the uterus and measures about 2.5cm in length. Fallopian tubes and ovaries The ovaries are paired female reproductive organs that produce the eggs (ova). They lie in the pelvic cavity on either side of the uterus, just below the opening of the fallopian tubes. They are kept in position through attachment to two ligaments. Women are born with a fixed number of immature eggs (ova), around 60,000 in number. The eggs are held in small pits in the ovaries, named ovarian follicles. Each ovum has the potential to mature and become ready for fertilization, but in actuality only about 400 ripen during the womans lifetime.Every month, several ovarian follicles begin to enlarge and the ovum inside it begins to mature, but usually only one will win the race and be released from

the ovary. The moment when the ovum is released is called ovulation. The other enlarging follicles degenerate. The enlarging ovarian follicles also produce the female reproductive hormones, oestrogen and progesterone, which are important in regulating the monthly menstrual cycle, and throughout pregnancy. After ovulation, the lining of the empty follicle grows and forms a yellow body in the ovary called the corpus luteum, which temporarily functions as a hormone-producing organ. It secretes oestrogen and progesterone for about the next 14 days. Oestrogen thickens the fatty tissues in the wall of the uterus in case pregnancy occurs. Progesterone stops further ovulation from occurring during the pregnancy. But if pregnancy does not occur within 14 days after ovulation, the corpus luteum degenerates and stops producing progesterone. As a result, the blood supply to this additional fatty tissue in the wall of the uterus is cut off, and it also degenerates and is shed through the vagina as the menstrual flow. The levels of oestrogen can then begin to rise, and the woman can ovulate again in the following month. When an ovary releases a mature ovum (ovulation), the fimbriae of the fallopian tube catch the ovum and convey it towards the uterus. The male sperm swim along the fallopian tubes, and if they find the ovum, they fertilize it .The lining of the fallopian tubes and its secretions sustain both the ovum and the sperm, encourage fertilization, and nourish the fertilized ovum until it reaches the uterus

SESSION OBJECTIVES; AT THE END OF THIS SESSION THE STUDENTS WILL BE ABLE TO ; Define the fetal skull, Describe division & landmarks of skull, Define sutures & fontanels, List out types of sutures& fontanels

-Is a bony box like cavity which contains and protects the delicate brain. It is the most important part of the fetus because It contain the delicate brain It is the least compressable part of the fetus. It the most difficult part to deliver It is the largest part of fetus

Division The fetal skill is divided in the three parts. the vault Base Face The vault is the large, dome shaped part above the imaginary line drown from below the occipital protuberance to the orbital ridges. The face; - area extending from the orbital ridges to the junction of the chin and neck. The base: - is composed of bones which are firmly united to protect the vital centers in the medulla. -Bones of the vault

called partial eminence. They are the largest of the cranial bones. Roughly square in shape and curves as they lie over the parietal lobes of the brain. Two frontal bones form the forehead or sinciout. Their ossification centers are named frontal eminencel or frontal bosses. These in to a single bone by 8 years Coronal suture- separate frontal bones and parietal bones, passing from one temple to the other.

Is an area of memberane between the skull bones where ossification has not been completed. Overlap during the process of molding at the time of birth. Types of sutures Lambdoidal suture separate the aceipital bone from the two parietal bones. - It is shaped like the Greek letter Lambde () Sagital suture- runs b/n the two parietal bones and runs from the anterior fontanels in front to the posterior fontanelle behind. Frontal suture- run b/n the frontal bones, extending from the root of nose below, to the anterior fontanel above.

 Coronal

suture- separate frontal bones and parietal bones, passing from one temple to the other.

Are areas where two or more suture meet. There are 6 fontanels, but only two are of great obstetrical importance. The anterior fontanel or bregma:-is formed where the sagital, coronal and frontal sutures meet -It is diamond in shape. -It is much larger than posterior fontanel Pulsation of cerebral vessels can be felt through it. -Normally closes at 18 months of age

occurs at the junction of the lambdoidal and sagittal sutures It is very small and triangular in shape. It normally closes by 6 weeks of age.

Vertex is bounded by the anterior and posterior fontanels and parietal eminences Occiput lies b/n the foramen magnum and posterior fontanel - Sub occipital region lie below occipital protuberance Sinciput (brow) extends from the anterior fontanel and coronal suture to the orbital ridge Face extends from the orbital ridges and the root of the nose to the junctions of the chin and neck. The point b/n the eye brow is known as the glabella.

REGINS OF THE SKULL

occipput Vertex sinciput Posterior fontanel (Lambda) glabella Mentum (chin) Anterior fontanel (Bregma) Occipital protuberance

- The diameters of the skulls are transverse, and anterioposterior (longitudinal). 1. Transverse Diameters Biparietal diameter- between the parietal eminences and measures 9.5cm - Engagement occur as this diameter pass through the plane of the brim Bitemporal diameter runs b/n the two extremities of the coronal sutures and is 8.2cm in length.

Biacromial diameter extends b/n the acromial processes of the scapulae, and measures 11.5cm. Bi- trchenteric diameter runs b/n the greater trochanters of the femora, and measures 9cm in length.

Suboccipito bregmatic- measured from below the occiput to the bregma. It measures 9.5cm Suboccipito frontal measured from below occipital protuberance to the center of the frontal sutures, and measures 10cm Occipito frontal measured b/n the occiput and the glabella. It is 11.5 cm in length

Mento-vertical measured from the point of the chin to the highest point on the vertex slightly nearer to posterior fontanel than anterior, and it measures 13.5cm. Submento vertical measured from the point where the chin joins the neck to the highest point on the vertex. It is 11.5 cm in length bSubmento-bregmatic - measure from the point where the chin joins the neck to the center of the bregma and measures 9.5 cm

are five layers of scalp tissue 1) The skin -is containing hairs, (outer covering) 2) subcutaneous tissue 3) muscle layer 4) connective tissue 5) periosteum which covers the skull bones

Two conditions involving these tissues can arise during labour and both cause a swelling on the infants head; a) Caput succedaneum is an edematous swelling of the subcutaneous tissues of the fetal skull -It occurs in early rupture of membranes in the 1st stage of labor because there is no bag of fore waters to take the pressure of dilating cervix off the fetal head.
a)

It is present at the birth It may lie over a suture line It pits on pressure It disappears with in 24 - 48hrs No treatment required unless it is excessive

b) Cephelo hematoma this swelling is due to bleeding the skull bone and periosteurn which covers it. -The bleeding occurs because of friction between the skill bones and the periosteum. Characteristics It is not present at birth, but appears 23 days after wards.

The swelling is limited by the periosteum and can there fore only occur over the bone, although it may be bilateral It can not lie over a suture. the hematoma increase in size over a number of days.

It is the change which takes place in the shape of the fetal skull as it passes through the birth canal. As the head descends through the pelvis, in response to the down ward pressure of uterine contractions, the skull bones overlap.

Molding takes place gradually with out being prolonged; the cerebral membranes and blood vessels are not likely to be damaged. -The dangerous types of molding are : Excessive molding:- Occurs when labor is prolonged or where the skull bones are not completely ossified ( as in prematurely

Upward molding: - Occurs when the baby delivers in the persistent occipito posterior position and the after coming head of the breach passes through the pelvis. It can result in intracranial hemorrhage.

 Rapid

moulding: - Occurs in a precipitate delivery, and during the delivery of the head of breach presentation. Results from rapid compression and decompression of the head which can rupture the cerebral membrane.

 The

infant subjected to severe molding will suffer some degree of asphyxia at birth as a result of intracranial compression, there fore they should be seen by pediatrician and get vit .K (0.5 mg/kg)

READING ASSIGNMENT; ANATOMY OF MALE REPRODUCTIVE ORGAN

LET ME SAY; READ MORE,KNOW MORE,SCORE MORE!!!

Prepared by;ASMARE.T, MAY 2O13