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THE PELVIS
contains :
the lower part of the alimentary canal,
the urinary bladder, parts of the
urethra
parts of the reproductive system
Bones of Pelvis
Formed by two hip bones at the front
and sides, and by the sacrum and
coccyx behind
The bony pelvis is divided into two
parts:
1. The true (lesser) pelvis
2. The false (greater) pelvis
The Lesser Pelvis
Has :
an upper pelvis aperture
a cavity
a lower aperture
Upper Pelvic Aperture =
Pelvic Inlet = Pelvic Brim
This plane scopes downward and forward
Passing from promontorium to the pubic
symphysis
Forms an angle about 48 degrees with
horizontal
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Diameters:
1. Antero posterior = conjugate diameter
passes from the upper margin of the
pubis symphysis to the middle of the
sacral promontory
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2. The Obstetrical Conjugate Diameter
From the back of the pubic symphysis to the
sacral promontory
Slightly shorter than the antero posterior
3.The Diagonal Conjugate Diameter
Only diameter that can be measured
pervaginam
The distance between the lower margin of the
pubic symphysis and the sacral promontory
When the sacral promontory cannot be
reached pervaginam, the antero posterior
diameter of the inlet is considered to be
adequat for successful parturition
Spina Ischiadica
Lower Pelvic Aperture
Diamond shaped
Extends from the arcuate pubic ligament
and the inferior rami of the pubic in front
to the tip of the coccyx behind
Bounded laterally by the ischial
tuberosities an the sacrotuberous
ligaments
Diameters
1. The antero posterior or conjugate
diameter passes from the lower margin of
the pubic symphysis to the tip of the
coccyx
2. The tranverse diameter, extends between
the ischial tuborosities
3. The oblique diameter
extends from the junction of the ischial
and pubic rami of one side to the point of
crossing of the sacrotuberous and
sacrospinous ligaments of the other side
Planes of the outlet forms an angle of about
10 to is degrees with the horizontal
Classification of pelvis
The shape and size of inlet are
important to parturition
Four main shapes are recognized
Subdivided into :
-Two lateral walls
-A posterior walls
-A floor
Lateral walls
Bony framework: the part of the hip
bone below the terminal line
Pelvic surface is covered by the
obturator internus muscle and the
obturator fascia
In the posterior part, it is crossed by
the ureter and in it anterior part by the
round ligament (teres)
At the junction of the lateral and posterior
walls, a bony framework is lacking
The space between hipbone and sacrum
is filled by the sacrotuberous and
sacrospinosus ligaments
The sacrospinosum ligament divide the
space into :
- the greater sciatic foramina
- the lasser sciatic foramina
Posterior walls is formed by:
Sacrum and coccyx
The lateral part which are covered by
the piriformis and coccygeus
The median sacral artery and
symphathetic trunks pass downward
on the sacrum
Floor of the pelvis
Comprises the structure that give
support to the abdominal and the
pelvic viscera
Chiefly by:
- peritoneum above
- pelvic diaphragm below
The Peritoneum
Reaches the lowest level
Reflected from the rectum to the urinary
bladder in the male to from the rectovecal
pouch, or to uterus and vagina in the female
to form the recto-uterine pouch
The connective tissue between peritoneum
and the pelvic diaphragm contain blood
vessels, nerve plexus, lower part of the
urethra and the terminal part of the ductus
deferens
The lower parts of the floor of the
pelvis has two openings
Both in the median plane
The posterior, for the rectum pass
through the pelvic diaphragm
The anterior, for the urethra in the
male for the urethra and vagina in the
female
The Pelvic Diaphragm
Consist of:
1. The levator ani muscle
the more important muscles of the pelvic
diaphragm
2. Coccygeus (ischiococcygeus) muscle the
relatively un important
Levator ani
Variable in thickness and in strength
Lie almost horizontally in the floor of the
pelvis
Between the posterior part and left crura in
front, there is urogenital hiatus
The hiatus transmits:
-vagina (female)
- urethra and rectum (both sex)
These organs lie immediately about these
muscles, so receive important support from
this muscles
The Levator Ani
Consist of three parts:
1. Iliococcygeus
2. Pubococcygeus
3. Puborectalis
Designated according to the direction
and attachment of their fibers
The Iliococcygeus
Most posterior part of the levator ani
It rised from the pelvic aspect of the
ischial spine and from the tendinous arch
of the levator ani behind the level of the
obturator canal
Its fibers pass obliquely and are inserted
into the sides of the coccyx and into the
anococcygeal ligament
The Pubococcygeus
The main part of the levator ani
Arises from the back of the body of the
pubis and runs backward in a sagittal plane
toward the coccyx
It has several insertion
1. In the male
it runs backward, some of its more
medial fibers are inserted into the
prostate
2. In the female
some of its medial fibers are inserted
into the urethra and vagina (pubovaginalis)
3. Other
a. Together with fibers from the
contralateral muscle, encircle the
urethra and vagina (spinchter
vagina)
b. Inserted into the perineal body and
few continue and a few continue to
the walls of the anal canal
The most lateral of the
pubococcygeus