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OBG - PRACTICAL Female Pelvis

Functions
FEMALE PELVIS.5 To allow movements of the body.

Pelvis transmits the weight of the trunk to the leg.

.‫اﻟﺤﻮض اﻟﺮﺟﺎل‬ Protects pelvic organs.

Sacrum transmits the cauda equina and distributes the nerves to the various parts of.
the body

Adopted for child bearing in female.

‫اﻟﻣﮭﺎم‬
‫ ﻟﻠﺳﻣﺎح ﺑﺣرﻛﺎت اﻟﺟﺳم‬.
‫ﯾﻧﻘل اﻟﺣوض وزن اﻟﺟذع إﻟﻰ اﻟﺳﺎق‬
‫ ﯾﺣﻣﻲ أﻋﺿﺎء اﻟﺣوض‬.
‫ﯾﻧﻘل اﻟﺻﻘر ذﯾل اﻟﻔرس وﯾوزع اﻷﻋﺻﺎب إﻟﻰ أﺟزاء اﻟﺟﺳم اﻟﻣﺧﺗﻠﻔﺔ‬
‫ ﺗﻌﺗﻣد ﻋﻠﻰ اﻹﻧﺟﺎب ﻓﻲ اﻷﻧﺛﻰ‬.

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Bony Pelvis Bony Pelvis

‫ اﺛﻧﯾن ﻣن اﻟﻠطﺧﺎت أو‬.I ‫ اﺛﻧﯾن ﻣن اﻟﻠطﺧﺎت أو‬.I

‫ﻋظﺎم اﻟورك‬ I. Two innominate or ‫ﻋظﺎم اﻟورك‬ I. Two innominate or
.‫ اﻟﻌﺟز‬.II .‫ اﻟﻌﺟز‬.II
.‫ اﻟﻌﺻﻌص‬.‫ﺛﺎﻟﺛﺎ‬ hip bones .‫ اﻟﻌﺻﻌص‬.‫ﺛﺎﻟﺛﺎ‬ hip bones

.II. Sacrum .II. Sacrum

III. Coccyx.
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Innominate bones a.ilium

Is a large flared out part ●

Each of these bones composed When hand is placed on ●

of ilium it rest on Iliac
three parts
‫ﻛل ﻣن ھذه اﻟﻌظﺎم ﺗﺗﻛون ﻣن‬ Ilium ●
creast ‫ﺟزء ﻛﺑﯾر ﻣﺷﺗﻌل‬
‫ﺛﻼﺛﺔ أﺟزاء‬ Concave anterior surface ●
‫ﻋﻧدﻣﺎ ﺗوﺿﻊ اﻟﯾد ﻋﻠﻰ اﻟﺣرﻗﻔﺔ ﻓﺈﻧﮭﺎ ﺗﺳﺗﻘر‬
‫ﺣرﻗﻔﺔ‬ Ischium ● ‫ﻋﻠﻰ ﻛرﯾﺎت اﻹﻟﯾﺎك‬
is called iliac fossa
‫اﻻﺳﻛﯾم‬ Pubic bone ● ‫ﯾﺳﻣﻰ اﻟﺳطﺢ اﻷﻣﺎﻣﻲ اﻟﻣﻘﻌر ﺑﺎﻟﺣﻔرة اﻟﺣرﻗﻔﯾﺔ‬
‫ﻋظم اﻟﻌﺎﻧﺔ‬

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b.Ischium

Is a thick lower part •

Has a large prominence known •
as ischial tuberosity on which
body rests on while sitting
It has a inward projection
called ischial spine helps to
estimate the station of fetal
head in labour
‫ﺳﻣﯾك‬ ‫ھو ﺟزء ﺳﻔﻠﻲ‬
• ‫اﻟﺣدﺑﺔ‬ ‫ﻟﮫ ﻣﻛﺎﻧﺔ ﺑﺎرزة ُﺗﻌرف ﺑﺎﺳم‬
‫اﻹﺳﻛﯾﺔ اﻟﺗﻲ ﯾرﺗﻛز ﻋﻠﯾﮭﺎ اﻟﺟﺳم أﺛﻧﺎء‬
‫اﻟﺟﻠوس‬
‫ﻟﮫ ﻧﺗوء داﺧﻠﻲ ﯾﺳﻣﻰ اﻟﻌﻣود اﻟﻔﻘري‬
‫اﻹﺳﻛﻲ ﯾﺳﺎﻋد ﻋﻠﻰ ﺗﻘدﯾر ﻣوﻗﻊ رأس‬
‫اﻟﺟﻧﯾن ﻓﻲ اﻟﻣﺧﺎض‬
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c. Pubic bones
.Forms anterior part of the pelvis •
Has a body and two oar-like •
projections,the superior ramus and
.inferior ramus
.‫ﯾﺷﻛل اﻟﺟزء اﻷﻣﺎﻣﻲ ﻣن اﻟﺣوض‬
Two pubic bones join at symphysis pubis •
Space enclosed by body of the pubic •
‫ﻟﮫ ﺟﺳم وإﺳﻘﺎطﺎن ﯾﺷﺑﮭﺎن‬
bone, rami and ischium is called the ‫ اﻟﻔرع اﻟﻌﻠوي واﻟﻔرع‬، ‫اﻟﻣﺟذاف‬
.obturator foramen .‫اﻟﺳﻔﻠﻲ‬
Innominate bone contain a deep cup like •
projection(Acetabulam) to receive head ‫اﺛﻧﯾن ﻣن ﻋظﺎم اﻟﻌﺎﻧﺔ ﺗﻧﺿم إﻟﻰ ارﺗﻔﺎق‬
.of the femur ‫اﻟﻌﺎﻧﺔ‬
‫ﯾُطﻠق ﻋﻠﻰ اﻟﻔراغ اﻟﻣﺣﺎط ﺑﺟﺳم ﻋظم‬
.‫اﻟﻌﺎﻧﺔ واﻟراﻣﻲ واﻹﺳك اﻟﺛﻘب اﻟﺳدّي‬
‫ﯾﺣﺗوي اﻟﻌظم اﻟﻣﺗﻘﻠب ﻋﻠﻰ ﻛوب ﻋﻣﯾق ﻣﺛل اﻹﺳﻘﺎط‬
.‫( ﻻﺳﺗﻘﺑﺎل رأس ﻋظم اﻟﻔﺧذ‬Acetabulam)

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Concave anterior surface is •

II.Sacrum called hollow of the sacrum

Is a wedge shaped bone consisting of five fused • Laterally forms ala or wing •
of the sacrum
Vertebrae. Upper border is called sacral promontry Four pairs of Holes or •
foramina pierce the sacrum
‫ھو ﻋظم إﺳﻔﯾﻧﻲ اﻟﺷﻛل ﯾﺗﻛون ﻣن ﺧﻣس‬ and through this nerves
‫ ﯾﺳﻣﻰ اﻟﺣد اﻟﻌﻠوي اﻟرﻋن‬.‫ﻓﻘرات ﻣدﻣﺟﺔ‬ from cauda equina enters
.pelvic organs
‫اﻟﻌﺟزي‬ ‫ﯾﺳﻣﻰ اﻟﺳطﺢ اﻷﻣﺎﻣﻲ اﻟﻣﻘﻌر أﺟوف‬
‫اﻟﻌﺟز‬
‫ﺗﺷﻛل ﻓﻲ وﻗت ﻻﺣق ﻋﻼء أو ﺟﻧﺎح اﻟﻌﺟز‬
‫أرﺑﻌﺔ أزواج ﻣن اﻟﺛﻘوب أو اﻟﺛﻘوب ﺗﺧﺗرق‬
‫اﻟﻌﺟز وﻣن ﺧﻼل ھذه اﻷﻋﺻﺎب ﻣن ذﻧب‬
.‫اﻟﻔرس ﺗدﺧل أﻋﺿﺎء اﻟﺣوض‬
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III. Coccyx
Consists of four fused • Pelvic joints
vertebrae, forming a Symphysis pubis(1)………….formed at the junction of pubic bones.1

small triangular bone Sacro iliac joint(2)……………join the sacrum to ilium. Is a.2
Strongest joint in the body

‫ﯾﺗﻛون ﻣن أرﺑﻊ ﻓﻘرات‬ Sacrococcygeal joint(1)…….base of the coccyx articulates with the.3
.tip of the sacrum
‫ﻣﻠﺗﺻﻘﺔ ﻣﻛوﻧﺔ ﻋظم ﻣﺛﻠث‬
‫ ﯾﺗﻛون ﻋﻧد ﺗﻘﺎطﻊ ﻋظﺎم اﻟﻌﺎﻧﺔ‬.………… (1) ‫ ﺗﺿﺧم اﻟﻌﺎﻧﺔ‬.1
‫ﺻﻐﯾر‬
‫ ﯾﻧﺿم إﻟﻰ اﻟﻌﺟز‬.................. (2) ‫ اﻟﻣﻔﺻل اﻟﺣرﻗﻔﻲ اﻟﺣرﻗﻔﻲ‬.2
‫ ھو أﻗوى ﻣﻔﺻل ﻓﻲ اﻟﺟﺳم‬.‫اﻟﺣرﻗﻔﻲ‬
.‫ ﻗﺎﻋدة اﻟﻌﺻﻌص ﺗﺗﻣﻔﺻل ﻣﻊ طرف اﻟﻌﺟز‬.…… (1) ‫ ﻣﻔﺻل اﻟﻌﺻﻌص‬.3

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Pelvic ligaments
Interpubic ligaments at the symphysis pubis(1).1
Sacroiliac ligaments(2)…….sacrum + ilium.2
Sacrococcygeal ligaments(1)……sacrum + coccyx.3
Sacrotuberous ligaments(2)….sacrum + ischial tuberosity.4
Sacrospinous ligaments(2)…….sacrum + ischial spine.5

(1) ‫ اﻷرﺑطﺔ ﺑﯾن اﻟﻌﺎﻧﺔ ﻋﻧد اﻻرﺗﻔﺎق اﻟﻌﺎﻧﻲ‬-1

…… (2) ‫ اﻷرﺑطﺔ اﻟﺣرﻗﻔﯾﺔ‬.2

…… (2) ‫ اﻷرﺑطﺔ اﻟﻌﻛﺳﯾﺔ اﻟﺷوﻛﯾﺔ‬.5
‫ اﻟﻌﺻﻌص‬+ ‫ اﻟﻌﺟز‬...... (1) ‫ اﻷرﺑطﺔ اﻟﻌﺻﻌﺻﯾﺔ‬.3

…(2) ‫ اﻷرﺑطﺔ اﻟﺣدﯾﺔ‬.4

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True pelvis False pelvis

Is a part situated below the • Is a part situated above ●
pelvic brim the pelvic brim
Bony canal through which the •
Includes flarredout ●
.fetus must pass during birth
portion of the iliac bones
It has brim,cavity and outlet •

‫ھو ﺟزء ﯾﻘﻊ أﺳﻔل ﺣﺎﻓﺔ‬

‫اﻟﺣوض‬
‫ھو ﺟزء ﯾﻘﻊ ﻓوق ﺣﺎﻓﺔ اﻟﺣوض‬
‫اﻟﻘﻧﺎة اﻟﻌظﻣﯾﺔ اﻟﺗﻲ ﯾﺟب أن‬
‫ﯾﻣر اﻟﺟﻧﯾن ﻣن ﺧﻼﻟﮭﺎ أﺛﻧﺎء‬
‫ﯾﺷﻣل اﻟﺟزء اﻟﻣﺗوھﺞ ﻣن ﻋظﺎم اﻟﺣرﻗﻔﻲ‬
.‫اﻟوﻻدة‬
‫ ﺗﺟوﯾف وﻣﺧرج‬، ‫ﻟﮭﺎ ﺣﺎﻓﺔ‬

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DIVISION IN TRUE PELVIS

Brim is round except where •

.sacral promontry projects into it

Cavity extends from brim above •
to the outlet below. circular in
shape and depth is about 4cm
.Outlet is present below the cavity •

.‫أﺳﻧﺎﻧﮭﺎ ﻣﺳﺗدﯾرة إﻻ إذا ﻛﺎﻧت اﻟﻧﺗوءات اﻟﻣﻘدﺳﺔ ﻣوﺟودة ﻓﯾﮭﺎ‬

.‫ﯾﻣﺗد اﻟﺗﺟوﯾف ﻣن اﻟﺣﺎﻓﺔ أﻋﻼه إﻟﻰ اﻟﻣﺧرج أدﻧﺎه‬
‫ ﺳم‬4 ‫داﺋري اﻟﺷﻛل واﻟﻌﻣق ﺣواﻟﻲ‬
.‫ﻣﻧﻔذ ﻣوﺟود أﺳﻔل اﻟﺗﺟوﯾف‬
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TYPES OF PELVIS Features of the four types of pelvis

Gynaecoid pelvis.1
Is ideal for child bearing ●

Brim is round in shape ●

Has generous fore pelvis, straight sidewalls, shallow cavity with a ●

broad ,well curved sacrum, ischial spines are blunt
.Present in 50% of women ●
‫ اﻟﺣوض اﻟﻧﺳﺎﺋﻲ‬-1
‫ﻣﺛﺎﻟﯾﺔ ﻟﻺﻧﺟﺎب‬
‫ﺣﺎﻓﺔ ﻣﺳﺗدﯾرة اﻟﺷﻛل‬
‫ﯾﺗﻣﯾز ﺑﺣوض أﻣﺎﻣﻲ واﺳﻊ وﺟدران ﺟﺎﻧﺑﯾﺔ ﻣﺳﺗﻘﯾﻣﺔ وﺗﺟوﯾف ﺿﺣل ﻣﻊ ﻋﺟز‬
‫ ﻛﻣﺎ أن اﻟﻌﻣود اﻟﻔﻘري اﻹﺳﻛﻲ ﻏﯾر ﺣﺎد‬، ‫ﻋرﯾض ﻣﻧﺣﻧﻲ ﺟﯾ ًدا‬
.‫ ﻣن اﻟﻧﺳﺎء‬٪50 ‫ﻣوﺟود ﻓﻲ‬

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Anthropoid pelvis.3
Android pelvis/Male pelvis.2 Long oval brim in which anteroposterior diameter is longer than ●
Resembles male pelvis ●
.transverse
.Brim is heart shaped ●
.Seen in tall women with broad shoulders ●
.Seen in 20% of women. Normal vaginal delivery is difficult ●

.Normal delivery may be possible ●

‫ ذﻛر اﻟﺣوض‬/ ‫ اﻟﺣوض اﻷﻧدروﯾد‬-2
‫ﯾﺷﺑﮫ ﺣوض اﻟذﻛور‬ .Seen in 25% of women ●
.‫اﻟﺣﺎﻓﺔ ﻋﻠﻰ ﺷﻛل ﻗﻠب‬ ‫ ﺣوض أﻧﺛروﺑوﯾد‬-3
‫ اﻟوﻻدة اﻟﻣﮭﺑﻠﯾﺔ‬.‫ ﻣن اﻟﻧﺳﺎء‬٪20 ‫ﺷوھد ﻓﻲ‬ ‫ﺣﺎﻓﺔ ﺑﯾﺿﺎوﯾﺔ طوﯾﻠﺔ ﯾﻛون ﻓﯾﮭﺎ اﻟﻘطر اﻷﻣﺎﻣﻲ‬
.‫اﻟطﺑﯾﻌﯾﺔ ﺻﻌﺑﺔ‬ .‫اﻟﺧﻠﻔﻲ أطول ﻣن اﻟﻣﺳﺗﻌرض‬
.‫ﺷوھد ﻓﻲ ﻧﺳﺎء طوﯾل اﻟﻘﺎﻣﺔ ﻣﻊ أﻛﺗﺎف ﻋرﯾﺿﺔ‬
.‫ﻗد ﯾﻛون ﻣن اﻟﻣﻣﻛن اﻟوﻻدة اﻟطﺑﯾﻌﯾﺔ‬
.‫ ﻣن اﻟﻧﺳﺎء‬٪25 ‫ﺷوھد ﻓﻲ‬
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The pelvic brim ‫ﯾﺟب أن ﺗﻛون اﻟﻘﺎﺑﻼت ﻋﻠﻰ دراﯾﺔ‬

Platypelloid pelvis/Flat pelvis.4 ‫ﺑﺎﻟﻧﻘﺎط اﻟﺛﺎﺑﺗﺔ ﻓﻲ اﻟﺣﺎﻓﺔ اﻟﻣﻌروﻓﺔ‬
Has a kidney shaped brim ● Midwives need to be familiar with • .‫ﺑﺎﺳم اﻟﻌﻼﻣﺎت اﻷرﺿﯾﺔ‬
the fixed points in the brim known (1) ‫رﻋن ﻋﺟزي‬
.as land marks
Normal vaginal delivery may be possible ● (2) ‫ﻋﻼء اﻟﻌﺟز أو اﻟﺟﻧﺎح‬
sacral promontory (1) •
sacral ala or wing (2) •
(3) ‫اﻟﻣﻔﺻل اﻟﻌﺟزي اﻟﺣرﻗﻔﻲ‬
Seen in 5% of women ● Sacroiliac joint (3) •
‫ وھو اﻟﺣﺎﻓﺔ‬، ‫اﻟﺧط اﻹﻟﯾوﺑﻛﺗﯾﻧﻲ‬
Iliopectineal line, which is the • ‫اﻟﻣﺗﻛوﻧﺔ ﻋﻧد اﻟﺟﺎﻧب اﻟداﺧﻠﻲ ﻣن‬
‫ اﻟﺣوض اﻟﻣﺳطﺢ‬/ ‫اﻟﺣوض اﻟﻣﺳطﺢ‬ edge formed at the inward (4) ‫اﻟﺣرﻗﻔﺔ‬
aspect of the ilium (4) (5) ‫ﺑروز إﻟﯾوﺑﻛﺗﯾﻧﺎل‬
‫ﻟﮭﺎ ﺣﺎﻓﺔ ﻋﻠﻰ ﺷﻛل ﻛﻠﯾﺔ‬ Iliopectinal eminence(5) •
(6) ‫اﻟﻔرع اﻟﻌﻠوي ﻣن ﻋظم اﻟﻌﺎﻧﺔ‬
Superior ramus of the pubic •
‫اﻟﺣد اﻟداﺧﻠﻲ اﻟﻌﻠوي ﻟﺟﺳم ﻋظم‬
‫ﻗد ﺗﻛون اﻟوﻻدة اﻟﻣﮭﺑﻠﯾﺔ اﻟطﺑﯾﻌﯾﺔ ﻣﻣﻛﻧﺔ‬ bone(6)
(7) ‫اﻟﻌﺎﻧﺔ‬
Upper inner border of the body
‫ ﻣن اﻟﻧﺳﺎء‬٪5 ‫ﺷوھد ﻓﻲ‬ of the pubic bone(7)
•
‫اﻟﺣد اﻟداﺧﻠﻲ اﻟﻌﻠوي ﻟﻠﻌﺎﻧﺔ‬
Upper inner border of the • (8) ‫اﻻرﺗﻔﺎق‬
symphysis pubis(8)

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Diameters of pelvic brim

Landmarks
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Pelvic diameters
a. Diameters of the brim
Diameter Description Measurement

Transverse Between the iliopectinal lines 13cm

‫ﻋﺮﺿﻲ ﺑﯿﻦ اﻟﺨﻄﻮط اﻟﺤﺮﻗﻔﯿﺔ‬

Oblique Iliopectinal eminence of one side to sacro-iliac joint 12 cm

of the opposite side(Right & left)
‫اﻟﺒﺮوز اﻹﻟﯿﻮﺑﯿﻜﺘﯿﻨﻲ اﻟﻤﺎﺋﻞ ﻣﻦ ﺟﺎﻧﺐ واﺣﺪ إﻟﻰ اﻟﻤﻔﺼﻞ اﻟﻌﺠﺰي‬
(‫اﻟﺤﺮﻗﻔﻲ ﻟﻠﺠﺎﻧﺐ اﻟﻤﻘﺎﺑﻞ )ﯾﻤﯿﻦ وﯾﺴﺎر‬
Anteroposterior
Antero-posterior Anatomical conjugate – From sacral promontry to 12cm
uppermost point of the symphysis pubis
diameter of
Obstetrical - From sacral promontry to 1.25cm
11 cm
pelvic brim
below the upper surface of the symphysis
pubis(TRUE)
Diagnonal conjugate - From sacral promontry to 12-13cm
lower border of the symphysis pubis
‫ ﻣﻦ اﻟﺮﻋﻦ اﻟﻌﺠﺰي إﻟﻰ أﻋﻠﻰ ﻧﻘﻄﺔ‬- ‫اﻗﺘﺮان ﺗﺸﺮﯾﺤﻲ ﺧﻠﻔﻲ أﻣﺎﻣﻲ‬
‫ﻣﻦ اﻻرﺗﻔﺎق اﻟﻌﺎﻧﻲ‬
‫ ﺳﻢ ﺗﺤﺖ اﻟﺴﻄﺢ اﻟﻌﻠﻮي‬1.25 ‫ ﻣﻦ اﻟﻨﺘﻮء اﻟﻌﺠﺰي إﻟﻰ‬- ‫اﻟﻮﻻدة‬
‫( ﻟﻌﺎﻧﺔ اﻻرﺗﻔﺎق‬TRUE)
‫ ﻣﻦ اﻟﻨﺘﻮء اﻟﻌﺠﺰي إﻟﻰ اﻟﺤﺪ اﻟﺴﻔﻠﻲ ﻣﻦ ارﺗﻔﺎق‬- ‫اﻗﺘﺮان ﺗﺸﺨﯿﺼﻲ‬
‫ ﺳﻢ‬12 "" ‫اﻟﻌﺎﻧﺔ‬

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pelvic diameters----contd
Diameters of Pelvic Outlet
Diameters of the cavity: The cavity is circular in shape and although it is not •
possible to measure its diameters exactly, they are all considered to be 12 cm
Diameters of the outlet: Outlet is diamond shaped •
‫ اﻟﺗﺟوﯾف داﺋري‬:‫أﻗطﺎر اﻟﺗﺟوﯾف‬
‫اﻟﺷﻛل وﻋﻠﻰ اﻟرﻏم ﻣن أﻧﮫ ﻻ ﯾﻣﻛن‬
‫ إﻻ أﻧﮭﺎ ﺗﻌﺗﺑر‬، ‫ﻗﯾﺎس أﻗطﺎرھﺎ ﺑدﻗﺔ‬
‫ ﺳم‬12 ‫ﺟﻣﯾﻌﮭﺎ‬
Diameter Description Measurement
‫ اﻟﻣﺧرج ﻋﻠﻰ ﺷﻛل‬:‫أﻗطﺎر اﻟﻣﺧرج‬
Antero- From lower border of 13 cm ‫ﻣﺎﺳﻲ‬
posterior symphysis pubis to the
sacro-coccygeal joint
Oblique From obturator 12 cm
foramen to the sacro
spinous ligament
Transverse Between 2 ischial 10-11 cm
spines
Narrowest diameter of
the pelvis.
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.……Overall
???……Mental questions
?Which is the strongest joint in the pelvis.1
?What is the significance of ischial spine.2
?Which is the narrowest diameter in the pelvis.3
12 ??Which diameter is called as true conjugate .4
?Tall women have which type of pelvis .5
‫ ﻣﺎ ھو أﻗوى ﻣﻔﺻل ﻓﻲ اﻟﺣوض؟‬-1
‫ أي ﻗطر ﯾﺳﻣﻰ ﺑﺎﻟﻣﻘﺎرن اﻟﺣﻘﯾﻘﻲ ؟؟‬.4

‫ ﻣﺎ ھﻲ أھﻣﯾﺔ اﻟﻌﻣود اﻟﻔﻘري اﻹﺳﻛﻲ؟‬.2

‫ أي ﻧوع ﻣن اﻟﻧﺳﺎء طوﯾل اﻟﻘﺎﻣﺔ ﻣن اﻟﺣوض؟‬.5

‫ ﻣﺎ ھو أﺿﯾق ﻗطر ﻓﻲ اﻟﺣوض؟‬.3

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REFERENCE
Diane Fraser, Margaret Cooper (2009). Myles' Textbook for .1
.Midwives 15th Edition, Churchill Livingstone

.‫ ﺗﺷرﺷل ﻟﯾﻔﯾﻧﺟﺳﺗون‬، ‫ اﻹﺻدار اﻟﺧﺎﻣس ﻋﺷر‬، ‫ ﻛﺗﺎب ﻣﺎﯾﻠز ﻟﻠﻘﺎﺑﻼت‬.(2009) ‫ ﻣﺎرﻏرﯾت ﻛوﺑر‬، ‫ دﯾﺎن ﻓرﯾزر‬.1