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Bony Pelvis

Prepared by:
Mr. Nestlee Sio Cabaccan RN,MSN

Mr. Nestlee Sio Cabaccan RN,MSN


Bones of the Pelvic Girdle
 Hip bones: Composed of three pair of fused bones
 Ilium
 Ischium
 Pubic bone
 The total weight of the upper body rests on the
pelvis
 Protects several organs
 Reproductive organs
 Urinary bladder
 Part of the large intestine

Mr. Nestlee Sio Cabaccan RN,MSN


Pelvis
Is formed by the:
1. Two hip bones
2. Sacrum
3. Coccyx

Mr. Nestlee Sio Cabaccan RN,MSN


The pelvic brim
False pelvis (lesser pelvis)
 above the brim forming the expanding part of the
pelvis.
 Above the pelvic brim or linea terminalies which
supports the enlarging uterus.
True Pelvis ( greater pelvis)
 Below the brim resembling a bowl which protects the
lower intestinal organs.
 Consist of an outlet, inlet and cavity.

Mr. Nestlee Sio Cabaccan RN,MSN


False Pelvis
True Pelvis

Linea Terminalis

Mr. Nestlee Sio Cabaccan RN,MSN


True pelvis-
Inlet/upper pelvic opening
 Widest from side to side or transverse
diameter (13.5 cm) and narrowest from the
aneteroposterior or diagonal conjugate
(11.5 cm or >).
 True conjugate- 1.5cm less than the
diagonal conjugate
 Obstetric conjugate- narrowest of the 3
conjugate diameter and cannot be directly
measured.

Mr. Nestlee Sio Cabaccan RN,MSN


Outlet or lower pelvic opening
-Has 3 important diameter
 Anteroposterior (9.5-11.5 cm)

measurment between the sacrococcygeal joint and


the tip of the cocyx and increases with movable
cocyx.
 Transverse (11 cm)

distance between the ischial tuberosities.


 Posterior sagital (atleast 7.5 cm)

measurment from the sacrococcygeal joint and


the middle of the transverse diameter.
 Pubic arch angle

should be atleast 90 degree in order to be wide


enough for the fetus to pass.
Mr. Nestlee Sio Cabaccan RN,MSN
AP

T
The Pelvic cavity
 The pelvic cavity is a
body cavity that is
bounded by the bones
of the pelvis and which
primarily contains
reproductive organs
and the rectum.

Mr. Nestlee Sio Cabaccan RN,MSN


Pelvic Planes
 Pelvic inlet: The line between the narrowest bony
points formed by the sacral promontoryand the
inner pubic archis termed obstetrical conjugate: It
should be 11.5 cm or more. This anteroposterior
line at the inlet is 2 cm less than the diagonal
conjugate (distance from undersurface of pubic
arch to sacral promontory).
 Midpelvis: The line between the narrowest bone
points connects the ischial spines; it typically
exceeds 12 cm.
 Pelvic outlet: The distance between the ischial
tuberosities (normally > 10 cm), and the
angulation of the pubic arch.
Mr. Nestlee Sio Cabaccan RN,MSN
Mr. Nestlee Sio Cabaccan RN,MSN
Mr. Nestlee Sio Cabaccan RN,MSN
Gender Differences of the Pelvis

Mr. Nestlee Sio Cabaccan RN,MSN


Important Measurements
1. Diagonal Conjugate – measure between sacral promontory
and inferior margin of the symphysis pubis.
Measurement: 11.5 cm - 12.5 cm basis in getting true
conjugate. (DC – 11.5 cm=true conjugate
2. True conjugate/conjugate vera – measure between
the anterior surface of the sacral promontory and superior
margin of the symphysis pubis. Measurement: 11.0 cm
3. Obstetrical conjugate – smallest AP diameter. Pelvis at 10 cm or
more.
4. Tuberoischi Diameter – transverse diameter of the pelvic outlet.
Ischial tuberosity – approximated with use of fist – 8 cm & above.

Mr. Nestlee Sio Cabaccan RN,MSN


Mr. Nestlee Sio Cabaccan RN,MSN
Pelvic Types
Gynecoid Anthropoid Platypelloid Android

Frequency Most common Rarest

Inlet Shape Round Vertically Horizontally Heart shape


oriented oval oriented oval
Side walls Straight convergent Divergent convergent

Ischial spines Not prominent Prominent (D Not prominent Prominent (D


(>/= 10 cm </=10 cm) </=10 cm)

Sacrum Inclined: Straight, Well curved Forward and


anterior/posteri deeper and well straight with
or roatated little curvature.
backward
Mr. Nestlee Sio Cabaccan RN,MSN
Fetal Relationship
 Engagement: The fetus is engaged if the widest leading part
(typically the widest circumference of the head) is negotiating the
inlet.
 Station: Relationship of the bi-parietal diameter of the fetus to the
maternal ischial spines. If at the level of the spines it is at “0 (zero)”
station, if it passed it by 2 cm it is at “+2” station.
 Attitude: Relationship of fetal head to spine: flexed, neutral
(“military”), or extended attitudes are possible.
 Position: Relationship of presenting part to maternal pelvis, i.e.
ROP=right occiput posterior, or LOA=left occiput anterior.
 Presentation: Relationship between the leading fetal part and the
pelvic inlet: cephalic, breech (complete, incomplete, frank or
footling), face, brow, mentum or shoulder presentation.
 Lie: Relationship between the longitudinal axis of fetus and mother:
longitudinal, oblique, and transverse.
 Caput or Caput succedaneum: oedema typically formed by the
tissue overlying the fetal skull during the vaginal birthing process.
Mr. Nestlee Sio Cabaccan RN,MSN
The Fetus

Mr. Nestlee Sio Cabaccan RN,MSN


The Fetal skull
 Consist of a vault, a face and a base.
1. Vault
 2 frontal bones separated by the frontal suture.
 2 parietal bones separated by the sagital suture,
separated from temporal bone on each side of
temporal suture.
 Occipital bone separated by the lumboidal suture
from the parietal bone, while the coronal suture
separate the frontal from the parietal bones.

Mr. Nestlee Sio Cabaccan RN,MSN


The Fetal Skull
 The fetal skull is
large compared to
the infants total body
length

Figure 5.13
Mr. Nestlee Sio Cabaccan RN,MSN
The Fetal Skull
 Fontanelles – fibrous
membranes
connecting the
cranial bones
 Allow the brain
to grow
 Convert to bone within
24 months after birth

Figure 5.13
Mr. Nestlee Sio Cabaccan RN,MSN
Fontanels:
 Anterior fontanel – bregma,
diamond shape, 3 x 4 cm,( > 5
cm – hydrocephalus), 12 – 18
months after birth- close
 Posterior fontanel or
lambda(vertex) – triangular
shape, 1 x 1 cm. Closes – 2 – 3
months

Anteroposterior diameter -
•suboccipitobregmatic 9.5 cm,
complete flexion, smallest AP
•occipitofrontal 12cm partial
flexion
•occipitomental – 13.5 cm
hyper extension
submentobragmatic-face
presentation

Mr. Nestlee Sio Cabaccan RN,MSN


Measurement fetal head:
 transverse diameter
– 9.25cm
 biparietal – largest
transverse
 bitemporal - 8 cm
 bimastoid - 7cm
smallest transverse

Mr. Nestlee Sio Cabaccan RN,MSN


Sutures
Sutures – intermembranous
spaces that allow molding.
 sagittal suture – connects 2
parietal bones ( sagitna)
 coronal suture – connect
parietal & frontal bone
(crown)
 lambdoidal suture –
connects occipital & parietal
bone
 Moldings: the overlapping of
the sutures of the skull to
permit passage of

Mr. Nestlee Sio Cabaccan RN,MSN