THE FEMALE PELVIS

BY

NAMASINGA JOYCE.
 FUNCTIONS OF THE PELVIS.
• The pelvis is important to the midwife because
it provides passage through which the fetus
must pass in order to be born.
• It allows movement of the body especially
walking and running.
• Contains and protects the internal
reproductive organs such as the bladder,
uterus and vagina.
• Transmits the weights of the trunk \sitting
body onto the ischial tubelosities.
Introduction
 Cont’d
• Definition: It is a bonny ring which is basin
shaped through which the baby must pass
during the process of child birth (normal)
 Size: varies with individuals, stage of
development, race/tribe and type of pelvis,
however, its believed to be the largest bonny
formation in the body
• Shape: it is similar to that of a bonny basin.
 Cont’d
• Situation: It lies at the lower end of the vertebral
column. Superiorly it articulates with the fifth
lumbar vertebrae, and laterally it articulates with
the right and left femur at the acetabullum.
• Structure: it is made up of;
 Bones
 Ligaments and
 Joints
 Bones of the pelvis
• It has four bones;

 The 2 innominate bones

 The sacrum

 The coccyx
 The innominate bones.
• They are two bones forming the lateral and
anterior walls of the pelvis
• Shape: irregular in shape
• Situation: posteriorly, they articulate with the
alae of the sacrum to form the sacral iliac joints,
anteriorly the two pubic bones meet at the
cartilaginous joint; the symphysis pubis and
laterally they articulate with the femur at the
acetabullum to form the hip joint on either sides
 Cont’d
• Each innominate bone is made up of 3
separate bones which fuse together
completely at around the 16th year of life.
• They include;
 The ilium
 The ischium and
 The pubis
DIAGRAM SHOWING THE INNOMINATE BONE
 The Ilium bone
• This is the large flared out part of the pelvis and
it forms the superior portion of the innominate
bone.
• Its inner surface is smooth and concave and is
known as the iliac fossa
• The outer surface is rough for attachment of
muscles of the buttocks
• The upper boarder of the Ilium is known as the
iliac crest
 Cont’d
• The terminal point/where the iliac crest ends
anteriorly is the anterior superior iliac spine
• About 2.5cm below the anterior superior iliac spine
is another projection of bone known as the
anterior inferior iliac spine
• The terminal posterior point of the iliac crest is the
posterior superior iliac spine
• About 2.5cm below it is another projection of bone
called the posterior inferior iliac spine which marks
the border of the great sciatic notch
 Cont’d
• Below the iliac fossa is a distinct edge known as
the ileopectineal line which ends at a
roughened swelling anteriorly known as the
ileopectineal eminence where the Ilium fuses
with the pubis.
• Below the eminence but on the outside of the
innominate bone is a cup shaped depression
known as the acetabullum
• The ilium bone forms 2/5 of the acetabullum
 The ischium
• This is the inferior part of the innominate bone
• Its upper part forms the lower 2/5 of the acetabullum
• The lower part forms a thick rounded body known as the
ischial tuberosity on which the body rests in a sitting up
position
• Posteriorly about 2.5cm superior to the ischial tuberosities
is an inward projection of a bone known as the ischial spine
• In labour, the station of the fetal head is estimated in
relation to the ischial spines
• The ischial spines also divide the sciatic notch into the
greater and lesser sciatic notches
 The pubic bone
• Is the smallest of the three bones
• Forms the remaining 1/5 of the acetabullum
• It consists of the body, superior and inferior rami. The
superior pubic ramus meets with the Ilium at the
ileopectineal eminence.
• The two lower borders of the pubic rami unite to form the
pubic arch
• The space enclosed by the superior and inferior pubic rami is
the obturator foramen
• These pubic bones are fused anteriorly by a pad of cartilage
called the symphysis pubis
 The sacrum
• It’s a wedge shaped bone which forms the
back of the pelvis and consists of five fused
bones
• Situation: superiorly articulates with the fifth
lumbar vertebrae, inferiorly with the coccyx at
the Sacro coccygeal joint, and laterally with
the innominate bones at the sacral iliac joint
 Structure:

 Sacro promontory: this is the first Sacro vertebrae which

protrudes over the hollow of the sacrum
 Sacro hollow: anterior surface of the sacrum which is
smooth and hollow
 Sacro alae(wings): widened out pieces of the bone on
each side of the first sacral vertebrae giving it the
appearance of wings
 Sacral foramen: four pairs found where each bone joins
the other and are for passage of nerves, blood vessels and
lymphatics
 Sacro canal: centrally located for passage of spinal cord.At
the level of the 2rd and 3rd sacral vertebra,the nerves
spread out to form the cauder equina
Illustration
 The coccyx
• This is a vestigial tail
• It consists of 4 fused vertebrae forming a small
triangular bone
• Situation: found posteriorly to the pelvis. It
continues with the lower end of the sacrum
where it articulates with it at the sacro
coccygeal joint.
 Joints of the pelvis

They are four joints;2 sacral iliac joints, the symphysis

pubis and the sacral coccygeous joint.
1.The two sacral iliac joints.(right and left)
• They lie between the first two bodies of the sacra
vertebrae and the upper surface of the ilium. They
allow limited movement supported by ligaments.
• They are the strongest joints in the body
2.The symphysis pubis.
• This is the pad of cartilage lying between the two
bodies of pubic bone. It is almost 4cm in length.
 Cont….
3.The sacro coccygeal joint.
• It is formed by the articulation of the coccyx
with the tip of the sacrum and allows a bend
backwards during labour.
• This allows more room for the fetal head as it
passes through the birth canal.
NB .Each of the above joints are held together
by the ligaments in position.
 The pelvic ligaments
1.The sacral-iliac ligaments
• They are two sacral iliac ligaments,2,5 cm and
are the strongest in the body.
• They strengthen the sacral iliac joint.
2.The sacro-tuberous ligament.
• They are also two and stretch from lower border
of the sacrum to the ischial tuberosities
3.Sacro-spinous ligament.
• These are two in number extending from lower
part of the sacrum to the ischial spines.They
form the posterior wall of the outlet.
 Cont….
4.Inter- pubic ligament
• It strengthens the pubic bones.
5.The two inguinal ligaments.
• Extend between the anterior superior iliac spine
and the body of the pubis.
6.The two lacuna ligaments.
• Each lie under the inguinal ligaments.
7.Sacro- coccygeal ligament.
• It strengthens the coccygeal joint
 Cont…
8.Obturator membrane.
• They are two and cover the obturator
foramen, an opening which allows the passage
of blood vessels nerves and lymphatic.
 Divisions of the pelvis
• For descriptive purposes the pelvis is divided
into two parts;
 The false pelvis (pelvis minor)
 The true pelvis(major).
THE FALSE PELVIS
This is the part of the pelvis that lies above the
pelvic brim/inlet. It is not a complete bonny
circle and it takes no direct part in child birth
thus of less importance in midwifery.
 Cont’d
• However, it is possible to measure the false
pelvis in living subjects to estimate the size of
the pelvis
BOUNDARIES OF THE FALSE PELVIS
• Posteriorly – lumbar vertebrae
• Laterally – iliac fossa
• Anteriorly - abdominal wall
Illustration
 The true pelvis
• This is a bonny canal through which the fetus
must pass during child birth
• It is made up of the;
 Brim
 Cavity and
 The outlet
 The brim
• Definition: is a ridge of bones which forms the
inlet of the pelvis.
• Shape: The brim is round except where the
sacro promontary projects in over the hollow
of the sacrum
• Situation: It is the part between the false
pelvis above and the cavity of the true pelvis
below
• Size: it has a circumference of 36cms
• Importance: It is where engagement of the
fetal head takes place.
 Boundaries of the pelvic brim
1.The sacro promontary
2.The sacro alae
3.The sacro iliac joints
4.Iliopectineal line
5.Iliopectineal eminence
6.Upper boarder of the superior pubic ramus
7.Upper border of the body of the pubic bone
8.Upper border of the symphysis pubis
 Landmarks of the pelvic brim
• These are areas of obstetrical importance in
midwifery practice. They include;
 The sacro promontary;if prominate reduces the
APD thus reducing obstructing labour.
 The symphysis pubis; if narrow reduces the APD.
 The iliopectineal eminences; its important
because its place where denominator faces to
determine position.
 Oblique diameter; important for engagement of
the fetal head.(sacro iliac joints)
 Diameters of the pelvic brim
There are 3 principal diameters
1. The antero posterior or conjugate diameters;
they extend from sacral promontory to the
symphysis pubis.3 conjugate diameters can be
measured;anatomical,obstetrical and internal
or diagonal conjugate.
 The anatomical conjugate ; is measure from the
centre of the sacro promontary to the upper
most border/point of the symphysis pubis
(summit) and it measures 12cm
 Cont’d

 The obstetrical conjugate; is measured from the

centre of the sacro promontary to the upper
border of the symphysis pubis about 1.25cm
below the summit and it measures 11 cm.
• The reason for this is that the obstetrical
conjugate represents the available space for the
passage of the fetus through bonny pelvis.
NB-The term true pelvis may be used to refer to
either of these measurements thus midwife
should take care to establish which is intended.
 Cont…
 The diagonal conjugate.
• This is assessed by vaginal examination(pelvic
assessment)and it helps in measuring the size
of the brim(Antero-posterior).
• It is measured from the lower border of
symphysis pubis to the centre of sacro
promontory.
• It measures 12-13cm.But to get the actual size
of the pelvic brim subtract 1-2 for the fats and
muscle.
 Cont’d
2. Oblique diameter; this is measured from the sacro iliac
articulation to the opposite iliopectineal eminence and it
measures 12cm. They are 2 and each takes its name from
the iliac joint it arises from i.e left or right oblique diameter
3. Transverse diameter; this is measured between the
farthest two points on the ilio pectineal lines. It lies 4cm
anterior to the sacro promontary and 7cm behind the
sympysis pubis . It is the largest diameter in the pelvis and
measures 13 cm.
However another dimension,
4. The sacro cotyloid diameter; measured from the sacro
promontory to the iliopectineal eminence of the same side.
It measures 9- 9.5cm. Important in posterior positions of
the occiput
 The pelvic cavity
• Extends from the brim above to the outlet below
• Importance; It is where internal rotation takes
place.
Boundaries
 Posteriorly- sacral hollow which is 12cm
 Anteriorly- formed by the symphysis pubis which
is 4cm. deep
 Laterally – by the sciatic notches, obturator
foramen, obturator internus muscle and
acetabullum on the outside.
 Cont’d

• Size; circumference of 36cms

• Shape; it is round in shape(circular)
• Landmarks;
 The hollow of the sacrum ;it should be well
curved to allow good rotation of the fetal
head.
 The greater sciatic notch; should be circular
and wide to aid free rotation.
 Symphysis pubis; should be wide to allow baby
to pass through the pelvis.
 Diameters of the cavity
• Antero posterior diameter; taken from
between the 2nd and 3rd sacral vertebrae to the
mid point of the symphysis pubis and it
measures 12cm
• Oblique diameter; it is an imaginary line
parallel to the oblique diameter of the brim
and it measures 12cm.No fixed point to
measure between the two diameters.
• Transverse diameter; it is taken from a point
above the ischial spines to the opposite lateral
walls of the pelvis and it measures 12cm
 Pelvic outlet
• Definition; this is the lowest part of the true pelvis.
• Shape; diamond or kite shaped
• Size; its circumference is 36cm
• Situation; extends from the cavity above and
continues below
• Structure; two outlets are described;
 The anatomical outlet and
 The obstetrical outlet
 Obstetrical outlet
• The obstetrical outlet is of greater practical
significance because it includes the narrow pelvic
strait
• It consists of (boundaries);
 anteriorly – the lower border of the symphysis pubis
 Laterally – the ischial spines and sacro spinous
ligaments
 Posteriorly – the lower border of the sacrum/sacro
coccygeal joint
 Diameters of obstetrical outlet
• Antero posterior diameter; measured from the
lower border of the symphysis pubis to the sacrum
and it measures 13cm
• Oblique diameter; has no specific points because of
the presence of the sacro spinous ligament but is
believed to be parallel to the oblique of the cavity &
brim and measures 12cm
• Transverse diameter; also called inter spinous
diameter. Is taken between the two ischial spines
and measures 10-11 cm
 Anatomical outlet
• Is the lowest part of the outlet
• It is bordered by;
 Anteriorly- the sub pubic arch,
 Laterally – the ischial tuberosities and sacro tuberous
diameter
 Posteriorly – the coccyx
Diameters of the anatomical outlet
 Antero posterior diameter; measured from the lower
border of the symphysis pubis to the top of the coccyx
and measures 13 cm
 Cont’d
• Transverse diameter; measured between the
two ischial tuberosities using knuckles when
assessing the pelvis externally and must
accommodate 4 knuckles. It measures 12 cm
• Oblique diameter; no specific points because
of the sacro tuberous ligaments laterally but
they are parallel to the oblique of the cavity
and brim and measure 12cm
Important landmarks of the outlet.
• Coccyx; during labour it tilts backwards to give
more room for passage of fetus.
• Sub-pubic arch; should accommodate at least
two and half fingers for passage of fetus.
• Ischial-spines; should be round, if prominent
they reduce the transverse diameter and
obstruct labour.
• Sacro-spinous ligament; should be soft and
stretch outwards for baby to pass.
Important landmarks of the outlet.
• Coccyx;
• Sub-pubic arch;
• Ischial-spines;
• Sacro-spinous ligament;
 Diameters of the outlet.

• Antero-posterior diameter; measured from

lower border of the symphysis pubis to the
lower border of the sacrum ,(sacral coccygeous
joint), and it is 13cm.
• The oblique diameter no fixed points it is said
to be between obuturator foramen and the
sacralspinous ligament; i.shd measure 12cm.
• Transverse diameter- is measured between
ischial spines and it is 11cm.
 Summary of diameters
Antero posterior Oblique Transverse

Brim 11cm 12cm 13cm

Cavity 12cm 12cm 12cm

Outlet 13cm 12cm 11cm

 Pelvic inclination and pelvic
planes
• When a woman is standing in an upright
position, her pelvis is on an incline. The
anterior superior iliac spines are immediately
above the symphysis pubis in the same vertical
plane.
• The brim is tilted and if an imaginary line
joining the sacro promontary and the top of
the symphysis pubis is extended, it would form
an angle of 60 degrees
 Cont’d
• Similarly, if the line joining the centre of the
sacrum to the centre of the symphysis pubis is
extended, a resultant angle of 30 degrees with
the floor would be created
• The angle of inclination of the outlet is 15
degrees
• When a woman is in recumbent position, same
angles are maintained and should be kept in
mind when doing an abdominal palpation.
 Cont’d
• Pelvic planes are imaginary surfaces at the brim,
cavity and outlet of the pelvic canal as described
AXIS OF THE PELVIC CANAL
• A line drawn exactly half way between the
anterior wall and the posterior wall of the pelvic
canal would trace a curve known as the curve of
carus. The midwife needs to be familiar with this
concept to make accurate observations on
vaginal examination so as to facilitate delivery
 Types of pelves
• Classically, there are four major types of pelves. They
include;
• Gynaecoid pelvis; is the ideal type of pelvis occurring
in 50% of African women
• Its main features are a rounded brim, straight side
walls, shallow cavity with a broad well curved sacrum,
blunt ischial spines, wide sciatic notch and a pubic
arch of 90 degrees
• It is found in women of average built and height with a
shoe size of 4 or larger
 Cont’d
• Effect on labour; fetus presents with its well
rounded portion and often results in normal
labour and delivery
• Android pelvis; resembles male pelvis and
occurs in about 20% of women
• Its brim is heart shaped, with a narrow fore
pelvis, transverse diameter is towards the back,
the sacrum is straight, side walls converge
making it funnel shaped and deep
 Cont’d
• Ischial spines are prominent, sciatic notch is narrow
and the angle of pubic arch is less than 90 degrees. It
is found in short and heavily built women
• Effect on labour; predisposes to occipital posterior
positions. The heart shaped brim favors a posterior
position and there is more room posteriorly. The
prominent ischial spines can also cause deep
transverse arrest. The narrow sub pubic arch can not
allow the bi parietal diameter to escape hence not
favorable for delivery
 Cont’d
• Anthropoid pelvis. Occurs in 25% of women.
Has a long oval brim in which the antero
posterior diameter is longer than the
transverse, side walls diverge and the sacrum
is long and deeply concave, sciatic notch very
wide, sub pubic arch more than 90 degrees
and ischial spines not prominent. It is normally
found in women who are tall with narrow
shoulders
 Cont’d
• Effect on labour; no difficulties usually but the
baby can present with a direct occipital
posterior or direct occipital anterior position
causing face to pubis delivery or the position
adopted for engagement may persist.
• A platypelloid pelvis; occurs in 5% of women.
Is a flat pelvis with a kidney shaped brim in
which the APD is reduced and transverse
diameter increased,
 Cont’d
• The side walls diverge, sacrum flat and the cavity is
shallow, ischial spines are blunt, sciatic notch and sub
pubic arch are wide.
• Effect on labour; the head must engage with the
sagital suture in the transverse diameter, but usually
descends through the cavity without difficulty
• Sometimes engagement may necessitate lateral
tilting of the head known as asynclitism in order to
allow the bi parietal diameter to pass the narrow
APD of the brim
 Other types of pelves
• A contracted pelvis; is a pelvis whose
diameters are reduced by 1cm or more
 Justo minor; is like a gynaecoid pelvis in
miniature. All diameters are reduced but in
proportion. Normally found in women of small
stature (petite) less than 1.5m in height with
small hands and feet, but occasionally in
women of normal stature
 cont’d
• Effect on labour; depends on the size of the fetus
and husband, if fetus is small consistent to the
maternal pelvis, normal labour and delivery will
take place, if the fetus is large, a degree of cephalo
pelvic disproportion will result. So big baby may
require caesarean section.
 Roberts pelvis; the alae of the sacrum are either
absent or poorly developed hence narrow opening
of the brim. Normally caesarean section is done.
 Cont’d
 Negele’s pelvis; sacrum with one wing due to
congenital abnormalities or
diseases(poliomyelitis).Delivery is by
caesarean section.
 Oesteomylitic pelvis; rare, occurs normally in
multi gravida due to gross deficiency of
vitamin D and minerals. It is characterized by
soft bones, sides of the pelvis are squeezed
together giving the brim a slit shape.
 Cont’d
 Justo major; it’s a big pelvis found in giant
women. Exceeds normal diameters. Normal or
precipitate delivery normally results.
 Assimilation pelvis;
• High assimilation pelvis where by the sacum
consists six vertebrae.
• Low assimilation pelvis where by the sacrum
consists of four vertebrae.
 Rachitic pelvis; this is where there is a
deformity due to rickets which affect the
person in early childhood.
 PELVIC ASSESSMENT
• Is a procedure done to find out if the pelvis is
adequate enough for the successful passage of
a particular baby( the current pregnancy).
Several methods can be used but currently
two are widely used viz;
 External pelvic assessment/clinical assessment
 Internal/digital pelvic assessment
 External pelvic assessment
It involves
 Observation; midwife observes the mother as
she comes towards her for;
 Gait
 Height
 Shape of the abdomen
 Cont’d
• Histories; these are taken as follows;
 Personal history;
 Age; a woman of age below 18 years is expected
to have an immature pelvis. Age 35 and above, the
pelvis has fully ossified and difficult labour may
result due to difficult in the give of the pelvis
 Tribe; different tribes are associated with different
types of pelves.
 Cont’d
 Medical history; ask if she has ever suffered
from any medical diseases that affect
development of the pelvis especially child
hood illnesses like anterior poliomyelitis,
rheumatic fever and rickets
 Surgical history; ask about accidents involving
the bones of the spine, pelvis or lower limbs as
they deform the pelvis reducing its diameters
 Cont’d
• Family history; ask conditions in the family like
sickle cells disease
• Past obstetrical history; ask if she had normal
pregnancies which were carried to term, if she
had normal labour and delivery, weight of the
baby at birth and their condition. A history of
assisted deliveries may cause a suspicion of
inadequate pelvis. It is important to note that
in prime paras such history Is not necessary
 General examination and special
investigations
• Upper limbs- should be equal in length and
size, size of hands
• Lower limbs – equal in length and size, look at
shoe size – 4 and above
• Height – 152cm- 170cm
• Stature – size of waist
 Cont’d
• Abdominal examination;
 Shape of abdomen – pendulous
 Engagement of fetal head especially in prime
gravidas by 36 weeks
 Internal pelvic assessment;
• Done by vaginal examination on all mothers in
labour by the midwife
• It is a sterile procedure therefore aseptic
technique should be ensured
• Mother is prepared for vaginal examination
explaining the procedure to her and ensuring the
bladder is empty
• It is also important for the midwife to know the
measurements her fingers
 Assessing the brim
• If the head is not yet engaged, the brim is assessed
by estimating the diagonal conjugate
• Two fingers are run immediately beneath the
symphysis pubis with an attempt to tip the sacro
promontary. The thumb is passed externally over
the symphysis pubis
• If not tipped, then the diagonal conjugate is said to
be normal and if tipped the conjugate is said to be
reduced but this is in relation to some ones fingers
 Assessing the cavity
• If the head is not yet in the pelvis, its possible
to feel the hollow of the sacrum and it should
be well curved and not straight.
• The midwife runs fingers through the sciatic
notches, they should be wide enough
• The sacro spinous ligaments should be wide
enough with width of two fingers across the
greater sciatic notch
 Assessing the outlet
• Assess the ischial spines, should be well rounded
or blunt not prominent
• The sub pubic arch should admit two fingers with
space for 3rd finger or 2 ½ fingers
• Inter tuberous diameter; this should be assessed
and should accommodate 4 knuckles between
the ,others thighs
• Findings are explained to the mother and she is
left comfortable.
 THANK YOU.
 ASANTE SANA.
 EYARAMA
 MWEBALE NNYO

GOD BLESS.