ANATOMY OF THE FEMALE REPRODUCTIVE

ORGANS, BONY PELVIS AND PELVIC GIRDLE

T.M
External genital organs
mons pubis: fatty tissue
labia majora
labia minora which lie inside the labia majora
clitoris: is located anterior to the labia minora
female anatomy Cross-sectional diagram
vestibule
Lies between the labia minora
Is bounded
Anteriorly by clitoris
Posteriorly by perineum
Urethra and vaginal orifice open to the midline of
the vestibule
Bartholin’s glands also empty into the vestibule
vagina
The vagial wall is consisted of
Mucouse membrance: is lined by squamous
Beneath this is a submucosal layer of connective
tissue which contains a rich of veins and
lymphatics
The muscular wall has three layers of smooth
muscle.
Fornix ：
the area
around the
cervix
(anterior,
posterior,later
al)
the
posterior
fornix is
important
pouch which
allows access
to the
peritoneal
cavity from
uterus
Lies between rectum and bladder
Volume: 7*5*3cm
Weight: 50g
Divided into two portions by isthmus

The body
Cornu:where the fallopians enter
Fundus:the part of the body above the
cornu
Histology of the uterus
There are three layers of the body
The inner is endometrium which is consisted of
the simple columnar epithelium
Beneath the mucosa is the muscular layer,
covered by peritoneal serosa on the outside
Arterial system
Ovarian artery: from abdominal aorta
(left may be from kidney artery
Uterine artery
Vaginal artery
Internal pudendal artery from internal iliac
artery
Arterial system
Ovarian arteries: from abdominal aorta
 (left may be from kidney
artery
Uterine
Fallopian tubes
Length: 8-14cm
The tube is divided four portions
 Interstitial:
 isthmun
 Ampulla:the centre portion
 Infundibulum:surroundthe ovary and
help to collect the oocyte at the
time of ovulation
Fallopian tubes
The inner layer is covered by ciliate columnar
epithelium
The cilia beat toward the uterus assisting in oocyte
transport
ovaries
Be located on either side of the uterus
Volume:4*3*1cm
Weight:5-6g
be almond-shaped
Is divided two portion:
 cortex(outer portion): contains follicles,
 medulla(central portion): blood vessels,
 nerve fibres, lymphatics
Pelvic girdle.
Functions
-allows movement of the body esp. walking, and
running,sitting,squatting.
-provides attachment to muscles of the lower limbs and
lower abdomen.
-in women its suited to child bearing
-transmission of weight of the trunk to the legs acting as a
bridge btwn the Femi.
Sacroiliac joint - strongest joint in the body
-is immensely strong and immobile.
-Ischial tuberosities takes the weight of the sitting body.
-protects and supports the pelvic organs and to a lesser
extent the abdominal contents.
-the sacrum transmits the cauda equina and distributes
the nerves to various parts of the pelvis.
Pelvic bones
-two innominate bones( Ilium , ischium,and pubic
bone)
-one coccyx
-one sacrum
1. Ilium
The uppermost broad and flared bone
Has the crest forming the upper boarder
Terminates anteriorly at the anterior iliac spine
And posteriorly at the posterior superior iliac spine
Anterior surface is concave and referred to as the iliac
fossa-on the lower aspect of this fossa the bone forms a
continous ridge from sacral promontory to the pubic
rami –called the arcuate line
-iliac tubercle –located 5cm above and behind the
anterior superior iliac spine
-iliac crest-provides attachment to muscles ie erector
spinae,transversus abdominis,sartorius,etc.
Ischium
-is the lowermost located bone .
-consists of
(a)body (b)superior ramus (c)inferior ramus
-forms the lower border of acetabulum.
-forms posterior and lower border of obturator foramen.
-fuses with the ilium and pubic bone at the acetabulum
-ischial tuberosity is a roughened mass of bone forming
the lower border of ischium.the body lies on this on
sitting.
-ischial spines are two inward projections of bones into
pelvic cavity from posterior margin of the ischium.is
separated from the ischial tuberosity by the lesser
sciatic notch.
If the spines are prominent indicates a contracted
pelvis.they serve as attachment sites for sacrospinous
ligaments .
-in labour the station(presenting part)is determined by
the ischial spines.
-the head is assumed to be engaged if it is at the level of
the ischial spines.
Pubic bone
-forms anterior part.
-has (a)body (b)2 oar like projections (superior ramus
and inferior ramus)
-the body is flattened portion of the bone adjacent to the
symphisis pubis.
-the body is the most anterior part united medially at the
symphisis pubis by a fibrocartillage
-the pubic crest is a ridge of bone extending from the
anterior superior border and backwards ending in a
small prominence called the pubic tubercle.
-the pubic crest i.e the superior border meets with the
arcuate line at the iliopectineal emminence
Pectineal line-is the anterior border of the superior
ramus of the pubis
The space enclosed by the body of the pubic bone ,rami
and the ischium is the obturator foramen
The innominate bone
-it contains a deep-cup(called acetabulum) which
receives the head of femur.
-all three parts of the bone contribute to the acetabulum
-lower border of the innominate bone has got 2 curves –
greater and lesser sciatic notch.one extends from the
posterior inferior iliac spine to the ischial spine(greater
sciatic notch).Its wide and rounded.
The other extends from ischial spine and ischial
tuberosities(lesser sciatic notch)
Sacrum
-Is a wedge shaped bone consisting of 5 fused vertebra
-upper border of 1st sacral vertebrae juts forward
encroaching into the pelvic cavity and is known as the
sacral promontory
-its anterior surface is concave referred to as the hollow
of the sacrum
-laterally it extends into a wing or ala
-there are four pairs of holes/foramina that pierce the
sacrum .its through this that nerves from the cauda
equina pass to supply the pelvic organs.
-posteriorly sacrum is roughened for attachment of
muscles.
-landmark-it’s the sacral promontory which helps to
asses the size of the pelvis esp the anteroposterior
diameter.
Coccyx
It’s a vestigial tail
-has four fused vertebrae .
-its has no obstetric significance.
Joints of the pelvis
-1 symphisis pubis –formed at the junction of the two
pubic bones joined by a fibrocartilage
-2 sacroiliac joints –joins sacrum to the ilium and thus
joins spine to pelvis .
-1 sacro coccygeal joint formed where base of coccyx
articulates with tip of sacrum.
Lumbosacral joint –L5 and 1st sacral vertebrae
In non pregnant state there is very little mvmts in these
joints.
-during pregnancy endochrine actions makes the
ligaments smooth allowing the joints to move.This
provides more room when the fetal head is
moving .The pubis symphisis separate slightly in late
pregnancy.If it widens a lot it may give pain during
walking.
Pelvic ligaments
Each of the pelvic joint is held together by ligaments.
-interpubic ligaments-symphisis pubis
-sacroiliac ligaments.
-sacrotuberous ligaments-from sacrum to ischial
tuberosity.
-sacrospinous ligaments –from sacrum to ischiospines
 Types of pelvices.
RATIONALE
Anatomy of the pelvis and fetal skull
should be understood in the context of
what happens during labour
TERMINAL OBJECTIVE
Should be able to describe the structure of the normal
female pelvis
Should be able to describe the abnormal female pelvis
Should be able to describe the fetal skull and
The mechanisms of labour
ENABLING OBJECTIVES
Student should be able to:
 State the components of the bony pelvis and fetal
skull
 Describe the joints of pelvis and skull
 State dimensions of pelvis and skull
 Differentiate male from female pelvis
 Identify various types of pelvis
 Differentiate various skull malformations
False pelvis –above pelvic brim.has no obstretic
significance
True pelvis-forms the canal through which the fetus pass
COMPONENTS (a)
Innominate Bone
a) Ilium. The upper expanded part. Iliopectineal
eminence is where ilium and pubis fuse. 2/5 of
acetabulum
b) Ischium. L shaped and forms the posterior-
inferior part of pelvis
c) Pubis. Has a body and two rami. Upper joins
ilium at iliopectineal eminence, 1/5 of
acetabulum
COMPONENTS (b)
Lower ramus fuses with ramus of ischium forming
anterior boundary of obturator foramen and subpubic
arch

In gynaecoid pelvis subpubic arch should be at least

90 degrees
COMPONENTS (c)
SACRUM
 Forms the back of the pelvis
 Wedge shaped consisting 5 fused vertebrae
 First forms the sacral promontory
 Anterior surface smooth and concave
 4 sets of foramina exit the sacral nerves
COMPONENTS (d)
COCCYX
 Small triangular shaped bone
 Consists 4 fused rudimentary vertebrae
 Gives attachment to ligaments, muscle fibres of
anal sphincter, ischiococcygeus muscle= posterior
section of pelvic floor
 During labour it moves backwards to increase
pelvic outlet.
PELVIC JOINTS
SACROILIAC JOINTS
 Two slightly movable synovial and fibrous joints
 Mobility greater in pregnant and puerperal
women
 This mobility enhances diameter of pelvic brim
PELVIC JOINTS
SYMPHYSIS PUBIS
 Slightly movable secondary cartilaginous joint
 In last two months of pregnancy gap increases
from 4mm to 7mm
 Waste space of Morris smaller in gynaecoid
than in android pelvis
DIMENSIONS
 True pelvis bounded by:
 Sacrum at the back, sides by ischia, and front by
pubes. Consists of:
 Brim or inlet= entry point
 A curved cavity, traversed next
 Outlet, emerging point
PELVIC BRIM OR INLET
 Bounded by:
 Promontory of the sacrum
 Wings or alae of the sacrum
 Right and left sacroiliac joints
 Right and left iliopectineal lines
 Right and left iliopectineal eminences
 Upper inner borders of the s.p. rami
 Upper inner borders of bodies of pubes
 Upper inner border of symphysis pubis
PELVIC CAVITY
Boundaries are:
 Hollow of sacrum
 Sacroiliac joints
 Ischia and the sacrospinous ligaments
 Right and left upper and lower pubic rami
 Bodies of the pubes and the symphysis pubis.
Cavity is circular, anterior is 4.5 cm deep and
posterior is 12cm deep
PELVIC OUTLET
Ovoid or diamond shaped and has 2 levels:
Boundaries of upper outlet are
 Lower sacrum
 Sacrospinous ligaments and ischial spines
 Pubic arch
Boundaries of lower outlet are
 Tip of coccyx
 Sacrotuberous ligaments and ischial
tuberosities
 Pubic arch
DIAMETERS of BRIM
Anteroposterior diameter
 From sacral promontory to upper inner border of
symphysis pubis=11cm=obstetric conjugate
 True conjugate(anatomical) is from promontory
to centre of upper surface SP
Right and left oblique diameters
 From R sacroiliac to L iliopectineal eminence and
vice versa=12cm
Transverse: Between widest points on iliopectineal
lines=13cm .it divides brim into anterior and
posterior segments.
DIAMETERS of BRIM
Sacrocotyloid: From sacral promontory to
iliopectineal eminence on same side=9cm
Obstetric conjugate :distance btw mid point of sacral
promontory to prominent bony symphysis on inner
side of symphysis pubis.Is the actual space available
for fetus to pass thru from most prominent part of
symphisis .Its the shortest anterior posterior
diameter.
Diagonal conjugate: From apex of pubic arch to sacral
promontory=1.25cm more than obstetric
conjugate.can be measured clinically in labour.
DIAMETERS OF CAVITY
Here cavity is almost circular and measures about 12
cm
DIAMETERS of OUTLET
From sacrococcygeal joint to the lower border of
SP=13cm
Transverse of outlet between ischial spines
measures 10.5-11 cm
Outlet is wider from front to back and narrower
from side to side.
This is why head emerges with its long diameter
anteroposterior
COMPARISON OF GENDER
In the female:
 Bones are lighter and smoother
 Brim is rounded
 Cavity shallower and more capacious
 Outlet larger
 Sacrosciatic notch wider
 Acetabula are further apart
 Pubic arch is wider
 Sacrum wider and more curved
PELVIC TYPES
Gynaecoid=50%. Normal female
 Brim is round in shape
 Pelvis shallow
 Subpubic angle wide
 Sacrosciatic notch is wide
 Transverse diameter of outlet is 10 cm at least.
Mechanism of labour is normal
PELVIC TYPES
Anthropoid pelvis= 25%
 The brim is oval in shape with an increase in AP
diameter
 Sacrum long and narrow and may have six
vertebrae=high assimilation
 This hinders engagement of fetal head
 POPP common, seen in unusually tall, well built
women
PELVIC TYPES
Android pelvis= 20%(Caldwell et al 1940)
 Brim triangular, broader at back
 True pelvis deep
 Sacrum straight
 Subpubic angle narrow
 Sacrosciatic notch narrow
 Transverse diameter of outlet < 10 cm
 Funnel shaped. Associated with severe tears
coz head displaced backwards
PELVIC TYPES
Platypelloid pelvis=5%
 The anteroposterior diameter short
 Sacrosciatic notch narrow
 AP narrowing of pelvis continues in cavity and
outlet.
 Deep transverse arrest common
CONTRACTED PELVIS
Definition: One in which one or more diameters are so reduced as to
interfere with normal mechanism of labour
-Mildly contracted-<1 cm
-moderately contracted-1-2cm
-severely contracted->2cm
Causes:
 Rachitic flat
 Traumatic pelvic fractures
 Kyphotic and scoliotic
 Chondrodystrophic dwarf pelvis
 Generally contracted
 Assymetrical, disease of hip or spine or Naegele’s
 Others: Osteomalacia, spondylolisthesis, Robert’s
pelvis,exostosis ,bony neoplasms.
Muscles and fascia in relation to pelvis organs.

1)Levator ani muscle

Its a broad thin muscle situated on the side of the pelvis.Its
formed from 3 muscle components.
=puborectalis
=pubococcygeus-this is divided into 3 parts:-the true
pubococcygeus,puborectalis,pubovaginalis(female) or
puboprostaticus(male)
=iliococcygeal
-most important which supports pelvic organs
-in combination with the coccygeal muscle,it forms the pelvic
floor(also called the pelvic diaphragm).
Functions of pelvic muscles and fascia
-support pelvic organs.
-pubovaginalis muscle –encleses the rectum and
vagina.supports the vagina and in turn other pelvic
organs.
-maintains intra-abdominal pressure in response to its
reflex changes.
-facilitates the anterior internal rotation of the
presenting part.
-responsible for vol luntary control of micturation and
defaecation.
-play an important role in sexual intercourse.
-they influence the passive movements of fetus through
the birth canal and relax to allow exit of fetus from
pelvis.
-puborectalis plays anncillary role in the action of the
external anal sphincter.
-ischiococcygeus help to stabilize the sacroiliac and
sacral coccygeal joints.
-supports the weight of abdominal and pelvic organs.
Muscle layers of the pelvic floor
1)Superficial layer-has 5 layers
a)External anal sphincter-surround the anus and
attached behind to the coccyx.
b)Transverse perinial muscle-pass from the ischial
tuberosities to the center of perinium
c)Bulbocavenosus-pass from perinium forward and
surround the vagina to corporal carvenosus of clitoris
d)Ischiocarvenosus –
d)Membraneous sphincter of urethra
passes above and below the urethra and attached to the
pelvic bone
Deep layer
Formed by levator ani(3 pair of muscles )-because they
lift/elevate the anus.They form pelvic diaphragm.
a)Pubococcygeous –surrounds lower 1/3 of vagina.Some
of the fibres form sphincter of vagina.
b)ileococcygeous-originates from the fascia of the
obturator interna.
c)ischiococcygeous-from coccyx to ischial spines.
The perineum
Is a wedge shaped structure situated between the rectum
and the external genitalia.
Perineal body.
A fibromuscular body receiving attachments of the
posterior ends of the bulbocavenosus muscle.
-medial ends of the superficial and deep transverse
perineal muscles.
-anterior fibres from the external anal sphincter of the
anal triangle.
-its always involved with a 2nd degree perineal tear or
incised by an episiotomy.
FETAL SKULL
Division(landmarks) of the fetal skull:
 The vault, containing the cerebral hemispheres.is the large dome
shaped part above an imaginary line drawn btwn orbital ridges
and the nape of the neck.
 The base
 The face-composed of 14 firmly united bones.2 parietal,2
temporal,2 nasal,2 frontal,2 palatine ,2 zygomatic bones,occipital
and wings of sphenoid.
 The bones of the face and the base are incompessible
 Vault is from orbital ridges to nape of neck and is compressible
-the fetal skull is large in comparison with the true pelvis therefore
small adaptations btwn pelvis and skull mvt take place during
labour.
Ossification
Fetal head bones originates in 2 diff ways .
The bones of the vault are laid down in membrane and
are much flatter and more pliable.they ossify from the
center outwards and this process is incomplete at birth
leaving small gaps-sutures and fontanelles.The
ossification center appears as a boss or protuberance.
Bones of the vault
Are 5 main bones
-1 occipital bone
-2 parietal bones
-2 frontal bones
Occipital bone
-lies at the back of the head
-contributes to the base of the skull as it contains the
foramen magnum which protects the spinal cord.at the
center is the occipital protuberance.
2 parietal bones
-Lies on either side of the skull.
-The ossification center of each is called parietal
emminence.
2 frontal bones
-forms the forehead or sinciput.At the center of each is a
frontal boss/emminence.
-they fuse into a single bone by 5 yrs of age.
Fontanelles and sutures
•Frontal suture between the 2 frontal bones.
•Coronal suture; between the frontal and parietal bones.
•Sagittal suture; between the 2 parietal bones.
•Lamboidal suture; between the occipital bone behind and
the parietal and temporal bones in front.
•Temporal suture; between the temporal and parietal bones.
•The anterior fontanelle or Bregma; is the large diamond
shaped depression at the anterior end of the cranium where
frontal, coronal and sagittal sutures meet. AP diameter is abt
2.5-3cm and transverse diameter is abt 1.5-2cm.It allows
moulding in labour and growth of the skull after birth. It closes
at 18 months of age.
•The posterior fontanelle; the posterior fontanelle is a
smaller triangular space at the posterior end of the cranium
where the sagittal suture meets the lamboidal sutures.ossifies
abt 6wks.measures abt 1.2 by 1.2 cm.

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