DIAMETERS OF MATERNAL

PELVIS AND FETOPELVIC

RELATIONSHIP
HUDHA MEHJABIN
2020 BATCH
 MATERNAL PELVIS-
OUTLINE
1.Composition of the bony pelvis
2.Pelvic anatomy
true pelvis
false pelvis
3.Planes of the bony pelvis
inlet
midpelvis
outlet
COMPOSITION OF THE BONY
PELVIS
 COMPOSITION OF THE BONY
PELVIS
PELVIC ANATOMY
• 1.FALSE(GREATER)PELVIS
• ABOVE LINEA TERMINALIS
• POSTERIOR:LUMBAR VERTEBRA
• LATERAL:ILIAC FOSSAE
• FRONT:LOWER ANTERIOR ABDOMINAL WALL
2.TRUE(LESSER)PELVIS
• BELOW LINEA TERMINALIS
• SUPERIOR:LINEA TERMINALIS
• POSTERIOR:PROMONTORY AND ALAE OF THE SACRUM
• ANTERIOR:UPPER MARGIN OF PUBIC BONES,ASCENDING SUPERIOR RAMI OF THE ISCHAIAL
BONES AND OBTURATOR FORAMINA
• INFERIOR:PELVIC OUTLET
• LATERAL:INNER SURFACE OF ISCHIAL BONES AND SACROSCIATIC NOTCHES AND LIGAMENTS
5
OBSTETRIC PLANES AND DIAMETERS
• THE PELVIS IS DESCRIBED AS HAVING FOUR IMAGINARY PLANES
1.PLANE OF THE PELVIC INLET-THE SUPERIOR
STRAIT.
2.PLANE OF THE PELVIC OUTLET-THE INFERIOR
STRAIT.
3.PLANE OF THE MIDPELVIS-THE LEAST PELVIC
DIMENSIONS.
4.PLANE OF GREATER PELVIC DIMENSION-OF
NO OBSTETRICAL SIGNIFICANCE
OBSTETRIC PLANES AND DIAMETERS
 1.PELVIC INLET

• FORMS THE BRIM OF THE TRUE PELVIS

• ALSO CALLED THE SUPERIOR STRAIT
• THE PELVIC INLET IS ALSO THE SUPERIOR PLANE OF THE TRUE PELVIS
• HAS 4 DIAMETERS:
1.ANTEROPOSTERIOR(AP)
A)DIAGONAL CONJUGATE
B)TRUE CONJUGATE
C)OBSTETRIC CONJUGATE
2.TRANSVERSE
3.OBLIQUES(2)
 PELVIC INLET:ANTEROPOSTERIOR
DIAMETER

1.DIAGONAL CONJUGATE:
• DISTANCE BETWEEN LOWER BORDER OF SYMPHYSIS
PUBIS
TO MIDPOINT OF SACRAL PROMONTARY
• MEASURE APPROX. 12 CM
• THE ONLY AP DIAMETER THAT CAN BE MEASURED
CLNICALLY
 PELVIC INLET:ANTEROPOSTERIOR
DIAMETER
2.TRUE OR ANATOMICAL CONJUGATE
• DISTANCE BETWEEN UPPER MARGIN OF
SYMPHYSIS PUBIS TO MIDPOINT OF SACRAL
PROMONTORY
• MEASURE APPROX. 11 CM
• MEASURED INDIRECTLY BY SUBSTRACTING 1.2 CMS
FROM THE DIAGONAL CONJUGATE
 PELVIC INLET:ANTEROPOSTERIOR
DIAMETER

3.OBSTETRIC CONJUGATE
• DISTANCE BETWEEN MIDPOINT OF
INNER SURFACE OF SYMPHYSIS PUBIS
TO MIDPOINT OF SACRAL PROMONTORY
• THIS CLINICALLY IMPORTANT OBSTETRICAL CONJUGATE
IS THE SHORTEST DISTANCE BETWEEN
THE SACRAL PROMONTORY AND THE SYMPHYSIS PUBIS.
• MEASURE APPROX. 10 CM.
• MEASURED INDIRECTLY BY SUBTRACTING 1.5 TO
2 CMS FROM THE DIAGONAL CONJUGATE.
PELVIC INLET TRANSVERSE
DIAMETER
• CONSTRUCTED AT RIGHT ANGLES TO THE
OBSTETRICAL CONJUGATE AND REPRESENTS THE
GREATEST DISTANCE BETWEEN
THE LINEA TERMINALIS ON THE EITHER SIDES.
• IT USUALLY INTERSECTS THE OBSTETRICAL
CONJUGATE AT A POINT APPROXIMATELY 5 CM
IN FRONT OF THE PROMONTORY.
• AVERAGE:13 CM.
• DIVIDES THE INLET INTO ANTERIOR AND POSTERIOR SEGMENTS.
 PELVIC INLET:OBLIQUE
DIAMETERS
• EXTEND FROM THE SACROILIAC JOINTS TO THE
OPPOSITE ILIOPUBIC EMINENCE.
• MEASURES < 13 CM
PLANES OF THE GREATEST PELVIC
DIAMETER
• CORRESPONDS TO THE ROOMIEST PLANE OF THE PELVIS.
• POSTERIOR:3RD TO 4TH SACRAL VERTEBRAE
• LATERAL:ISCHIAL BONES
• ANTERIOR:MIDDLE SURFACE OF SYMPHYSIS PUBIS
• ITS AP DIAMETER AND TRANSVERSE DIAMETERS AVERAGE 12.5 CM
 MIDPELVIS
• MEASURED AT THE LEVEL OF THE ISCHIAL SPINES
• ALSO CALLED THE MIDPLANE OR PLANE
OF LEAST PELVIC DIMENSIONS
• DURING LABOUR, THE DEGREE OF THE FETAL
HEAD DESCENT INTO THE TRUE PELVIS MAY
BE DESCRIBED BY STATION, AND THE MIDPELVIS
AND ISCHIAL SPINES SERVE TO MARK ZERO STATION.
• THE ANTEROPOSTERIOR DIAMETER THROUGH
THE LEVEL OF THE ISCHIAL SPINES NORMALLY
MEASURES AT LEAST 11.5 CM.
 MIDPELVIS

• EXTENDS FROM THE LOWER MARGIN OF THE SYMPHYSIS

PUBIS,THROUGH THE LEVEL OF THE ISCHIAL SPINES,UP TO THE TIP
OF THE SACRUM.
• TRANSVERSE DIAMETER:DISTANCE BETWEEN THE ISCHIAL SPINES
(10.5 CM)-INTERSPINOUS DIAMETER.
• THE INTERSPINOUS DIAMETER(STATION 0,WHEN THE BIPARIETAL
DIAMETER OF FETAL HEAD PASSES THE DIAMETER)IS 10 CM OR
SLIGHTLY GREATER, IS USUALLY THE SMALLEST PELVIC DIAMETER.
 MIDPELVIS

• SUSPICION OF MIDPELVIS CONTRACTION IS POSSIBLE WITH

• THE FOLLOWING:

1.PROMINANCE OF THE ISCHIAL SPINES.

2.PELVIC SIDEWALLS ARE CONVERGENT.
3.CONCAVITY OF THE SACRUM IS SHALLOW.
4.BI-ISCHIAL DIAMETER OF THE OUTLET IS <8CM
 PELVIC OUTLET

• OUTLET IS BOUNDED
ANTERIORLY: PUBIC ARCH
LATERALLY: ISCHIOPUBIC RAMI,ISCHIAL TUBEROSITY AND
SACROTUBEROUS LIGAMENT.
POSTERIORLY:TIP OF THE COCCYX
 PELVIC OUTLET

• THE PELVIC OUTLET CONSISTS OF TWO APPROXIMATELY TRIANGULAR

AREAS.

• POSTERIOR TRIANGLE
• ANTERIOR TRIANGLE
• THEY HAVE A COMMON BASE, WHICH IS A LINE DRAWN BETWEEN THE
TWO ISCHIAL TUBEROSITIES.
• CLINICALLY, THREE DIAMETERS OF THE PELVIC OUTLET USUALLY ARE
DESCRIBED-THE ANTEROPOSTERIOR,TRANSVERSE AND POSTERIOR
SAGITTAL.
1.ANTEROPOSTERIOR DIAMETER - 12 CM
LOWER MARGIN OF PUBIC SYMPHYSIS TO THE SACROCOCCYGEAL
JUNCTION
2.TRANSVERSE DIAMETER – 10.5 CM
BETWEEN INNER EDGES OF THE ISCHIAL TUBEROSITIES
3.POSTERIOR SAGITTAL DIAMETER – 7 CM
MIDDLE OF TRANSVERSE DIAMETER TO THE SACROCOCCYGEAL
JUNCTION
CALDWELL-MOLOY ANATOMICAL CLASSIFICATION
OF THE PELVIS

• BASED ON PELVIC SHAPE

GYNECOID
ANTHROPOID
ANDROID
PLATEYPALOID
• ITS CONCEPTS AIDS AN UNDERSTANDING OF LABOUR MECHANISMS.
• THE POSTERIOR SEGMENT DETERMINES THE TYPE OF PELVIS, WHERE AS
THE ANTERIOR SEGMENT DETERMINES THE TENDANCY.
• EG:A GYNECOID PELVIS WITH AN ANDROID TENDENCY-POSTERIOR PELVIS
IS GYNECOID AND THE ANTERIOR PELVIS IS ANDROID SHAPED-MIXED
TYPES.
CALDWELL-MOLOY CLASSIFICATION
PELVIC SHAPES

)
CALDWELL-MOLOY CLASSIFICATION
PELVIC SHAPES
CALDWELL-MOLOY CLASSIFICATIO
PELVIC SHAPES

PELVIC SHAPES:
PELVIC SHAPES:
(CALDWELL-MOLOY CLASSIFICATION)
CALDWELL-MOLOY
CLASSIFICATION
 TYPES OF
FETOPELVIC
RELATIONSHIPS
 FETOPELVİC RELATİONSHİP DESCRİBED
İN TERMS OF
• LİE
• PRESENTATİON
• PRESENTİNG PART
• ATTİTUDE
• DENOMİNATOR
• POSİTİON
• CEPHALİC PROMİNENCE
 LİE
▪ THERELATIONSHIP B/W THE LONG AXIS OF
FETAL OVOID TO THE LONG AXIS OF UTERINE
OVOID

LONGITUDINAL LIE

TRANSVERSE LIE

OBLIQUE LIE
 PRESENTATİON

▪ THAT PART OF THE FETUS THAT LIES OVER THE PELVIC INLET
& OCCUPIES THE LOWER POLES OF THE UTERUS
▪ 3 PRESENTATION

CEPHALIC

PODALIC/BREECH

SHOULDER
PRESENTING PARTS
THE MOST DEPENDANT PART OF THE FETUS, WHICH IS FELT FIRST ON
VAGINAL EXAMINATION
IN CEPHALIC PRESENTATION DEPENDING UPON DEGREE OF FLEXION,
VERTEX
BROW
FACE
DEFLEXED HEAD
 IN BREECH PRESENTATION
• FLEXED BREECH (FETAL LEGS MAY BEFLEXED)
• EXTENDED BREECH (EXTENDED ATKNEES)
• FOOTLING BREECH (COMPLETELY EXTENDED)
 ATTITUDE
THE RELATION OF FETAL PARTS TO EACH
OTHER MAIN ATTITUDES FLEXION
EXTENSION
• TYPICAL FETAL ATTITUDE
UNIVERSAL FLEXION
• WITH HEAD FLEXED OVER CHEST,
• ARMS & LEGS FLEXED IN FRONT OF THE BODY
• AND BACK CURVED FORWARD
ANTEROPOSTERIOR DIAMETERS
OF THE FETAL SKULL
 DENOMİNATOR
▪ AN ARBITRARILY CHOSEN POINT ON THE PRESENTING
PART OF THE FETUS WHICH IS USED TO DESCRIBE THE
POSITION.
FREQUENCY OF LİE AND
PRESENTİNG PART
 POSİTİON

• THE RELATİONSHİP OF THE

DENOMİNATOR TO THE 4
QUADRANTS OF MATERNAL PELVİS
IN VERTEX PRESENTATION

• LEFT OCCIPITOANTERIOR(COMMON)
• LEFT OCCIPITOTRANSVERSE
• LEFT OCCIPITOPOSTERIOR
• RIGHT OCCIPITOANTERIOR
• RIGHT OCCIPITOTRANSVERSE
• RIGHT OCCIPITOPOSTERIOR
CEPHALİC PROMİNENCE
• THE MOST PROMINENT PART OF THE HEAD PALPABLE PER
ABDOMEN
• PRODUCED BY FLEXION AND EXTENSION OF THE HEAD
• WHEN NO CEPHALIC PROMINENCE IS FELT, THERE IS
NEITHER FLEXION NOR EXTENSION AND THE ATTITUDE IS
ONE OF DEFLEXION. THIS IS ALSO CALLED MILITARY
POSITION
• LONGITUDINAL LIE COMMONER -FETUS BEING
AN OVOID ACCOMMODATES ITSELF EASILY
ALONG THE LONG AXIS OF THE UTERINE OVOID
• CEPHALIC PRESENTATION COMMONER -THE HEAD
BEING HEAVIER AND MORE COMPACT, DUE TO
GRAVITATION, COMES TO OCCUPY LOWER POLE
AND BULKIER BREECH ADAPTS TO THE FUNDUS
OF UTERUS, WHICH IS ROOMIER
MOULDİNG
• CRANIAL BONES CONNECTED BY MEMBRANE
• THIS ALLOWS CONSIDERABLE SHIFTING OR SLIDING OF
EACH BONE TO ACCOMMODATE TO THE MATERNAL PELVIS
• FRONTAL AND OCCIPITAL BONE PASS UNDER PARIETAL
BONE
• POSTERIOR PARIETAL IS SUBJECT TO MORE PRESSURE BY
THE SACRAL PROMONTORY, IT PASSES UNDER ANTERIOR
PARIETAL.
CLİNİCAL SİGNİFİCANCE

• 1. SOME AMOUNT OF MOULDING IS BENEFICIAL AND

THIS IS ONE OF THE FACTORS THAT DECIDE THE SUCCESS
OF A TRIAL OF LABOUR.
• 2. SEVERE MOULDING CAN LEAD TO INTRACRANIAL
HAEMORRHAGE.
• 3. THE SITE OF MOULDING GIVES INFORMATION ABOUT
THE POSITION OF THE HEAD IN UTERO.
THANK
YOU