FEMALE PELVIS part 1 IN ENGLISH

                                              

                                    FEMALE PELVIS part 1 IN ENGLISH

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FEMALE PELVIS

›  It is a gynaecoid pelvis which is round through which the fetus passes during the process of birth. As it forms a bony canal, therefore , it is called as bony pelvis.

WHY TO STUDY EMALE PELVIS 

›  A knowledge of pelvic anatomy is needed for the conduct of labour as one of the ways to estimate the progress made is assessing the relationship of the fetus to certain pelvic landmarks.

›  A midwife must be competent to recognize a normal pelvis in order to  be able to detect deviations from normal and refer them to doctor.

FUNCTIONS OF FEMALE PELVIS

›  The primary function of the pelvis  is to allow movement of the body at hip joint , especially walking and running .

›  It permits the person to sit and kneel.

›  It is adapted for childbearing, and because of its increased width and rounded brim women are less speedy than men.

›  It transmits the weight of the trunk to the legs, acting and bridge between the femurs. This makes it necessary for the sacroiliac joint to be immensely strong and  immobile.

›  It also takes weight of the sitting body on the ischial tuberosities.

›  It provides protection to the pelvic and, to a lesser extent abdominal organ.

›  The sacrum transmits the cauda equina and distributes the nerves to the various parts of the pelvis.

PELVIC BONES

›  There are four pelvic bones:

1. Two innominate bone or hip bones 
2. One sacrum
3. One coccyx

›  Each innominate (hip) bone is composed of three parts:

1. The ilium
2. The ischium
3. The pubic bones

a) THE ILIUM :

›  It is the large flared - out part .

›  When  the hand is placed on the hip it rest on the ILIAC CREST, which is the UPPER BORDER.

›  At the front of the iliac crest  can be felt a  bony prominence  known as the ANTERIOR SUPERIOR ILIAC SPINE.

›  A short distance below there is the anterior INFERIOR ILIAC SPINE.

›  There are two similar points at the other end of the iliac crest, namely  the POSTERIOR SUPERIOR ILIAC SPINE and POSTERIOR INFIRIOR ILIAC SPINE.

›  The concave anterior surface of the ilium is the ILIAC FOSSA

b). THE ISCHIUM :

›  It is the thick lower part .

›  It has large prominence known as THE ISCHIAL TUBEROSITY, on which the body rest when sitting.

›  Behind and a little above the tuberosity is an inward projection, THE ISCHIAL SPINE. In labour the station of the fetal head is estimated in relation to the ischial spine.

c). THE PUBIC BONE :

›  It forms the anterior part .

›  It has two oar – like projection, the SUPERIOR RAMUS and the INFERIOR RAMUS.

›  The two pubic bones meet at the SYMPHYSIS PUBIS and the two inferior ramus form the PUBIC ARCH, merging into  a similar ramus on the ischium.

›  The space or hole enclosed by the body of the pubic bone, the rami and the ischium is called the OBTURATOR FORAMEN.

›  The innominate bone contains deep cup to receive the head of the femur. This is termed as ACETABULUM.

›  On the lower border of the innominate bone are found two curves. One extend from the posterior inferior iliac spine upto ischial spine and is called the GREATER SCIATIC NOTCH.

›  It is wide and rounded .

›  The other lies between the ischial spine and the ischial tuberosity and is the LESSER SCIATIC NOTCH.

THE SACRUM

›  It is wedge - shaped bone consisting of five fused vertebrae.

›  The upper border of the first sacral  vertebrae just forward and is known as the SACRAL PROMONTORY.

›  The anterior surface of the sacrum is concave and is referred to as the hollow of the sacrum.

›  Laterally the sacrum extends into a WING OR ALA OF SACRUM.

›  Four pairs of holes or formina pierce the sacrum and through these, nerves from the cauda equina emerge to supply the pelvic organs.

›  The posterior surface is roughened to receive attachments of muscles.

THE COCCYX

›  The coccyx is a vestigial tail. It consists of four fused vertebrae, forming a small triangular bone, which articulates with the fifth sacral segment.

PELVIC JOINTS

›  There are four pelvic joints:

1. One symphysis pubis
2. Two sacroiliac joints
3. One sacrococcygeal joint

1. THE SYMPHYSIS PUBIS :

it is formed at the junction of two pubic bones, which are united by a pad of cartilage.

2.THE  SACROILIAC JOINTS : these are the strongest joints in the body. They join the sacrum to the ilium and thus connect the spine to the pelvis.

3. THE SACROCOCCYGEAL JOINT: it is formed where the base of the coccyx articulates with the tip of the sacrum.

›  IN NON- PREGNANT STATE there is very little movement in these joints., but during pregnancy endocrine activity causes the ligament to soften , which allows the joint to move slightly.

›  This may provide more room for the fetal head as it pass through the pelvis.

›  The symphysis pubis may separate slightly in later pregnancy .

›  If it widens appreciably; the degree of movement permitted may give rise to pain on walking.

›  The sacroiliac joints allow a limited backward and forward movement of the tip and promontory of the sacrum, sometimes known as ‘nodding’ of the sacrum.

›  The sacrococcygeal joint permits the coccyx to be deflected backward during the birth of the head.

PELVIC LIGAMENTS

Each of the pelvic joints is held together by ligaments:

1. Inter-pubic ligaments at the symphysis pubis
2. Sacroiliac ligaments
3. Sacrococcygeal ligaments

›  There are other ligaments important in midwifery.

The Sacro-tuberous ligament

The sacro-spinous ligament

The sacro-tuberous ligament runs from the sacrum to the ischial tuberosity and the sacro-spinous ligament from the sacrum to the ischial spine.

these two ligaments (sacro-tuberous   and sacro-spinous) cross the sciatic notch and form the posterior wall of the pelvic outlet.

›  The pelvic joints are held together by very strong ligaments that are designed not to allow movement. However, during pregnancy the hormone relaxin gradually loosens all the pelvic ligaments allowing slight pelvic movement providing more room for the fetal head as it passes through the pelvis.