Anatomy of the female pelvis

and
vaginal birth

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Take a look at the bony pelvis you have been

given.
View it from the front.
In the following slides, the bony landmarks will
be described.

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Innominate bone

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Sacrum

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Coccyx

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Sacroiliac joint

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Sacrococcygeal
joint

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Symphysis pubis

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Ischial spine

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Ileopectineal line

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Obturator foramen

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Pubic arch

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Sacral promontory

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Anterior foramina

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Now look at the pelvis from one side.

In the following slides, more landmarks will be
shown.
You will also see how the pelvis is orientated
when a woman is standing up straight.

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Anterior superior
iliac spine

Symphysis pubis

Vertical plane

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Ileum

Pubis
Ischium

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Acetabulum
Obturator foramen

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Look at the pelvis from the front again.

In the following slides, you will be shown a little more
anatomy.
Look at the position of the sacrotuberous and
sacrospinous ligaments.

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Sacrotuberous
ligament

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Sacrospinous
ligament

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Look at the pelvis from behind.

Look at the position of the sacrotuberous and
sacrospinous ligaments.
These delineate the greater and lesser sciatic foraminae.

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Sacrospinous
ligament

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Sacrotuberous
ligament

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Greater sciatic
foramen
Lesser sciatic
foramen

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We are now going to add in some muscles.

You will see piriformis from front and back.
You will see obturator internus from the back.

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Piriformis

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Piriformis

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Obturator internus

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We are now going to add in blood vessels and nerves.

Look at the pelvis from the front again.

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Common Iliac A

Internal Iliac A

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External Iliac A

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Common Iliac V

Internal Iliac V

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The Lumbosacral Plexus

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Sciatic nerve

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Pudendal nerve

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Obturator nerve

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Look at the pelvis from the side.

We will look at the muscles and ligaments on the side wall
of the pelvis.
You will see where the levator ani muscles originate.
You will also see the critical dimensions of the pelvis.

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Sacrotuberous
ligament

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Sacrospinous
ligament

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Obturator canal

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Obturator internus
Muscle
Covered by
Fascia

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Pudendal canal

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Line of
attachment of
levator ani
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Critical pelvic
dimensions

Pelvic inlet

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Critical pelvic
dimensions

Pelvic midplane

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Critical pelvic
dimensions

Pelvic outlet

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Female

Male

Pelvic inlet

Pelvic outlet

Pelvic cavity

Pubic arch

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Look at the pelvis from the front again.

Imagine a coronal plane through the middle of the
pelvis.
You will see the rectum coming through the pelvis.
You will see where the levator ani muscles originate.
You will see which structures form the pelvic diaphragm.
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Iliac crest

Pelvic brim

Ischial tuberosity

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Rectum

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Obturator
Internus
With Fascia

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Levator ani

Plus coccygeus
Makes
Pelvic diaphragm
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There are some structures above the pelvic diaphragm.

There are some structures below the pelvic diaphragm.

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Peritoneum

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Subperitoneal
space

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Contains:
Pubocervical
Trans cervical
Sacrocervical
Ligaments

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Perineum
everything under
pelvic diaphragm

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Ischiorectal fossae
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Now look at the pelvis from below.

Look at the layout of the bones and the ligaments.
They define the pelvic outlet.

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Obturator
membrane

Obturator canal

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Pubic arch

Symphysis pubis
Inferior pubic
ramus

Ischial ramus

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Sacrotuberous
ligament

Ischial tuberosity

Sacrum / coccyx

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Pelvic outlet

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Urogenital
triangle

Anal triangle

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Keep looking at the pelvis from below.

Imagine the anatomy above the pelvic diaphragm.
The following slides show the structures encountered as
you descend through the pelvis.

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Bladder
Above the
Cervix

Pelvic diaphragm

Rectum

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Pubocervical
ligament

Above the
Pelvic diaphragm

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Above the
Pelvic diaphragm
Transverse
cervical ligament

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Above the
Pelvic diaphragm
Sacrocervical
ligament

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Pelvic diaphragm

Levator ani:
Pubococcygeus
Iliococcygeus
Ischiococcygeus
Coccygeus

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Keep looking at the pelvis from below.

Imagine the anatomy as you descend below the pelvic
diaphragm.
The following slides show the structures encountered as
you continue to descend through the pelvis.

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Urogenital
diaphragm

Superior layer
of fascia

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Urogenital
diaphragm
Sphincter urethrae

Deep transverse
peroneal muscles

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Perineal
membrane

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Structures in
Superficial pouch
Clitoris & crus
Bulb of vestibule
Vestibular glands

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Muscles in
Superficial pouch
Ischiocavernosus
Bulbospongiosus
Supl transverse
peroneal muscles

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Perineal body

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Keep looking at the pelvis from below.

You have now reached the most superficial level.

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Labium majus
Labium minus

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Mons pubis
Prepuce of clitoris
Vestibule

vagina

Fourchette

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Here is the female abdomen and pelvis viewed from one

side.
The structures shown should now be familiar to you.

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Peritoneum

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Sacrocervical
ligament
Pubocervical
ligament

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Pelvic diaphragm

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Urogenital
diaphragm

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Here is the rectum.

Look at its anatomical relations.

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Rectum
Sacrum
Perineal body

Anococcygeal
body

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Puborectalis
Deep
Superficial
Subcutaneous

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Take your fetal skull and view it from above.

Note the near central position of the anterior fontanelle.

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parietal
eminence

coronal
sutures
frontal
bones

lambdoid
sutures
occipu
t

anterior
fontanelle
saggital
suture

posterior
fontanelle

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The following slides will demonstrate the

orientation of the fetal skull as it passes
through the pelvis in normal labour.

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passenger

the head flexes as the uterus contracts

the head descends and engages in the pelvis
the leading part approaches the ischial spines
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passenger

the occiput starts to rotate anteriorly

the occiput reaches the pelvic floor (levator ani)
internal rotation continues to achieve an occipito-anterior position
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passenger

the occiput clears the symphysis pubis

the head extends to deliver
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passenger

the head sits on the maternal perineum

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passenger

the fetal head realigns itself with the fetal shoulders restitution
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passenger

the shoulders contact the pelvic floor and rotate so that the
bisacromial diameter lies in an anteroposterior orientation
the head therefore continues to rotate - external rotation
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