Anatomy of pelvis in relation to

obstetrics and of the fetal skull

Dr Mu Mu Win
Senior Lecturer
Faculty of Medicine
UiTM
 The bony pelvis
Bones forming the pelvis:
1.hip bones, left and right
a.pubic
b.ilium
c.ischium
2.sacrum
3.coccyx
 Aspects of pelvic architecture
In a normal pelvis:

• Anterior superior iliac spines and the

pubic symphysis are in the same
coronal plane
 The bony pelvis
Anatomical position of the pelvis
• Longitudinal axix of the
symphysis is parallel to
sacrum

• Tip of the coccyx and the

upper margin of the pubic
symphysis lie in the horizontal
plane
 The pelvic inclination
• Angle that any pelvic plane
makes with the horizontal line

Plane of the pelvic inlet(brim)

• Is directed downward and

Vertical plane
forward from the sacral

Pla
inle
promontry to the pubic

ne
t
of
symphysis
Plane
of outle
t
• Forms an angle of about 60
degrees with the horizontal Horizontal plane

plane

• In negros , this angle may

approach 90 degrees and the
fetal head may be slow to
engage during labour
 The pelvic inclination

Plane of the plevic outlet

Vertical plane
Pla
inle
ne
•

t
inclined about 25 degrees

of
to the horizontal line
Plane
of outle
t

Horizontal plane
 The pelvic axis
Axis of the pelvic cavity(Axis of the
birth canal)
• The axis of the birth canal is the
path followed by the fetal head in
its course through the pelvic
cavity
• It extends downward and
backward in the axis of the inlet
(ie. at a right angle to the plane
of the inlet ) as far as the ischial
spine
• The axis turns downward and
forward ,at a right angle and
parallel to the plane of the inlet
 The bony pelvis

Joints of the pelvis:

• I .Lumbo-sacral joints
• ii. Sacro-iliac joints
• iiii.Sacro-coccygeal joints
• Iv.Pubic symphysis
 The bony pelvis

Divisions of the pelvis:

1. Pelvis major (False pelvis ,
Greater pelvis)
i. Ala of the sacrum
ii. Iliac fossa

2. Pelvis minor (True pelvis ,

Lesser pelvis )
i. an upper pelvic apature
(pelvic inlet)
ii. a cavity ( pelvic cavity)
iii.a lower pelvic aparture
( pelvic outlet)
 Planes and diameters of the pelvis

True pelvis has three planes

of obstetrics significance

Vertical plane
• The inlet

Pla
inle
• Planes of least dimensions

ne
t
of
– or the mid plane
• The outlet Plane
of outle
t

Horizontal plane
The pelvic cavity extends from
the inlet to the outlet
 Planes and diameters of the pelvis
Pelvic inlet
• Pelvic brim is the boundary line
between the pelvic major and the
pelvic minor (ie. The boundary line
between the abdominal and pelvic
cavities)
• The pelvic cavity is composed of:
a. promontry of sacrum
b. anterior border of ala of sacrum
c. arcuate line of ilium
d. pectinial line of pubis
e. pubic crest
f. upper end of pubic symphysis
 Planes and diameter of the pelvis
Diameter of the pelvic inlet
• 6 diameters of the inlet are
customarily described

a. Anatomical conjugate (true

conjugate,)

• Antero-posterior diameter
extending from middle of
sacrum promontry to middle of
the upper margin of the
symphysis pubis
• Normally 11 cm, of no
obstetric significance
 Planes and diameter of the pelvis
b. Obstetric Conjugate
• Obstetrically important antero
posterior diameter
• Shortest distance from the sacral
promontry and the symphysis
pubis
• Generally drawn from the middle
of the sacral promontry to the
closest point on the convest
posterior surface of the
symphysis pubis
• Approx; 11 cm
• Represent the actual space
available to the fetus in
negiotiating the pelvic inlet
• If OC less than 10 cm, it is
considered contracted pelvis
 Planes and Diameter of the Pelvis

C. Diagonal Conjugate
• Extend from the midpoint of
sacral promontory to the
midpoint of the inferior margin
of the symphysis pubis
• Approx 12.5 cm
• It is the only diameter of the
inlet that can be measured
clinically
• By subtracting 1.5 cm from
the DC, approx length of the
OC can be obtained
Diagonal conjugate
 Planes and diameter of the pelvis
d. Transverse diameter

• Widest distance between the

iliopectineal line which is
Transverse
perpendicular to the AP diameter diameter
• Approx; 13.5 cm

e. Oblique diameter
Oblique diameter

• Extend from one sacroiliac joint

to opposite iliopectineal
eminence Anteroposterior
diameter
• Designated right or left according
to the sacroiliac joint from which
it originates
• Approx; 12.75 cm
 Planes and diameter of the pelvis

Midplane (plane of the least

dimensions)
• Bounded;

• A. anterior – middle of the

symphysis pubis

• B. lateral- pubic bone,

obturator fascia, inner aspect
of the ischial bones and
spines

• C. posterior- junction of the 2nd

and 3rd sections of the
sacrum
 Planes and diameter of the pelvis

Midplane
• A.Transverse diameter
• B. anterioposterior diameter

• Distances similar at 12 cm
• Ischial spines are palpable
vaginally
Assessing descent of the fetal head by
vaginal examination
 Planes and diameter of the pelvis

Pelvic outlet
Boundaries of the pelvic outlet:
• Lower margin of the symphysis
pubis,
• on each side by the descending
ramus of the pubic bone, the
ischial tuberosity and the
sacrotuberous ligament,
• Last piece of the sacrum
 Planes and diameter of the pelvis
Pelvic oulet
• Anterioposterior diameter of
the outlet_ measures from
inferior margin of the
symphysis pubis to last piece
of the sacrum.
• Approxi; 13.5 cm
• Because the coccyx is usually
pushed out of the way by the
advancing presenting part ,its
not included in measurements
of the outlet for obstetrics
purpose
• Bituberous diameter –distance
between inner aspects of the
ischial tuberosities
• Transverse diameter is 11 cm
 Classification of the pelvic type
Based on the shape of the
pelvic inlet

• A. Anthropoid

• B. Platypelloid

• C. Android

• D. Gynaecoid
 Classification of pelvic type

A. Gynaecoid(50%)

• Normal female pelvis and ideal for

childbearing
• Has a round or transverse oval
inlet
• Transverse diameter is greater
than anterioposterior diameter
• 13.5 cm > 11 cm
• Forepelvis is wide and round
• Side walls are straight
• Sacraum usually well curve
• Wide sacrosciatic notch
• Ischial spines are everted (blunt)
• Pubic arch is wide
• Engagement occurs in the transverse or oblique anterior position followed by
descend, anterior rotation and spontaneous vaginal delivery
B. Android (20%)

• Typical male type pelvis

• Bone structure is heavy in comparison with other 3 pelvic types
• Inlet is heart shaped or wedge- shape with a narrow and angulated
forepelvis
• Prominent sacral promontry
• Sacrum bone is long, flat and inclined forward
• Side walls are convergent producing a funnel pelvis
• Sacrosciatic notch is narrow
• Ischial spines are inverted and prominent
• Pubic arch is narrow
• Engagement usually occurs in transverse or posterior postion
• Frequent outcome is deep transverse arrest or arrest as an occipitoposterior
with failure of rotation
Deep transverse arrest
Differences between Gynaecoid and Android Type
C. Anthropoid (25%)

• Inlet is oval, with the AP diameter is much longer than transverse diameter
• All the AP diameters are longer and all transverse diameters are shorter than in
comparison with the average gynaecoid pelvis
• Forepelvis is oval and more narrow than in gynaecoid pelvis
• Side walls are generally straight
• Ischial spines are usually not encroaching
• Pubic arch is normal or relatively narrow but well shaped
• sacrum has an average curvature with a wide sacrosciatic notch ,thus creating an
increased space in the post pelvis
• Engagement usually occurs in the anterioposterior or oblique diameter and
occipitoposterior are common
• Fetuses in OP usually descend and deliver without rotating
• Progress is good for spontaneous vaginal delivery with increased frequency of OP
deliveries
D. Platypelloid type (<3%)

• Flat pelvis _ rare

• Inlet is transverse oval (transverse diameter is longer than AP diameter)
• Characteristics of this pelvis are those of a gynaecoid pelvis that has been
compressed in the anteriorposterior direction
• All the transverse diameters are long and all AP diameters are short
• If engagement occour ,it is transverse position , often with marked acyclinism
• Frequently there is associated with an increased risk of obstructed labour (eg;
Brown presentation)
 Clinical pelvimetry

Pelvimetry:
Measurement of the dimensions and
capacity of the pelvis
• more accurate accomplished by
radiographic pelvimetry, however

Diagonal
Conjugate
risks of radiation to fetus
• Clinical pelvimetry – entails using
hands to measure :
– certain pelvic diameter
– Pelvic architecture
– Predict the adequacy of the
pelvis for a particular fetus
• Fetal skull bone
 Fetal relationship

• Engagement –the fetal is engaged if the widest leading part (typically

the widest circumference of the head) is negotiating the inlet.

• Station –Relationship of the leading bony part of the fetus to the

maternal ischial spines. If at the level of spines, it is at “zero” 0 station, if
it passed it by 2 cm, it is at +2 station.

• Attitude– Relationship of the fetal head to spine,flexed, “ neutral”

(military) or extended attitudes are possible.

• Position– Relationship of the presenting part to maternal pelvis, ie.

ROP=Rt occiput posterior, LOA=Lt occiput anterior
 Fetal relationship

• Presentation –Relationship between the leading fetal

part and the pelvic inlet; cephalic, breech or shoulder
presentation

• Lie – Relationship between the longitudinal axis of fetus

and mother; longitudinal , oblique and transverse

• Caput or Caput succedaneum: edema typically formed

by the tissue overlying the fetal skull during the vaginal
delivery process.
Different positions of the fetal head