Anatomy of The Female Pelvis and Vaginal Birth

Anatomy of the female pelvis
and
vaginal birth
© Royal College of Obstetricians and Gynaecologists

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.

Innominate bone

Sacrum

Coccyx

Sacroiliac joint

Sacrococcygeal
joint

Symphysis pubis

Ischial spine

Ileopectineal line

Obturator foramen

Pubic arch

Sacral promontory

Anterior foramina

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.

Anterior superior
iliac spine
Symphysis pubis
Vertical plane

Ileum
Pubis
Ischium

Acetabulum
Obturator foramen

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.

Sacrotuberous
ligament

Sacrospinous
ligament

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

Sacrospinous
ligament

Sacrotuberous
ligament

Greater sciatic
foramen
Lesser sciatic
foramen

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.

Piriformis

Piriformis

Obturator internus

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

Common Iliac A
Internal Iliac A

External Iliac A

Common Iliac V
Internal Iliac V

The Lumbosacral Plexus

Sciatic nerve

Pudendal nerve

Obturator nerve

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.

Sacrotuberous
ligament

Sacrospinous
ligament

Obturator canal

Obturator internus
Muscle
Covered by
Fascia

Pudendal canal
Line of
attachment of
levator ani
Critical pelvic
dimensions
Pelvic inlet

Critical pelvic
dimensions
Pelvic midplane

Critical pelvic
dimensions
Pelvic outlet

Female Male
Pelvic inlet
Pelvic outlet
Pelvic cavity
Pubic arch

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.

Iliac crest
Pelvic brim
Ischial tuberosity

Rectum

Obturator
Internus
With Fascia

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

Peritoneum

Subperitoneal
space

Contains:
Pubocervical
Trans cervical
Sacrocervical
Ligaments

Perineum
everything under
pelvic diaphragm © Royal College of Obstetricians and Gynaecologists
Ischiorectal fossae

Now look at the pelvis from below.
Look at the layout of the bones and the ligaments.
They define the pelvic outlet.

Obturator
membrane
Obturator canal

Pubic arch Symphysis pubis
Inferior pubic
ramus
Ischial ramus

Ischial tuberosity
Sacrotuberous
ligament
Sacrum / coccyx

Pelvic outlet

Urogenital
triangle
Anal triangle

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.

Bladder
Above the
Cervix Pelvic diaphragm
Rectum

Pubocervical
ligament Above the
Pelvic diaphragm

Above the
Pelvic diaphragm
Transverse
cervical ligament

Above the
Pelvic diaphragm
Sacrocervical
ligament

Pelvic diaphragm
Levator ani:
Pubococcygeus
Iliococcygeus
Ischiococcygeus
Coccygeus

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.

Urogenital
diaphragm
Superior layer
of fascia

Urogenital
diaphragm
Sphincter urethrae
Deep transverse
peroneal muscles

Perineal
membrane

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

Muscles in
Superficial pouch
Ischiocavernosus
Bulbospongiosus
Supl transverse
peroneal muscles

Perineal body

You have now reached the most superficial level.

Labium majus
Labium minus

Mons pubis
Prepuce of clitoris
Vestibule
vagina
Fourchette

Here is the female abdomen and pelvis viewed from one side.
The structures shown should now be familiar to you.

Peritoneum

Sacrocervical
ligament
Pubocervical
ligament

Pelvic diaphragm

Urogenital
diaphragm

Here is the rectum.
Look at its anatomical relations.

Rectum
Sacrum
Perineal body Anococcygeal

body

Puborectalis
Deep
Superficial
Subcutaneous

Take your fetal skull and view it from above.
Note the near central position of the anterior fontanelle.

parietal eminence
coronal sutures
frontal bones lambdoid sutures
occiput
anterior fontanelle
posterior fontanelle
saggital suture

The following slides will demonstrate the orientation of
the fetal skull as it passes through the pelvis in normal
labour.

passenger
the head flexes as the uterus contracts

the head descends and engages in the pelvis
the leading part approaches the ischial spines
passenger
the occiput starts to rotate anteriorly

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

the head extends to deliver
passenger
the head sits on the maternal perineum

passenger
the fetal head realigns itself with the fetal shoulders - restitution
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

Anatomy of The Female Pelvis and Vaginal Birth

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Anatomy of the female pelvis

© Royal College of Obstetricians and Gynaecologists

View it from the front.

In the following slides, the bony landmarks will be described.

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

In the following slides, more landmarks will be shown.

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

In the following slides, you will be shown a little more anatomy.

Look at the position of the sacrotuberous and sacrospinous ligaments.

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

Look at the position of the sacrotuberous and sacrospinous ligaments.

These delineate the greater and lesser sciatic foraminae.

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

You will see piriformis from front and back.

You will see obturator internus from the back.

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

Look at the pelvis from the front again.

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

You will see where the levator ani muscles originate.

You will also see the critical dimensions of the pelvis.

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

© Royal College of Obstetricians and Gynaecologists

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.