Anatomy of the bony

pel is
pelvis
Lateefa Al Dakhyel FRCSC, FACOG
Assistant professor & consultant
Obstetric & gynecology department
Collage of medicine
Ki Saud
King
S d University
U i
it

Q.1- the clinically important important diameter in pelvic inlet is:

1-true conjugate
2-obesteric
2
obesteric conjugate
3-diagunal conjugate
4- all of the above

Q.2Q
2 mostt common ttype off pelvis
l i iis
1- gynecoid
2-anthropoid
3-platlypelloid
p yp
4-android

Q.3-the narrowest diameter in the pelvis is

1 interspinous
1-interspinous
2-anteroposterior of mid pelvis
3-oblique diameter
4.obestric conjugate

Q.4-Which statement is incorrect

1-adequcy of female pelvis for labor can be accurately assessed by CT scan
2 progress of labor is the true assessment of female pelvis
2.
3.labor dystocia can caused by android pelvis
4.intra labor pelvic assessment can be done

Female bonyy p
pelvis
False pelvis
lies above the linea terminalis (pelvic brim)
has no obstet
obstetrical
ical significance.
significance

True pelvis
Lies below linea terminalis (pelvic brim)
has important role in child birth
It has inlet, cavity & outlet

True pelvis
Pelvic

inlet

(superior strait)

boundaries: a. rami of Pubic bone, symphysis pubis

p.
p sacral promontory
p
y
l. linea terminalis
diameters:
1.anteroposterior
anteroposterior diameter

obstetrical conjugate:

shortest distance between the promontory and symphysis pubis

normally measures 10
10cm
cm or more.
(others: true conjugate & diagonal conjugate)
2.The transverse diameter
greatest distance between linea terminalis on either side
3.Rt & Lt oblique diameter
extend from one of the sacroiliac synchondroses to the iliopectineal
eminence on the other side

 Mid

pelvis

-at the level of ischial spines

-interspinous diameter usually ~
~10
10cm
cm
- Smallest diameter of the pelvis

Pelvic outlet

-boundaries a. the area under the pubic arch

p. the tip of the sacrum
l. ischial tuberosities
tuberosities,, sacrosciatic ligments
-diameters
1.Anteroposterior
Anteroposterior diameter(9
diameter(9.5-11
11..5)
from the lower margins of the symphesis pubis to the tip of the sacrum
2. The transverse diameter (11
(11cm)
cm)
th distance
the
di t
b
between
t
th
the iinner edges
d
off the
th ischial
i hi l tuberositis
t b
tuberositis.
iti .
3.The posterior sagittal diameter (>
(>7
7 .5 )
from the tip of the sacrum to the line between ischial tuberositis

Pelvic shapes
Caldwell
Caldwell--Moloy

classification

-A line drawn through

g the greatest
g
diameter of the inlet divides it to ant.
& post.

 Gynaecoid pelvis:
1.It is the commonest type (50
1.It
(50%)
%)
2.Inlet
2.
Inlet is slightly oval or round (TD~APD)
Sacrum is wide with average
g concavityy and
3.Sacrum
3.
inclination.
4.ischial
4.
ischial spines not prominent (transverse
diameter is = >10
>10cm)
cm)
5.Sacro
5.
Sacro--sciatic notch is wide.
6. wide pubic arch

 Anthropoid pelvis:
1.It makes 25
1.It
25%
% of white & ~ 50%
50% of nonwhite
women.
women
2.All
2.
All anteroposterior diameters are more than
transverse diameters (Oval anteroposteriorly)
3.Ischial
3.
Ischial spines mostly prominent.
4 Sacrum is long and narrow.
4.Sacrum
4.
narrow
5.Sacro
5.
Sacro--sciatic notch is wide.
6 Subpubic
6.Subpubic
6.
S b bi angle
l is
i narrow.

 Android pelvis :
1. It is~ 30
1.It
30%
% of white & ~15
~15%
% 0f nonwhite women.
2 Inlet is triangular or heart2.Inlet
2.
heart-shaped with anterior narrow
apex.
3.Side
3.
Side walls are converging (funnel pelvis) with projecting
ischial spines.
4.Sacro
4.
Sacro--sciatic notch is narrow.
5. Subpubic angle is narrow <90
5.Subpubic
<90o.
o.
6.The
6.
The extreme android pelvis have poor prognosis for
vaginal delivery.
delivery

 Platypelloid pelvis :
1.It is a flat female type
1
1.It
type, it is rarest ~3
~3% of
women only.
All anteroposterior
p
diameters are short.
2.All
2.
3.All
3.
All transverse diameters are long (oval
transverse)
4.Sacro
4.
Sacro--sciatic notch is narrow.
5.Subpubic angle is wide.
5.Subpubic
6.The
6.
The sacrum usually is well curved and rotated
backward.

 Intermediate
Intermediate--type
yp

pelvis
p

mixed types are much more frequent than pure types.

significant clinical points
-obstructed labor caused narrowing of midpelvis or pelvic
outlet
-obstetric conjugate can be measured radiological only,
diagonal
g
conjugate
j g
can be estimated clinically
-ischial spins can be felt with vaginal exam
-most important test for pelvic adequacy is labor progress it
self
lf

Clinical estimation of pelvic size

Best test of pelvic adequacy is progress of labor it self

History of vaginal delivery of average weight fetus means the pelvic is

adequate.
Pelvic inadequacy: -big baby
-small pelvis
-abnormal
abnormal position