ANATOMI PELVIS

Dr. dr. Mohd. Andalas SpOG.FMAS

 Introduction
• Pelvis
• Pelvic floor
• External genitalia
• Internal genitalia
• Vessel and nerve and lymph
• Adjacent organs
Pelvis
 Bony pelvis
• Composition: formed by
paired hip bones, sacrum, os ilium
coccyx, and their
articulations
• Terminal line ( pelvic
inlet): formed by
promontory of sacrum,
arcuate line, pectin of
pubis, pubic tubercle,
upper border of pubic
symphysis os sacrum
• Pelvic outlet: formed by
tip of coccyx, os coccyx
sacrotuberous ligament,
ischial tuberosity, ramus
of ischium, inferior
ramus of pubic os pubis
symphysis
os ischium
Anteroposterior view of a normal female pelvis. Anteroposterior (AP) and
transverse (T) diameters of the pelvic inlet are illustrated
 The True Pelvis
• The posterior boundary is the anterior surface of the sacrum
• the lateral limits are formed by the inner surface of the
ischial bones and the sacrosciatic notches and ligaments.
• In front, the true pelvis is bounded by the pubic bones, the
ascending superior rami of the ischial bones, and the
obturator foramen.
• The ischial spines are of great obstetrical importance because
the distance between them usually represents the shortest
diameter of the pelvic cavity, as valuable landmarks in
assessing the level to which the presenting part of the fetus
has descended into the true pelvis
Pelvic Inlet
 Midpelvis
• The midpelvis is measured at the level of the
ischial spines
• important following engagement of the fetal
head in obstructed labor.
• The interspinous diameter, 10 cm or slightly
greater, is usually the smallest pelvic
diameter.
• The anteroposterior diameter through the
level of the ischial spines normally measures
at least 11.5 cm.
Pelvic Outlet
 Ligaments
Iliopectineal Line

Sacrotuberous Greater
Ligament Sciatic
Sacrospinous
Ligament Foramen

Lesser
Sciatic Sacrospinous
Foramen Ligament

Sacrotuberous Ligament
 Types of pelvis
• The gynecoid type
Round, slightly ovoid or elliptical inlet. adequate sacrosciatic notch.
wide interspinous diameters(≥10cm). 52%-58.9%

• The platypelloid type

Distinct oval inlet. very wide subpubic arch. 23.2%-29%
• The anthropoid type
Long, narrow, oval inlet. extended and narrow anterior and posterior segment. wide
sacrosciatic notch. long , narrow sacrum. Straight side walls.

• The android type

External Genitalia
 External Genitalia
• The external genitalia lie outside the true
pelvis.
• Perineum, mons pubis, clitoris, urethral
(urinary) meatus, labia majora and
minora, vestibule, greater vestibular
(Bartholin) glands, Skene glands, and
periurethral area.
• The boundaries of vulva include the mons
pubis anteriorly, the rectum posteriorly,
and the genitocrural folds (thigh folds)
laterally.
 Internal Genitalia

The internal genitalia are those organs that are within the true pelvis.
 Vagina
Strong canal of muscle (7.5cm)
• Extend from the uterus to the vestibule of the external genitalia. its long
axis is almost parallel with that of the lower part of the sacrum. the
anterior wall of the vagina is 1.5-2cm shorter than the posterior wall.
Vaginal fornix: the circular cul-de-sac formed around the cervix 4 regions:
the anterior fornix, the posterior fornix and 2 lateral fornices.
Wall structure
mucosal layer (stratified squamous epithelium)
muscular layer (3 layer)
submucous area ( with a dense plexus of veins and lymphatics)
 Cervix
• lower 1/3 of uterus. connects uterus to
vagina via endocervical canal
• External os: opening of endocervical
canal to ectocervix
• Internal os: indistinct upper limit of
endocervical canal
 Uterus
Pear-shaped,thick-walled, muscular organ
Body and cervix: Babyhood 1:2, manhood 2:1
Layers of uterine wall
The serous layer (perimetrium), from peritoneum
Thin and firmly adherent over the fundus and most of the body
Uterovesical pouch of the peritoneum
Rectouterine pouch of the peritoneum (pouch of Douglas)
The muscular layer
Outer layer (longitudinal fibers)
Inner layer (interlaced and various directions)
The mucous layer (endometrium)
• Functional zone – layer closest to the cavity – contains majority of
glands. Thicker portion – undergoes changes with monthly cycle
• Basal zone – layer just under myometrium, attaches functional layer to
myometrial tissue, has terminal ends of glands.
 Oviduct
Anatomy
• Interstitial portion:
• Isthmic portion: narrow
• Ampulla: wide and tortuous
• Fimbria: funnel-shaped mouth
Layers of wall
• Serous
• Muscular: outer longitudinal and inner
circular
• Mucous: ciliated columnar epithelium,
coarse longitudinal folds
 Ovary
Anatomy
• Paired organ, elliptic
• The suspensory ligament of the ovary
• The ovarian ligament
Structure of ovary
• Covered by cuboid or low columnar epithelium
• Consist of a cortex and a medulla
• Cortex: oocytes in various stages of maturity.
• Medulla: fibers, smooth muscle cells, blood vessel,
nerves.
 Ligaments
1. Cardinal ligament
2. Utero-sacral ligament
3. Broad ligament
4. Round ligament
 Common iliac artery

• Common iliac artery

• Continuation of
abdominal aorta at
level of L4 vertebra
• Terminates in front of
sacroiliac joint by
dividing into internal
and external iliac
arteries
 Internal iliac artery

Parietal iliac
artery
• Obturator a.
• Iliolumber a.
• Lateral sacral a.
• Superior gluteal a.
• Inferior gluteal a.
Visceral branches
• Umbilical a→ superior vesical a.
• Inferior vesical a.
• Uterine A, about 2cm from neck
of uterus it crosses above and in
front of ureter
• Inferior rectal a.
• Internal pudendal a.
Pelvic blood supply.
 Pelvic floor Tissues
Outer layer
• Bulbocavernosus muscle
• Ischiocavernosus muscle
• Superficial transverse perineal muscle
• External anal sphincter
Mid layer: urogenital diaphragm
Inner layer (pelvic diaphragm)
• the main support of the pelvic floor
• formed by the levator ani and coccygenus muscles and
covering fasciae.
• Levator ani: pubococcygenus, iliococcygenus, puborectalis
 Pelvic floor
• The tissues closing down the pelvic outlet (muscles and
fasciae)
suspend and support the pelvic organs, such as uterus and
bladder and rectum
• Posterior part (urogenital triangle)urethra and vagina
pass through
• Anterior part (anal triangle)rectum pass through
• Perineum
general conception: the tissues closing down the pelvic outlet
Clinical conception: the tissues between vagina and anus
 Perineum
• Urogenital and Pelvic
Diaphragm

Urogenital Diaphragm
• Triangular in shape
• Attached laterally to
ischiopubic rami and ischial
tuberosities
• Formed by sphincter of
urethra, deep transverse
perineal muscle, superior
and inferior fascia of
urogenital diaphragm
• Origin or insertion of
several small muscles
and insertion of part
of pelvic diaphragm
• These muscles are:
– Sphincter ani externus
– Levator ani
– Superficial transverse
muscle perineum
– Deep transverse muscles
perineum
– Bulbocavernousus
 –
Special places
• Inguinal canal:
4 cm long running from Anterior superior iliac spine and pubic tubercle.
– Contains spermatic cord (or round ligament) and ilioinguinal nerve.
– Spermatic cord contains: 3 structures (vas deferens, cremaster muscle and pampiniform plexus), 3
arteries (artery to vas, artery to cramster and testicular artery) and 3 nerves (sympathetic,
parasympathetic and genitofemoral)
– Floor: fibres of external oblique = inguinal ligament
– Roof: transversus abdominis and internal oblique
– Anterior: external oblique and internal oblique
– Posterior: transversalis fascia and conjoint tendon
• Alcock’s canal:
– Where pudendal nerve, vein and inetrnal pudendal artery run.
– Formed by obturator internus fascia
– Runs on the lateral wall of ischiorectal fossa
– Femoral canal:
– Contains lymphatic vessels and cloquet’s lymph node
– Anterior border is inguinal ligament
– Posterior border is pectineal ligament
– Medial border is lacunar ligament
– Lateral border is femoral vein
– Site of bowel herniation

• Pubic tubercle:
• Herniae above ad medial are inguinal and those below and
lateral are femoral