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Haider Al huliali Haider Al Ali

Normal Pelvis, types of female pelvis and fetal skull. Haider Al huliali Haider Al Ali. Pelvic anatomy. Bony pelvis : it is made up of four bones : the sacrum , coccyx , and two innominates (composed of the ilium , ischium ,and pubis). Joints.

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Haider Al huliali Haider Al Ali

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  1. Normal Pelvis, types of female pelvis and fetal skull Haider Al huliali Haider Al Ali

  2. Pelvic anatomy Bony pelvis : it is made up of four bones : the sacrum , coccyx , and two innominates (composed of the ilium , ischium ,and pubis).

  3. Joints

  4. Pelvis is divided into the false pelvis and the true pelvis • The true pelvis is a bony canal and is formed by the sacrum and the coccyx posteriorly and by the ischium and pubis laterally and anteriorly . • The posterior wall is twice the length of the anterior wall. • The true pelvis is area of concern because its dimensions are sometimes not adequate to permit passage of the fetus . • The false pelvis is bordered by the lumbar vertebrae posteriorly , an iliac fossa bilaterally ,and the abdominal wall anteriorly . • It supports the pregnant uterus .

  5. Pelvic planes • The pelvic inlet • The plane of greatest diameter • The plane of least diameter • The pelvic outlet

  6. Pelvic Diameters The diameters of the pelvic planes represent the amount of space available at each level .

  7. Pelvic Inlet Pelvic inlet has five important diameters : • The anteroposterior diameter : described by one of two measurements: • the true conjugate (anatomic conjugate ):from sacral promontory to superior pubis • obstetric conjugate: from sacral promontory to posterior pubis . • The transverse diameter : the widest distance between iliopectineal lines • Two oblique diameters :from sacroiliac joint to the opposite iliopectineal eminence • The posterior sagittal diameter: from AP & transverse intersection to the middle of sacral promontory

  8. Plane of Greatest Diameter • The anteroposterior diameter : from the midpoint of the posterior surface of pubis to the junction of S2 and S3 vertebrae . • The transverse diameter : widest distance between the lateral borders of the plane (upper part of obturator foramina )

  9. Plane of Least diameter (midplane ) • The anteroposterior diameter :extends from the lower border of the pubis to the junction of S4 and S5 . • The transverse (bispinous ) diameter : extends between the ischial spines . • The posterior sagittal diameter : from midpoint of bispinous diameter to the junction of S4 and S5

  10. Pelvic outlet • Anatomic anteroposterior diameter :from the inferior margin of pubis to tip of coccyx • Obstetric anteroposterior diameter : from inferior margin of pubis to sacrococcygeal joint . • Transverse diameter : between the inner surface of ischialtuberosities • Posterior sagittal diameter : from middle of transverse diameter to the sacrococcygeal joint .

  11. Pelvic Shapes Android 30% Gynecoid 50% Anthropoid 18% Platypelloid 2%

  12. Gynecoid • Round at the inlet • Side walls stright • Ischeal spines of average prominence • Well-rounded sacrosciatic notch • Well-curved sacrum • Spacious subpubic arch, with an angle of approximately 90 degrees Cylindrical shape

  13. Android • Triangular inlet • Convergent Side walls • Shallow sacral curve • Long and narrow sacrosciatic notch • Narrow subpubic arch • It is the typical male type

  14. Anthropoid • Long narrow oval inlet (AP>transverse) • Side walls that not converge • Ischial spines close, owing to overall shape • Variable, but usually posterior, inclination of the sacrum • Long sacrosciatic notch • Narrow, outwardly shaped subpubic arch

  15. Platypelloid • Oval-shaped inlet (AP<transverse) • Straight or divergent side walls • Ischial spines close, owing to overall shape • Posterior inclination of a flat sacrum • Wide bispinous diameter • A wide subpubic arch flat shape

  16. Clinical Pelvimetry • For assessment of obstetric capacity, most important measurements are: • Obstetric conjugate of inlet • Distance between ischial spines • Subpubic angle & bituberous diameter • Posterior sagittal of three planes • Curve & length of sacrum • - It is only an estimate • - The best time is late in pregnancy when the soft tissue are distensible

  17. Clinical Pelvimetry • palpate the SACRUM • It should be concave. Flat or convex is abnormal • midpelvis and pelvic outlet: can’t accurately be measured clinically but it can be estimated through clinical examination.

  18. X-ray Pelvimetry • Its purpose is to aid in determining the need for C-S. • Other factors affecting need for C-S include: Fetal size, Force of contractions, & Position of fetus, & degree of molding • It is an accurate measure • Indications: • No longer needed in cephalic presentation • Breech delivery • To rule out pelvic abnormalities either inherited or traumatic • 2 films are needed • Lateral view – AP diameter • Inlet view – transverse diameter

  19. Fetal Skull

  20. Objectives • General characteristics • Sutures,Fontanelles and bones • landmarks • Diameters • Cephalic pelvic disproportion

  21. General characteristics Fetal Head: is the Largest and least compressible part of the fetus

  22. General characteristics fetal skull: 1-base 2-cranium

  23. sutures • Definition: • The membrane occupied spaces between the cranial bones.

  24. fontanelle • The membrane filled spaces located at the point where the sutures intersect.

  25. fontanelles

  26. Land Marks (bregma) 5 3 (sinciput) 6 (lambda) 2 Glabella Nasion 1 7

  27. Land Marks 1- Nasion : root of the nose 2- Glabella: elevated area between the orbital ridges 3-Sinciput(brow):the area between anterior fontanelle and glabella 4- anterior fontanelle(bregma) 5- vertex the area between the fontanelles and bonded laterally by the parietal eminence 6- posterior fontanelle ( lambda) 7-occiput the area behind and inferior to the posterior fontanelle and lambdiod sutures

  28. Diameters • Antero-posterior diameters( 4 ) • Transverse diameters ( 2 )

  29. Antero-posterior diameters

  30. Transverse diameters: • Biparietal(9.5cm): • between the parietal bones. • Bitemporal(8cm): • between the temporal bones

  31. Cephalic pelvic disproportion • An obstetric condition where there is mismatch in size between (fetal head & the maternal pelvis), resulting in failure of the fetus to pass safely through the birth canal for mechanical reasons.

  32. 1- Absolute CPD: There is no possibility of a normal vaginal delivery (extremely rare). • Fetal (Temporary): • macrosomia (diabetes) & Fetal hydrocephalus • Maternal (Permenant): • Congenitally abnormal pelvis. • Damaged pelvis(RTA). • Distorted pelvis (osteomalacia).

  33. CPD 2- RelativeCPD: the baby is large but would pass through the pelvis if the mechanisms of labor function correctly. • If, however, the head is deflexed or fails to rotate in the mid-cavity, then prolonged, abnormal labor will occur. • CPD: • Can only truly be diagnosed after a trial of labour. • May be suspected antenatally in women who are ≤ 1.58m height. • Should be suspected in a women with a high head at term, after excluding the other causes.

  34. Thank You

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