Pelvis

THE PELVIS/BONY GRIDLE/PELVIC GRIDLE

A bony griddle formed anteriorly and laterally by the innominate bone and posteriorly by the sacrum
and coccyx is known as pelvis. The bony pelvis is a basin like structure. It has a muscular floor and
contains the uterus, fallopian tubes, ovaries and urinary bladder. The ligaments join the bones of the
pelvis and help to keep the pelvic and abdominal organs in place and join the trunk to the lower limbs.
In female, it is adopted for child bearing.

Parts of pelvis
• Two innominate bone or hip bone

• One sacrum bone

• One coccyx bone

Innominate bone
It is also known as hip bone or nameless bone; the two innominate bones form the three sides of the
pelvis. Each innominate bone consists of three parts;
1. The ilium

2. Ischium

3. Pubis
The illlium
• It is the large flared out part.

• When the hand is placed on the hip it rests on the iliac crest

which is the upper boarder.

• It has two surfaces;

 The inner surface is concave and is called iliac fossa.

 The upper outer surface is convex and is called the iliac crest.

• The ilium has two projections;

 The projection in front is called the anterior superior iliac spine.

 The ones at the back are called the posterior superior iliac spine.

• The two posterior superior iliac spines are marked by two dimples below each anterior and
posterior superior iliac spine lie the inferior iliac spines.

Ischium
• It is the thick lower part.

• The thick rounded and thickest part of the ischium is known as the ischial tuberosity.

• This is the part on which the body rests while sitting.

• The sharp projection above the ischial tuberosity which is directed backwards and slightly
inwards are known as the ischial spines.

• These are the inner aspects of ischium and are important when doing vaginal examination

Pubis
• It is also known as pubic bone.

• It forms the anterior part.

• It has the body and two ears like projections; the superior ramus and the inferior ramus.

• The superior ramus and the ischium join and form the ilio-pectineal eminence.

• The two pubic bones are connected by the cartilage in front and are called symphysis pubis.

• The public arch lies below the symphysis pubis.

• The inferior ramus of pubis and inferior ramus of ischium forms obturator foramen.
 • The innominate bone contains a deep cup to receive the head of the femur; this is termed as the
acetabulum.

Sacrum
• The sacrum is located behind the pelvic.

• Five bones fused into triangular shape and form a sacrum.

• The sacrum fits between the two hip bones connecting the spine to the pelvic.

• The last lumber vertebrae articular with sacrum.

Coccyx
• It can be move backward and forwards.

• Though the movement is very little, it helps in the process of normal birth of a baby by
increasing

• the diameter of the pelvic outlet.

• This consists of the fourth terminal vertebrae fused to form a very small triangular bone called

Coccyx and articulates with the tip of the sacrum.

Functions of pelvis
1. The pelvic helps the body to maintain its balance to support our body weight.

2. The pelvis is a basin like structure which helps to protect the reproductive organs (uterus, ovaries, and
fallopian tubes), urinary bladder and the other organs contained in the pelvis.

3. It helps in locomotion and in the movement of the body.it permits sitting and kneeling.

4. The pelvic form the part of the birth canal since uterus lies inside the pelvic and fetus must come
through this bony canal so it give birth canal.

5. The sacrum contains foramina which provide a passage to transmit nerve from cauda equine to pelvic
organs.

Structure of pelvis
1. False pelvis:
 It is the part of the pelvic lying above the pelvic brim.
 Its only obstetric function is to support the gravid uterus.
 It consists posteriorly the lumbar vertebrae, laterally the iliac fossa and anteriorly the
anterior abdominal wall.

2. True pelvis
 It is the part of the pelvic lying below the pelvic brim.
 It is bony passage through which the baby must pass during labour in vaginal delivery.
 It is shallow in front formed by symphysis pubis and measures 4cm, and deep
posteriorly, formed by the sacrum and coccyx and measures 11.5cm.
 For descriptive purposes, true pelvis is divided into:
• The pelvic inlet (brim)
• Pelvic cavity
•  Pelvic outlets.

Pelvic inlet
 The brim is round except where the sacral promontory projects into it.
 The promontory and wings of the sacrum form its posterior border, the iliac bones its lateral
border and the pubic bone its anterior border.
  The midwife needs to be familiar with the fixed points on the pelvic brim which are known as its
landmarks.
 The landmarks of pelvic brim are:

1. Sacral promontory

2. Sacral ala or wing

3. Sacroiliac joint

4. Ilio- pectineal lilne

5. Ilio- pectineal eminence

6. Superior ramus of the pubic bone ( Ramus of pubic ).

7. Upper inner border of the body of the pubic bone ( summit of symphysis pubis ).

8. Upper inner border of the symphysis pubis.

Shape: It is almost round with the antero- posterior diameter being the shortest.

Plane: It is an imaginary flat surface bounded by the bony points.

Diameter of pelvic brim

The main pelvic diameters of the pelvic brim (inlet) are as follows:-

1. Antero-posterior diameter

 anatomical conjugate

 obstetric conjugate

 diagonal conjugate

2. Oblique diameter
3. Transverse diameter

Antero- posterior diameter

True conjugate, anatomical conjugate:

• It is the distance between the midpoints of the sacral promontory to the inner margin of the
upper border of symphysis pubis which measures 11cm and isn’t shortest diameter in A.P.
palne.

• In actual practice, it can't be estimated directly.

• However, its measurement is inferred by subtracting 1-2 cm from the diagonal conjugate thus,

allowing for the inclination, thickness and height of the symphysis pubis.

Obstetric conjugate:
• It is the distance between the midpoints of the sacral promontory to prominent bony projection
in the midline on the inner surface of the symphysis pubis.

• It measures 10cm and is shortest antero-posterior diameter in the antero-posterior plan of the

inlet.

Diagonal conjugate:
• It is the distance between the lower borders of the symphysis pubis to the midpoint of the
sacral promontory.

• It measures 12 cm.

• The diameter is measured through vaginal examination

Oblique diameter
• It is line form one sacroiliac joint to the ilio-pectinal eminence on the opposite side of the pelvis
and measures 12cm.

• There are two oblique diameters as left and right.

• The right oblique begins at the right sacroiliac joint and the left oblique from the left sacroiliac
joint.

3. Transverse diameters:
• It lies between the farthest two points on the ilio-pectinal lines.

• It lies 4 cm anterior to the promontory and 7 cm behind the symphysis.

• It is the largest diameter in the pelvis.

• Obstetric transverse diameter bisects the true conjugate and is slightly shorter than the
anatomical transverse diameter.

Pelvic cavity
• It is almost circular or round shape.

• Cavity is the segment of the pelvis bounded above by the inlet and below by plane of least pelvic
dimensions.

• The anterior wall is formed by the pubic bones and symphysis pubis and its depth is 4cm.

• The posterior wall is formed by the curve of the sacrum which is 12cm in length. Because there
is such a difference in these measurements, the cavity forms a curved canal.

• Its lateral walls are the sides of the pelvis which are mainly covered by the obturator
internus muscle.

• Shape: It is almost circular or round shape

• Plane: The plane extends from the midpoint of posterior surface of symphysis pubis to the
junction of second and third sacral vertebrae.

• Landmarks:

• Hollow of the sacrum.

• Sacroiliac joints.

• Ischial and sacrospinous ligaments.

• Right and left upper and lower pubic rami.

 • Bodies of the pubis and symphysis pubis.

Diameters of the pelvic cavity

• Anterior –posterior, oblique and transverse diameter is same e.g. approximately 12cm
because of round cavity. 

Mid cavity:
• An important feature of the pelvic cavity is that the ischial spine project slightly into it.

• These can be felt easily during vaginal examination .this is an important landmark.

• The level of the ischial spines is the mid cavity; the above the ischial spines are known as
high cavity and below the ischial spine is low cavity.

• The ischial interspinous diameter is 10 to 10.5cm and is the smallest diameter of the pelvis.

• If the ischial interspinous diameter is narrow, it causes pelvic dystocia i.e. prolonged labour.

Pelvic outlet
• It is diamond shape and bounded anteriorly by the sub pubic arch, laterally by the
ischial tuberosities and the sacro-tuberous ligament and posteriorly by the tip of the sacrum. 

• Shape: It is antero- posteriorly oval.

• Plane: The plane is otherwise known as plane of least pelvic dimensions or narrow pelvic plane.
The plane extends from the lower border of the symphysis pubis to the tip of ischial spines and
posteriorly to meet the tip of the 5th sacral vertebrae.

Diameter of pelvic outlet 

The antero-posterior diameter:
 It extends from the lower border of the symphysis pubis to the sacro- coccygeal junction.

 It measures13cm.
  As the coccyx may be deflected backwards during labour this diameter indicates the space
available during delivery.

The oblique diameter:

 It is said to be between the obturator foramen and the sacro spinous ligament, although there is
no fixed points.

 The measurement is taken as being 12cm.

The transverse diameter:

 It is the distance between the inner surfaces of the ischial tuberosites (two).

 It measures10-11cm and is the narrowest diameter in pelvis.

The posterior sagittal diameter:

 It is the distance between the mid of the transverse diameter of the pelvic outlet
up to the sacrococcygeal joint and is 9cm.

AP diameter Oblique diameter Transverse diameter

Pelvic inlet 11 12 13

Pelvic cavity 12 12 12

Pelvic Outlet 13 12 11

Pelvic joints
There are four pelvic joints;

 one symphysis pubis

 two sacro – iliac joints

 one sacro-coccygeal joints

One symphysis pubis:
• It is formed at the junction of the two pubic bones which are united by a pad of cartilage.

Two sacro – iliac joints:

• These are the strongest joint in the body.

• They join the sacrum to the ilium and thus connect the spine to the pelvis.

One sacro-coccygeal joint:

• This is the joint between sacrum and coccyx.

• This joint is important in midwifery because it can increase the diameter of the pelvic outlet.

• This joint allows permits coccyx to be deflected backwards during the birth of the head.

Pelvic ligament
 Each of the pelvic joint is held together by ligaments.
 They are made of fibrous tissue. They are :
• Sacro tuberous ligaments: It is attached to the posterior aspect of the lower 3 sacral
vertebrae and medial border of ischial tuberosity.
• Sacro spinous ligaments: It is triangular and thin .It extends from the lateral border of
the sacrum and coccyx to the ischial spines.
 This two ligaments cross the sciatic notch from posterior wall of the pelvic outlet.
Types of pelvis
There are many types of pelvis but in midwifery we are concerned with the four most common types
found in women. They are classified as:

• the Gynaecoid pelvis

• the anthropoid pelvis

• the android pelvis

 • the platypelloid pelvis

The gynaecoid pelvis

• This is the most common type of pelvis in women.

• It is known as the true female pelvis.

• Its cavity is shallow and spacious which allows for easy delivery.

• More than 50 percentage women have this type of pelvis.

• The sacrum in this pelvis is well curved, the sub pubic arch is 90 degree and more and the
sacrosciatic notch is wider compared to other pelvis.

• The iliac crest is broad and well curved.

The anthropoid pelvis

• This type of pelvis is narrow and deep.

• It is oval in shape.

• Women with this type of pelvis tend to be tall with narrow shoulders.

• Found in 15% in Asian women; 15 to 30% on white women.

The android pelvis:
• It is male type pelvis.

• This type of pelvis is likely to occur in tall women with narrow hips and is also found in African
women.

• It is funnel shape with a deep cavity and a straight sacrum.

• Found in 0.6% in Asian women; 2-8% on white women.

The platypelloid pelvis:

• It is also called a flat pelvis and shortened with a flattened transverse ,oval shape.

Pelvic floor
The pelvic floor is a muscular diaphragm that separates the pelvic cavity above from the perineal space
below.

Functions
 It support the weight of the abdominal and pelvic organs.
 To maintain the continence of urine and feces.
 Allows voiding, defecation, sexual activity and childbirth.

Muscles of pelvic floor

Pelvic floor is made up of a number of muscles, which are further organized as: 

 Superficial muscle layer

 Deep muscle layer
Superficial muscle layer:
 It includes five muscles;

 The external anal sphincter encircles the anus and is attached behind by a few fibres to the
coccyx.

 Transverse perineal muscle passes from the ischial tuberocity to the centre of the perineum. 

 Bulvocavernous also  called Bulvospongiosus muscle pass from the perineum forwards around
the vagina to the corposa cavernosa of the clictoris

 The ischiocavernous muscles pass from the ischial tuberosity along the pubic arch to the corposa
cavernosa.

 The membranous sphincter of the urethra is composed of muscle fibre passing above and below
the urethra and attached to the pubic bones.

Deep muscle layer

 Deep muscle layer is composed of three pairs of muscles which together are known as levator
ani muscle.
 They are so called because they lift or elevate the anus.
 Each levator ani muscle ( left and right) consists of the following;

 the pubococcygeus muscle:

Pubococcygeus muscle passess from the pubis to the coccyx with a few fibres crossing over in
the perineal body to form its deepest part.

 the iliococcygeus muscle:

  The iliococcygeus muscles pass from the fascia covering the obturator internus muscle( the
white  line of pelvic fascia) to the coccyx.

 Ischiococcygeous muscle:

Ischiococcygeous muscle passes from the ischial spine to the coccyx in front of the
sacrospinous ligaments.

Pelvic inclination
• When a women stands up in an upright position, the pelvic brim is not horizontal but is tilted at
an angle of 60 degrees, this angle is called inclination of the pelvis.

• The angle of brim is 60 degree, the cavity is 30 degree and the outlet is 15 degree.

• The pelvic inclination is important in the mechanism of labor.

Pelvic effect on labor
Gynaecoid
 Fetal head:

• Engage in transverse or oblique diameter, slight asynclitism, good flexion.

 Labour:

• Good pains, and average fetal size, internal rotation and delivery.

 Prognosis:

• Good

Android
 Fetal head:

• Engages in transverse or posterior diameter marked asynclitism, marked moulding.

 Labour:

• Deep transverse arrrest is common. Instrumental delivery often needed. Deep perineal tears can
occur.

 Prognosis:

• Guarded

Anthropoid
 Fetal head:

• Engages in antero-posterior diameter, often occiput presentation or oblique.

 Labour:

• Delivery is usually easy, face to pubis delivery is common.

 Prognosis:

• Good

Platypelloid
 Fetal head:

• Engages in transverse diameter with marked asynclitism

 Labour:
 • Delay at inlet, thereafter easy birth.

 Prognosis:

• Guarded

Possible injuries of the birth canal during labour

Mild abrasion and lacerations of the cervix, vagina, vulva and the perineum occur in labour. The
following injuries may occur during labour:

1) Laceration of the vagina

2) Perineal laceration and tear

3) Labial laceration

4) Cervical laceration and tear.

5) Uterine rupture.

Ways of preventing injuries to the birth canal

i. Educate mother about breathing exercise during labour i.e. when

• To pant and push. The mother should not push early (before the

• Cervix is fully dilated. The mother should be encouraged and asked

• To push and pant at the proper time. She should particularly be asked

• to pant when the head is crowning and this should happen at the

• End of contraction.

ii. Explain her why she should not push too soon and also the importance of deep breathing and
panting
iii. Control of the fetal head during the second stage of labour is very important to prevent
excessive tear of the perineum.
iv. Head should be delivered by slow extension.