Antenatal Care Module for

Second Year BSc Midwifery Students

4/1/2022 ANC Module 1

 Overview Female Reproductive
Anatomy

4/1/2022 ANC Module 2

 Outline
• Parts of female pelvic bones
• Function of pelvis
• Pelvic joints
• Pelvic ligament
• Pelvic cavity
• Diameters of pelvis
• Types of female pelvis

4/1/2022 ANC Module 3

 Female Reproductive Anatomy
• Session objectives
• By the end of this session, students will be able to :
Describe the bones, joints and ligaments of the
female pelvis
List the functions of female pelvis
Appreciate different female pelvic diameters and
types

4/1/2022 ANC Module 4

 Anatomy of the female pelvis cont…
The student should be competent enough to recognize a
normal pelvis in order to recognize deviation from normal
and to refer for better management.
The bones of the pelvis:
It is composed of four bones
 Two innominate or hip bones
 One sacrum
 One coccyx
Each innominate bone is formed by fusion of three bones
• The ileum
• The ischium
• The pubic bone
 The three bones fussed at acetabulum
4/1/2022 ANC Module 5
 Fig 1. female Pelvic bones
4/1/2022 ANC Module 6
 The ilium
 Is the large flared out part of the innominate bone
 Is made up of a relatively flat of bone above and
part of acetabulum below.
 It has the following characteristics:
 The external aspect is gently curved and has
a roughened surface to which are attached
the gluteal muscles of the buttock.
 The greater part of the inner aspect is
smooth and concave forming the iliac fosse.
 The ridge which surmount these two surface
is known as iliac crest, which serves for the
attachment of the muscles of the abdominal
wall.

4/1/2022 ANC Module 7

 The ilium cont.…
 Anteriorly the crest ends in the anterior superior iliac
spine, a bony prominence which can be palpate under
the skin.

 Posteriorly iliac crest ends in the posterior superior

iliac spine.

 Below the anterior superior iliac spine is an other bony

prominence the anterior inferior iliac spine, while
posteriorly, there is posterior inferior iliac spine.

 At its lower most part the ileum forms the upper two-
fifths of the acetabulum, where it fuses with ischium
and pubis.
4/1/2022 ANC Module 8
 The ilium…
 Behind the acetabulum, the ileum forms the upper
part of a large notch, the greater sciatic notch,
through which pass the piriforms muscles and the
nerves of the sacral plexus, on their way from the
front of the sacrum in to the thigh.

 On the inner aspect of the bone, the iliac fossa is

bounded below by a prominent ridge, which is the
iliac part of the ilio pectineal line.
 Anteriorly the ilio pectineal line swells into a bony
prominence, at the point where the ileum fuses
with superior ramus of the pubis, to form the ilio-
pectineal eminence.
 Posterior to the ilio – pectineal line and above the
greater sciatic notch, is a roughened area , where
the ileum articulate with the sacrum to form the
4/1/2022
sacro -iliac joint. ANC Module 9
 The ischium
 The lowest constituent bones of the innominate
bone

 Formed by the following parts;

 The head forms the lowest two-fifths of the

acetabulum, where it fuses with the ileum and
pubis.

 Below the acetabulum a thick buttress of bone

pass down and terminates in ischial tuberosity
the part which the weight of the body rest on
when sitting.

 Passing up wards and in ward from the ischial

tuberosity a small shaft of the ischium becomes
continuous with the inferior ramus of the pubis
so forming the public arch.

4/1/2022 ANC Module 10

 The ischium…
 The ischium forms the lower boundary of the large
foramen, the obturator foramen or foramen ovale.

 On its internal aspect the ischium forms the side

wall of the true pelvis.

 Protruding in wards from its posterior edge, about

5cm above the tuberosity, is a prominent projection
known as the ischial spine which is use to estimate
the station of fetal head.

 Lesser sciatic notch is situated between the ischial

spine above and ischial tuberosity below.

4/1/2022 ANC Module 11
 The pubis
• The smallest of the three bones forming the
innominate bone and form the lower one fifth of the
acetabulum.

• The right and left pubic bones unite with each other
anteriorly at the square shaped pubic bodies. They are
fused by a pad of cartilage, the symphysis pubis.

• The upper surface of the body forms a crest, the pubic

crest, which ends laterally in the pubic tubercle.

• Extending upwards from each pubic body, the

superior ramus unites with ilium at ilio-pectineal
eminence.
4/1/2022 ANC Module 12
 The pubis…
• Below the body of the pubic, the inferior ramus
passes down wards and out wards to join the
ischium, so forming the upper part of pubic arch
The sacrum:
• Is situated in the posterior part of the pelvis and
consists of five fused sacral vertebrae
• The anterior surface is smooth, and is concave from
above down wards and slightly so from side to side
forming the hollow of the sacrum
• The sacral alae – are the widened out wings of
bone on each side of the 1st sacral vertebra.

4/1/2022 ANC Module 13

 The sacrum
 Promontory of the sacrum – is the center point of the
upper border of the 1st sacral vertebrae which with the
base of the 5th lumbar vertebra, protrudes over the
hollow of the sacrum.
 Sacral canal – runs longitudinally through the center of
the sacrum and opens at the level of the 5th sacral
vertebra.
 The posterior surface for the sacrum is rough and
irregular and serves for the attachment of the ligaments
and muscles of the back.
 The sacrum articulates laterally with the ileum at
sacroiliac joint and lower margin of it articulate with
coccyx at sacro-coccygeal joint
4/1/2022 ANC Module 14
 The coccyx
 Consists of four fused coccygeal vertebrae.
 It is triangular in shape with its base uppermost.
 The 1st coccygeal vertebra articulates with lower
end of the sacrum at the sacro-coccygeal joint.
 The remaining three vertebrae mere rudimentary
nodules of bone; they are smooth in their inner
surface where they support the rectum, while their
lowest most tip are attached to the external anal
sphincter and ano-coccygeal body.

4/1/2022 ANC Module 15

4/1/2022 ANC Module 16
 Function of pelvis
• Adapted for child bearing
• Allow movement of the body
• Permits the person to sit and kneel
• Transmits the weight of the trunk to the
leg
• Affords protection to pelvic organs and a
lesser extent to the abdominal contents

4/1/2022 ANC Module 17

 Pelvic joints
There are four pelvic joints
 Two sacro-iliac joints
 One symphysis pubis
 One sacro-coccygeal joints
1. The sacro – Iliac joints
Are the strongest joint in the body.
They join the sacrum to the ileum and thus connect
the spine to the pelvis.
Their main features are;-
The joint cavity is very small
The articular surfaces are placed on the inner surface
of the ileum above the greater sciatic notch and on the
lateral aspect of the sacrum, extending for the 1st two
4/1/2022
sacral vertebrae ANC Module 18
 The sacro – Iliac joints…
 The supporting ligaments pass from the sacrum
and the fifth lumbar vertebrae to the ileum both
anterior and posterior to the joint cavity.
 Movements at these joints occur under normal
conditions but are very slight. They increase in
range during pregnancy and labor when the
ligaments become softened under the influence of
the hormone relaxin.
2.The symphysis pubis joint :
 Is formed at the junction of the pubic bones which
are united by a pad of cartilages.
 It is reinforced by supporting ligaments which pass
from one pubic bone to the other in front, behind,
4/1/2022 above and below the disc of cartilage
ANC Module 19
 3. The sacro- coccygeal joint
• Is situated between the lower border of the
sacrum and the upper border of the coccyx.

• Slight back ward and forward movement of the

coccyx on the lower end of the sacrum occur
normally; the back ward movement is greatly
increased during labor at the time of the actual
birth of the head.

4/1/2022 ANC Module 20

 The pelvic ligaments
Each of the pelvic joints held together
by
ligaments
• These are:
pubic ligaments
sacro-iliac ligament
sacro-coccygeal ligaments

4/1/2022 ANC Module 21

 The pelvic ligaments…
 Sacro- tuberous ligaments – is a strong ligament
passing from the posterior superior iliac spine and
lateral borders of the sacrum and coccyx to the
ischial tuberosity. It bridges across the greater and
lesser sciatic notches
 The sacro- spinous ligament - passes from the
side of the sacrum and coccyx across the greater
sciatic notch to the ischial spine. It lies in front
of the sacro- tuberous ligament.

 The inguinal ligament (pauper’s ligament )-runs

from the anterior superior iliac spine to the pubic
tubercle forming the groin.
 The sacro- tuberous ligament and sacro- spinous
ligaments cross the sciatic notch and form the
posterior wall of the pelvic out let.
4/1/2022 ANC Module 22
4/1/2022 ANC Module 23
 The regions of the pelvis
The brim of the pelvis divides the pelvis
into two parts, the false and true pelvis .
 The false pelvis – lies above the pelvic
brim and consists mainly of the iliac fosse.
 It has little importance in midwifery.
 The true pelvis – included the pelvic brim
and all the area that lies below- It consists
of three constituent parts;
 The in let or brim of the pelvis
 The cavity
 The out let

4/1/2022 ANC Module 24

 1. The pelvic brim
 Is round except where the sacral promontory
projects in to it.
 It appears heart – shaped because of sutting
sacral prominence. It is wider transversely than
in the anterior-posterior dimension.
 It is marked by 8 fixed land marks
1. The promontory of the sacrum
2. The alae of the sacrum
3. The sacro- iliac joint
4. Ilio - pectineal line -(which is the edge
formed at the inward aspect of the ilium)
5. Ilion- pectineal eminence-(the superior
ramus of the pubic bone meets the ilium)
6. Inner border of the superior ramus of pubic
bone.
7. Upper inner border of the body of pubic
bone
4/1/2022 8. upper inner border of symphysis pubis
ANC Module 25
 2. The pelvic cavity
 Extends from the in let above to the out let below.
 Formed by the hollow of the sacrum.

 The posterior wall is deeply concave and

approximately 12cm in length.
 The anterior wall is formed by symphysis pubis
and is approximately 4cm long.

 The lateral walls comprise the greater sciatic

notch, the internal surface of a small portion of the
ileum, the body of the ischium and the foramen
ovale.
 The plane of the cavity of the pelvis – is an
imaginary surface which extends from the mid
point of the symphysis pubis in front to the
junction of the 2nd and 3rd sacral vertebrae.

4/1/2022  Ischial spine marks the mid plane of the pelvis

ANC Module 26
 3. The pelvic out let
 Two out let of the pelvis are described - the
anatomical and the obstetrical.
i) The anatomical out let
 It is diamond in shape .
 Is formed by the structures which mark the lower
border of the pelvis- these are:
 The lower border of the symphysis pubis
 The pubic arch
 The inner border of the ischial tuberosity.
 The sacro – tuberous ligament
 The tip of the coccyx.

4/1/2022 ANC Module 27

 The pelvic out let…
ii) The obstetrical out let – is the constricted
lower portion of the pelvis and not merely
its lower bony border.
• It is the segment of the pelvis which lies
between the anatomical outlet below and
an artificial line above.
• Its land marks are:-
 The lower border of the symphysis pubis
 The ischial spine
 The sacro-spinous ligament
 The lower border of the sacrum

4/1/2022 ANC Module 28

 The Dimensions of the Normal pelvis
Diameters of the Brim
♥ Anterior – posterior diameters – is a line from the
sacral promontory to the upper border of the
symphysis pubis.

• When the line taken to the upper most point of the

symphysis it is called the anatomical conjugate or
conjugate Vera and it measures 12cm.

• The measurement from the promontory of the

sacrum to inner most margin of the symphysis
pubis is the obstetrical conjugate and measures
11cm.

4/1/2022 ANC Module 29

 Dimensions….
♥ The diagonal conjugate – is measured anterior-
posteriorly from the lower border of the
symphysis pubis to sacral promontory and
measures 12-13cm.
• It may be estimated pervaginum as a part of
pelvic assessment.
♥ The oblique diameter – passes from the sacro-iliac
joints to the opposite ilio- pectineal eminence.
• It measures12cm.
♥ The transverse diameters – is a line between the
points farther most a part on the ilio- pectineal
lines and measures 13 cm.
♥ The sacro- cotyloid diameter – is a line passing
from the promontary of the sacrum to the ilio-
pectineal eminence and it measures 9.5 cm on
each side.

4/1/2022 ANC Module 30

 Dimensions…
The diameters of the cavity
- The cavity is circular in shape and all
diameter are equal in length.
♥ Anterior- posterior diameters – posses
from the mid point of symphysis pubis to
the junction of the 2nd and 3rd sacral
vertebrae and measures 12cm.
♥ The oblique diameter- pass obliquely in
the plane of the cavity parallel to the
oblique diameters of the brim. It measures
12cm.
♥ The Transverse diameter- passes in the
plane of the cavity between the points far
most apart in the lateral pelvic walls and
measures 12cm.
4/1/2022 ANC Module 31
 Dimensions…
The diameters of out let
♥ The anterior-posterior diameter – passes from the
lower border of the symphysis pubis to the sacro-
coccygeal joint and measures 13cm.
♥ There are two transverse diameters;
 The 1st is a line passes between the two ischial
spines. It measure 11 cm.
 The 2nd is a line passing between the inner
borders of the two ischial tuberosities and
measures 11cm
♥ The oblique diameters – is said to be between the
obturator foramen and the sacrospinous ligament.
 It measures 12cm
4/1/2022 ANC Module 32
 Variations in pelvic shape
Features of normal female pelvis
♣ Sacral promontory is not prominent or un
reachable.
♣ Rounded brim
♣ The cavity is shallow(deep) with straight sides
♣ Smooth (blunt) ischial spines
♣ The sacrum is smoothly concave (curved in)
♣ Wide sciatic notch.
♣ The pubic arch is round
♣ Sub pubic angle 900
4/1/2022 ANC Module 33
 Types of pelvis
Based on the shape of the brim, there are four
main groups of pelvis
• Gyneacoid
• Android
• Platypelloid
• Anthropoid

4/1/2022 ANC Module 34

 Gyneacoid pelvis(50%)
It is the normal female type.
Inlet is slightly transverse oval.
Sacrum is wide with average
concavity and inclination.
Side walls are straight with blunt
ischial spines.
Sacro-sciatic notch is wide.
Subpubic angle is 90-1000.

4/1/2022 ANC Module 35

4/1/2022
Fig. Gynaecoid
ANC Module 36
pelvis
 Android pelvis (20%):
♠ It is a male type.
♠ Inlet is triangular or heart-shaped with
anterior narrow apex.
♠ Side walls are converging (funnel pelvis)
with projecting ischial spines.
♠ Sacro-sciatic notch is narrow.
♠ Subpubic angle is narrow <900.

4/1/2022 ANC Module 37

 Fig .Android pelvis
4/1/2022 ANC Module 38
 Anthropoid pelvis (25%)
It is ape-like type

All antero-posterior diameters are long.

All transverse diameters are short.

Sacrum is long and narrow.

Sacro-sciatic notch is wide.

Subpubic angle is narrow.

4/1/2022 ANC Module 39

 fig. Anthropoid pelvis
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 Platypelloid pelvis (5%)
♦ It is a flat female type.

♦ It has kidney shaped brim.

♦ All antero-posterior diameters are short.

♦ All transverse diameters are long.

♦ Sacro-sciatic notch is narrow.

♦ Subpubic angle is very wide.

4/1/2022 ANC Module 41

 Fig. platypelloid pelvis
4/1/2022 ANC Module 42
4/1/2022
Gyneac Anthrop
ANC Module Andr 43
oid oid oid
 Others rare types of pelvis
 Justo-minor pelvis
 It is similar to Gynaecoid in shape but all diameters are
equally reduced.
 Found in woman who is less than 1.5M tall.
 Face difficulties to deliver large baby .
 Robert pelvis
 Has no wings (alae) of the sacrum and there fore
contracted in all diameters
 It is a type very rarely seen and is the result of
congenital abnormality .
 Caesarean section is always necessary for delivery

4/1/2022 ANC Module 44

 Naegele’s pelvis
 It has one wing of the sacrum
 This may be due to congenital abnormality but
can be caused by injury .
 Delivery by c/s is always indicated .

Fig. Naegele’s
pelvis
4/1/2022 ANC Module 45