UNIT 2: FEMALE

PELVIS, FOETAL SKULL

OBJECTIVES
By the end of this lesson students should
be able to describe the following:
 Explain the functions of the female pelvis
 Outline the differences between the true
pelvis and the false pelvis
 Describe the anatomical structure of the
bony female pelvis
 Describe the different types of pelves

FEMALE PELVIS FOETAL SKULL

OBJECTIVES…
 Describe the diameters of the pelvic brim
 Describe the anatomical structure of the
foetal skull
 Describe the diameters of the foetal skull

FEMALE PELVIS, FOETAL SKULL

The normal female pelvis is called
gynaecoid pelvis and has specific
characteristics that make it suitable for
child birth
TERMS
 Innominate – having no name
 Obturator foramen – opening created by
the ischium and pubis bones through
which nerves and blood vessels pass
 Foramen magnum – the opening at the
base of the skull, through which the spinal
cord and the brainstorm pass

FEMALE PELVIS, FOETAL SKULL

TERMS
 Ossification – the hardening into a bony
substance
 Protuberance – a usually rounded part
that sticks out from a surface

FEMALE PELVIS, FOETAL SKULL

FUNCTIONS OF THE FEMALE PELVIS NB
 Allows movement of body
 Permits sitting and kneeling
 Forms bony passage through which the
fetus passes (Passage in the 3 Ps)
 It is adapted to child bearing
- Increased width and rounded brim (this
makes women to be less speedy than man)

FEMALE PELVIS, FOETAL SKULL

TRUE AND FALSE PELVIS NB
 FALSE PELVIS
 Part situated above the brim
 Formed by the upper flared out portions
of the iliac bones
 It protects the abdominal organs
 Bounded on each side by the ilium but
incomplete in front

FEMALE PELVIS, FOETAL SKULL

 FALSE PELVIS… NB
 No significance in obstetrics
 TRUE PELVIS
 Consists of the brim, cavity and outlet
 Protects the pelvic organs
 Bony walls are more complete (cartilage
and ligaments anteriorly)
 Bony canal through which the foetus
passes

FEMALE PELVIS, FOETAL SKULL

 FEMALE PELVIS, FOETAL SKULL
ANATOMY OF THE PELVIS NB
 PELVIC BONES NB
 Comprises of 4 bones – 2 innominate, the
sacrum and the coccyx
 Each innominate bone has 3 components
 The ilium
- large broad bone
- The top of which is felt when a woman
rests her hands upon her hips (iliac crest)

FEMALE PELVIS, FOETAL SKULL

 PELVIC BONES
 The ilium…
 Anterior to the iliac crest, upper, is a bony
prominence – anterior superior iliac
spine and below it, the anterior
inferior iliac spine
 Posterior to the iliac crest, 2 similar points
– posterior superior and posterior
inferior iliac spines

FEMALE PELVIS, FOETAL SKULL

 PELVIC BONES
 The ilium
 Iliac fossa is the large shallow depression
that forms much of the inner surface of
the ilium
 The ridge beneath the iliac fossa is the
iliopectineal line and it separates the
false pelvis from the true pelvis

FEMALE PELVIS, FOETAL SKULL

 PELVIC BONES
 The ilium
- The iliopectineal line has a prominence at
the juncture where the ilium and pubis
fuse, the iliopectineal eminence

FEMALE PELVIS, FOETAL SKULL

 PELVIC BONES
 The ischium
 Forms the lower part of the pelvis
 Broad but small, thick, L-shaped bone that
connects to the ilium posteriorly and the
pubis anteriorly
 It has a large thickened area of bone
known as the ischial tuberosity – the
body rests on this bone when one is sitting

FEMALE PELVIS, FOETAL SKULL

 PELVIC BONES
 The ischium…
 Behind the ischial tuberosity and a short
distance above it is the ischial spine –
important when assessing a woman’s
progress in labour and foetal descent

FEMALE PELVIS, FOETAL SKULL

 PELVIC BONES
 The pubis (pubic bone)
 It consists of a body and 2 arms, the
superior and the inferior pubic rami
 The bodies merge in front anteriorly to
form the symphysis pubis
 The superior ramus forms the pubic crest
and joins the lower anterior border of the
ilium in the acetabulum

FEMALE PELVIS, FOETAL SKULL

 PELVIC BONES
 The pubis…
- The inferior rami, on either side, together
make up the pubic arch which forms part of
the pelvic outlet

FEMALE PELVIS, FOETAL SKULL

 PELVIC BONES
 The pubis…
 The 2 arms of the pubic bone meet the
ischium inferiorly and the ilium superiorly
to form an oval shaped window known as
the obturator foramen

FEMALE PELVIS, FOETAL SKULL

 PELVIC BONES
 On the lower aspect of each innominate bone
there is:
 The lesser sciatic notch – the notch
between the ischial tuberosity and the ischial
spine
 The greater sciatic notch – the notch on
the inferior portion of ilium located
posteromedial to the ischial spine

FEMALE PELVIS, FOETAL SKULL

 PELVIC BONES
 The sacrum
 Forms the posterior wall of the pelvis
 A very strong heavy bone which
articulates on either side with the ilium at
the sacroiliac joints
 Comprises 5 vertebrae that are fused
together to form a wedge shaped bone

FEMALE PELVIS, FOETAL SKULL

 PELVIC BONES
 The sacrum…
 Wide end of the wedge is directed upwards,
articulates with the fifth lumbar vertebra where
the anterior border forms the sacral
promontory
 Narrow end of the wedge is directed downward
and backward and its inferior border articulates
with the upper end of the coccyx
 These wedges are known as the sacral alae

FEMALE PELVIS, FOETAL SKULL

 PELVIC BONES
 The sacrum…
posteriorly, on either side of the spinous
processes, is a row of inter-vertebral foramina
through which the sacral and coccygeal nerves
pass
 The main branch of the sacral plexus is the
sciatic nerve – largest nerve in the body.
The anterior surface is concave forming the
curve of Carus

FEMALE PELVIS, FOETAL SKULL

 PELVIC BONES
 The coccyx
 Small wedge shaped bone
 Consists of 3 to 5 fused rudimentary vertebrae
 Situated at the end of the vertebral column
 Wide edge of the wedge articulates with the
lower end of the sacrum
 It serves as the origin for important muscles
of the pelvic floor and the hip

FEMALE PELVIS, FOETAL SKULL

 PELVIC JOINTS NB
 The symphysis pubis
 Formed anteriorly where the 2 pubic bones meet
 There is a pad of cartilage between the 2 pubic
bones and as a result of hormone action, this
joint may widen spontaneously during late
pregnancy giving rise to the movement of the
joint and pain on walking
 It is strengthened by the interpubic ligaments

FEMALE PELVIS, FOETAL SKULL

 PELVIC JOINTS…
 The symphysis pubis
 It widens during the last months of
pregnancy causing pain

FEMALE PELVIS, FOETAL SKULL

 PELVIC JOINTS
 The sacro-iliac joints
 strongest in the body, weight bearing synovial
joints
 Situated posteriorly between sacrum and ilium
 Joined by strong sacro-iliac ligaments
 Much stress during pregnancy causing
backache during pregnancy and a few weeks
after delivery

FEMALE PELVIS, FOETAL SKULL

 PELVIC JOINTS
 The sacro-coccygeal joint
- formed posteriorly where the sacrum and
the coccyx articulate, strengthened by the
sacro-coccygeal ligament
 It enables the coccyx to bend backwards
 The bending widens the outlet and
enables foetal head to negotiate outlet

FEMALE PELVIS, FOETAL SKULL

 Other ligaments
 Sacrospinous ligament
 runs from the lower sacrum and the coccxy,
to the ischial spine and encloses the lower
border of the greater sciatic notch.
 Sacrotuberous ligament
- runs from the lower sacrum to the ischial
tuberosity enclosing the lesser sciatic notch

FEMALE PELVIS, FOETAL SKULL

 THE PELVIC BRIM NB
 This is the bony ridge in the cavity of the
pelvis that marks the boundary between
the false pelvis and the true pelvis
 It has the following landmarks:
 Posteriorly
 Promontory of sacrum
 Alae of sacrum and sacro-iliac joints

FEMALE PELVIS, FOETAL SKULL

 THE PELVIC BRIM
 Laterally
 The ilio–pectineal lines
 Ilio-pectineal eminences (where the iliac bones
meet the superior rami of the pubic bones)
 Anteriorly
 The pubic crests on each pubic bone
 The symphysis pubis (upper inner border)

FEMALE PELVIS, FOETAL SKULL

 Significant diameters of the pelvic brim
 Anteroposterior diameter
 Line from sacral promontory to upper
border of the pubis
 Anatomical conjugate is 12cm
 Obstetrical (true) conjugate 11cm, is the
narrowest point of the pelvic inlet – from
the back portion of the pubis to the sacral
promontory

FEMALE PELVIS, FOETAL SKULL

 Diameters…
 Diagonal
 From the lower border of the symphysis
pubis to the sacral pomontory 12 to
13cm
 Oblique
- from sacroiliac joint to iliopectineal
eminence
12cm

FEMALE PELVIS, FOETAL SKULL

 Diameters…
 Transverse
 Line between points furthest apart on the
iliopectineal lines 13cm

FEMALE PELVIS, FOETAL SKULL

 PELVIC CAVITY NB
 It extends from the pelvic brim to the
pelvic outlet.
 It forms the curve of carus which the
foetus has to navigate in order to be born

FEMALE PELVIS, FOETAL SKULL

 PELVIC CAVITY
 Anterior walls
 Pubic bone and symphysis pubis
 Its depth is 4cm
 Lateral walls
 These are the sides of the pelvis
 Mainly covered by the obturator internus
muscle

FEMALE PELVIS, FOETAL SKULL

 PELVIC CAVITY…
 The posterior wall
 formed by the curve of the sacrum
 Diameters
 Not possible to measure the diameters
 They are all, however, considered to be
12 cm

FEMALE PELVIS, FOETAL SKULL

 PELVIC OUTLET NB
 It is either an ovoid or diamond shaped
space
 Its perimeter is partially comprised of
ligaments
 Its landmarks are:
 Posteriorly
- The coccyx and the sacrotuberous
ligament

FEMALE PELVIS, FOETAL SKULL

 PELVIC OUTLET…
 Landmarks
 Laterally
 Ischial tuberosities
 Ischial spines
 Anteriorly
- Pubic arch

FEMALE PELVIS, FOETAL SKULL

 PELVIC OUTLET…
 Diameters
 Significant diameter
 Ischial bi-spinous
- between the ischial spines
- Narrowest diameter of the midpelvis 10 to
10,5cm

FEMALE PELVIS, FOETAL SKULL

 SELF STUDY NB!
 Describe the gynaecoid, android,
anthropoid and platypelloid pelves in
relation to:
 the brim (inlet)
 The cavity (midpelvis)
 The outlet

FEMALE PELVIS, FOETAL SKULL

THE ANATOMY OF THE FETAL SKULL NB
 The passenger in the 3 Ps
 It is delicate and large in relation to fetal
body

FEMALE PELVIS, FOETAL SKULL

 Objectives

To describe the anatomical structure of

the foetal skull

To describe the land marks of the foetal

skull
FEMALE PELVIS, FOETAL SKULL
There are certain areas and land marks on
the head which are identifiable on
abdominal palpation and on vaginal
examination
They enable a midwife to identify and
estimate the size, presentation, position
FETAL SKULL ANATOMY NB
 REGIONS
 Vault / cranium:
 Upper dome shaped part of the skull
 Extends above the face in front to the
base of the skull posteriorly
 Includes the temporal sutures laterally
 Bones thin and pliable allowing for
moulding at birth

FEMALE PELVIS, FOETAL SKULL

 REGIONS
 Base
 Bony area surrounding the opening known
as the foramen magnum
 Bones are firmly united to protect the vital
centres in the medulla

FEMALE PELVIS, FOETAL SKULL

 REGIONS
 Face
 Extends from the root of the nose to the
junction of the chin with the neck
 Bones are small and firmly united

FEMALE PELVIS, FOETAL SKULL

 BONES OF THE FETAL SKULL
 Occipital
 Contributes to the base of the skull
 Forms region of occiput
 Occipital protuberance is at the centre

FEMALE PELVIS, FOETAL SKULL

 BONES…
 Parietal bones
 Are 2 and are on either side of the skull
 the ossification at the centre of each bone
is the parietal eminence

FEMALE PELVIS, FOETAL SKULL

 BONES
 Frontal bones
 There are 2 halves of the frontal bones
 They form the sinciput
 At the centre of each bone is the frontal
eminence which fuses at 8 years

FEMALE PELVIS, FOETAL SKULL

 SUTURES OF THE FOETAL SKULL
 These are essentially cranial joints
 Lambdoidal suture
 Separates occipital bone from 2 parietal
bones
 Runs transversely across the posterior
end of the sagittal suture
 Join centrally to form one long suture –
the sagittal suture

FEMALE PELVIS, FOETAL SKULL

 SUTURES…
 Sagittal suture
 Lies between the parietal bones
 Runs in an AP direction, dividing the skull
into left and right halves

FEMALE PELVIS, FOETAL SKULL

 SUTURES…
 Coronal sutures
 Separate the frontal bones from the
parietal bones
 Run at right angles to the sagittal suture
and the frontal suture bisecting these
sutures

FEMALE PELVIS, FOETAL SKULL

 SUTURES…
 Frontal (metopic) sutures
- It bisects the frontal bones down the
centre of the forehead (sinciput) and is a
forward extension of the sagittal suture

FEMALE PELVIS, FOETAL SKULL

 SUTURES…
 Temporal sutures
 Lie on either side of the skull between
temporal bones laterally and the frontal
and parietal bones above
 The coronal suture meets the temporal
suture on either side of the skull to form
the temporal fontanelle

FEMALE PELVIS, FOETAL SKULL

 LANDMARKS
 Occiput
 Between foramen magnum and posterior
fontanelle
 It is in the suboccipital region – below
occipital protuberance

FEMALE PELVIS, FOETAL SKULL

 LANDMARKS
 Vertex
 Is bounded by posterior fontanelle, 2
parietal eminences and anterior fontanelle
 95% of babies present by vertex

FEMALE PELVIS, FOETAL SKULL

 LANDMARKS…
 Sinciput/ brow
- Extends from anterior fontanelle and
coronal suture to orbital ridges

FEMALE PELVIS, FOETAL SKULL

FEMALE PELVIS, FOETAL SKULL
FEMALE PELVIS, FOETAL SKULL
 FONTANELS
 The posterior fontanelle / lambda
 At the junction of lambdoidal and sagittal
sutures
 Is triangular in shape and small
 Is situated centrally on the posterior
aspect of the foetal skull, where the
parietal bones meet the occipital bones
 Closes by 6weeks

FEMALE PELVIS, FOETAL SKULL

 FONTANELS…
 The anterior fontanelle / bregma
 At the junction of sagittal, coronal and
frontal sutures
 Broad and kite shaped
 Is situated at the midpoint on the top of
the foetal skull, where the frontal and
parietal bones meet

FEMALE PELVIS, FOETAL SKULL

 FONTANELS…
 Bregma…
 Closes by 18 months
 Measures 3 to 4 cm long and 1,5 to 2cm
wide
 Pulsation of cerebral vessels can be felt
through it

FEMALE PELVIS, FOETAL SKULL

DIAMETERS OF THE FOETAL SKULL
 TRANSVERSE DIAMETERS
 Biparietal
 Between the 2 parietal eminences
 9,5cm
 Bitemporal
 Between furthest points of coronal suture,
at the temples
 8,2cm

FEMALE PELVIS, FOETAL SKULL

DIAMETERS…
 ANTEROPOSTERIOR DIAMETERS
 Suboccipito-bregmatic
 From below occipital protuberance to the
centre of the bregma
 9,5cm
 This is the diameter (together with the
biparietal) that presents in a well flexed vertex
presentation

FEMALE PELVIS, FOETAL SKULL

 AP DIAMETERS…
 Suboccipito-frontal
 from below occipital protuberance to
centre of frontal suture
 10cm
 Is the diameter that presents in a slightly
deflexed vertex presentation

FEMALE PELVIS, FOETAL SKULL

 AP DIAMETERS…
 Suboccipito-frontal
 from below occipital protuberance to
centre of frontal suture
 10cm
 Is the diameter that presents in a slightly
deflexed vertex presentation

FEMALE PELVIS, FOETAL SKULL

 AP DIAMETERS
 Mentovertical
 Largest 13,5cm!
 From tip of the chin to a point on the
vertex which is just above the posterior
fontanelle (highest point on the vertex)
 Presents in a brow presentation

FEMALE PELVIS, FOETAL SKULL

 AP DIAMETERS
 Submento-vertical
 From the angle of the chin and the neck,
to the highest point on the vertex (about
midway between the anterior and
posterior fontanelle)
 This diameter (together with the
bitemporal) presents in an incompletely
extended face presentation – 11,5cm

FEMALE PELVIS, FOETAL SKULL

 AP DIAMETERS
 Submento-bregmatic
 From the angle of the chin with the neck
to the centre of the anterior fontanelle
 9,5cm
 This diameter (together with the
bitemporal) presents in a fully extended
face presentation

FEMALE PELVIS, FOETAL SKULL

FEMALE PELVIS, FOETAL SKULL
RESOURCES:
Seller’s midwifery. 2nd edition. Chapter 8

FEMALE PELVIS, FOETAL SKULL

THANK YOU

FEMALE PELVIS, FOETAL SKULL