Pelvic Anatomy

PELVIC ANATOMY PELVIC ANATOMY AND AND

FEMALE REPRODUCTIVE ORGANFEMALE REPRODUCTIVE ORGAN

dr. Udin S, SpOG (K), MMdr. Udin S, SpOG (K), MM

Depart. of Obstetrics & GynecologyFaculty of Medicine, Padjadjaran University

Hasan Sadikin HospitalB A N D U N G

BAGIAN LAB ANATOMI FK UNILA 2012

THE BONY PELVISTHE BONY PELVISThe pelvis is composed of four bonesThe pelvis is composed of four bones SacrumSacrum CoccyxCoccyx Two innominate bonesTwo innominate bones

–– Fusion of the iliumFusion of the iliumischiumischiumpubispubis

4BAGIAN LAB ANATOMI FK UNILA 2012

SACRUMSACRUM

Foramina sacralia anteriora Foramina sacralia anteriora passed by passed by plexus sacralis plexus sacralis pain and leg cramp pain and leg cramp until the baby head descent to the pelvic until the baby head descent to the pelvic cavitycavity

Crista sacralisCrista sacralis PromontoriumPromontorium

COCCYGISCOCCYGISDuring labor pushed posteriorlyDuring labor pushed posteriorly out let pelvic widerout let pelvic widerBAGIAN LAB ANATOMI FK

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PELVIC JOINTSPELVIC JOINTS

Anterior Anterior Joined together by the symphisis pubisJoined together by the symphisis pubis

Consists of fibrocartilageConsists of fibrocartilagesuperior pubic ligamentssuperior pubic ligamentsinferior pubic ligamentsinferior pubic ligaments(arcuate ligament of the(arcuate ligament of the pubis)pubis)

Has a certain degreeHas a certain degree of mobilityof mobilityPosteriorPosterior Sacro iliac jointsSacro iliac jointsHave a certain degree of mobilityHave a certain degree of mobilityBAGIAN LAB ANATOMI FK

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PELVIC ANATOMYPELVIC ANATOMYTHE FALSE PELVISTHE FALSE PELVIS Above the linea terminalisAbove the linea terminalis Bounded Bounded Posteriorly by lumbar vertebraePosteriorly by lumbar vertebrae

Laterally by iliac fossaeLaterally by iliac fossaeAnteriorly by lower portion of the Anteriorly by lower portion of the

anterior abdominal wallanterior abdominal wall

THE TRUE PELVISTHE TRUE PELVIS Important in child bearing (melahirkan)Important in child bearing (melahirkan) Bounded above by : Bounded above by :

The promontory and alae of the sacrum The promontory and alae of the sacrum Linea terminalisLinea terminalis Upper margins pubic bonesUpper margins pubic bonesBelow : pelvic out letBelow : pelvic out let 9BAGIAN LAB ANATOMI FK

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TRUE PELVIS :TRUE PELVIS :

Describe as having four imaginary Describe as having four imaginary planesplanes

1. Pelvic inlet (Superior strait)1. Pelvic inlet (Superior strait)

2. Greatest pelvic dimensions2. Greatest pelvic dimensions

3. Mid pelvis (least pelvic dimensions)3. Mid pelvis (least pelvic dimensions)

4. Pelvic outlet (inferior strait)4. Pelvic outlet (inferior strait)BAGIAN LAB ANATOMI FK

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HODGE PLANEHODGE PLANE

I =I = Pelvic inletPelvic inlet

II =II =Hodge I through lower margin of Hodge I through lower margin of the symphysisthe symphysis

III =III =Hodge I through ischial spineHodge I through ischial spine

IV =IV =Hodge I through the tip of Hodge I through the tip of coccygiscoccygis

DIAMETER OF THE PELVISDIAMETER OF THE PELVIS

Pelvic inletPelvic inlet Diagonal conjugate (CD)Diagonal conjugate (CD) True conjugate [ CD True conjugate [ CD –– (1.5(1.5--2 cm) ]2 cm) ]

normaly normaly >> 10 cm10 cm

Mid pelvisMid pelvis(Cannot be assessed clinically)(Cannot be assessed clinically) The interspinous diameter The interspinous diameter >> 10 cm)10 cm) The AThe A--P diameter P diameter >> 11.5 cm11.5 cm

Pelvic outletPelvic outlet The AThe A--P diameter 9.5 P diameter 9.5 –– 11.5 cm11.5 cm The transverse diameter 11 cmThe transverse diameter 11 cmBAGIAN LAB ANATOMI FK

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Outer measurementOuter measurement Distantia spinarumDistantia spinarum Distantia cristarumDistantia cristarum External conjugate (Baudelaque)External conjugate (Baudelaque)

Vaginal examinationVaginal examination

CALDWELL CALDWELL -- MOLOY MOLOY CLASSIFICATIONCLASSIFICATION

Gynecoid pelvisGynecoid pelvis

Android pelvisAndroid pelvis

Anthropoid pelvisAnthropoid pelvis

Platypelloid pelvisPlatypelloid pelvis

Intermediate Intermediate –– type pelves/ mixed types type pelves/ mixed types of pelves of pelves more frequent than pure more frequent than pure typestypes BAGIAN LAB ANATOMI FK

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MUSCLES OF THE PERINEUMMUSCLES OF THE PERINEUM

Ischio cavernosusIschio cavernosus

Transversus perinei superficialisTransversus perinei superficialis

Sphincter ani externusSphincter ani externus

Bulbo spongiosusBulbo spongiosus

THE UROGENITAL DIAPHRAGMTHE UROGENITAL DIAPHRAGM(Triangular ligament)(Triangular ligament)

Consists of two sheets of fascia with a Consists of two sheets of fascia with a layer of muscle in between layer of muscle in between

Upper fascia of diaphragmUpper fascia of diaphragm Muscle layer : Muscle layer : -- trans.perinei profundustrans.perinei profundus

-- sphincter urethraesphincter urethrae

Lower fascia of diaphragmLower fascia of diaphragm

ANATOMY OF ANATOMY OF THE REPRODUCTIVE TRACTTHE REPRODUCTIVE TRACT

External GenitalExternal GenitalMons pubisMons pubisLabia majoraLabia majora

Labia minoraLabia minoraClitorisClitorisVestibuleVestibuleHymenHymenUrethral orificeUrethral orificeBartholin’s glands & skeneBartholin’s glands & skene 31BAGIAN LAB ANATOMI FK

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Internal GenitalInternal Genital VaginaVagina UterusUterus Fallopian tubeFallopian tube Broad ligamentBroad ligament OvaryOvary

VaginaVagina

A canal of plain muscule extending from the A canal of plain muscule extending from the vestibule to the uterusvestibule to the uterus

Nulliparous adult : H shapedNulliparous adult : H shapedTransverse ridges or rugae Transverse ridges or rugae Permit great distension during parturitionPermit great distension during parturition

Vaginal secretion Vaginal secretion –– composed of alkaline composed of alkaline cervical secretion desquamated epithelial cervical secretion desquamated epithelial cells & Bacteriacells & Bacteria

The epithelium is rich in glycogen, converted The epithelium is rich in glycogen, converted by Doderlein’s bacillus into lactic acidby Doderlein’s bacillus into lactic acid

pH 4,5 pH 4,5 barrier against infectionbarrier against infectionBAGIAN LAB ANATOMI FK

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UTERUSUTERUS

Hollow viscus composed of plain muscle,Bulb Hollow viscus composed of plain muscle,Bulb shapeshape

Corpus or Body : the upper twoCorpus or Body : the upper two--thirdthirdCervix or Neck : the lower thirdCervix or Neck : the lower third

Length Length : 7.5 cm: 7.5 cmThickness Thickness : 2.5 cm: 2.5 cmLength of cavity : 6 cmLength of cavity : 6 cmThickness of muscle wall is 1.2 cmThickness of muscle wall is 1.2 cm

Ratio corpusRatio corpus : cervix: cervixChildren Children : 1 : 2: 1 : 2Teen ageTeen age : 1 : 1: 1 : 1Adult Adult : 2 : 1: 2 : 1

Isthmus uteriIsthmus uteri BAGIAN LAB ANATOMI FK UNILA 2012

UTERINE WALLUTERINE WALL

PerimetriumPerimetriumMyometriumMyometrium EndometriumEndometrium

Muscle structure Muscle structure –– three layerthree layer

LIGAMENTS OF THE UTERUSLIGAMENTS OF THE UTERUS

Broad ligaments : lig latumBroad ligaments : lig latum Contains fallopian tubeContains fallopian tube

the round and ovarian lig, ovario the round and ovarian lig, ovario ––uterine anastomosis the ureteruterine anastomosis the ureter

Round ligaments : lig rotundumRound ligaments : lig rotundum Infundibulo pelvicum ligInfundibulo pelvicum lig Transverse cervical ligamentsTransverse cervical ligaments

(Mackenrodt’s , cardinal lig)(Mackenrodt’s , cardinal lig) Uterosacral ligamentsUterosacral ligaments Vesico uterine ligamentVesico uterine ligamentBAGIAN LAB ANATOMI FK

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UTERUSUTERUS

Position :Position : Ante/retroflexionAnte/retroflexion Ante/retroversionAnte/retroversion TorsionTorsion

Blood vesselsBlood vessels Uterine vesselsUterine vessels Ovarian vesselsOvarian vessels

FALLOPIAN TUBEFALLOPIAN TUBE

Interstitialis partInterstitialis part1 cm long and verry narrow (< 1 mm)1 cm long and verry narrow (< 1 mm)

IsthmusIsthmus2 cm long, straight and cord like (2 cm long, straight and cord like ( 1 mm)1 mm)

AmpulaAmpula5 cm long, thin walled and convoluted5 cm long, thin walled and convoluted

InfundibulumInfundibulum2 cm long, the terminal expansion with 2 cm long, the terminal expansion with fimbrial processes which help to attract the fimbrial processes which help to attract the ovumovum BAGIAN LAB ANATOMI FK

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OVARYOVARY

3 cm long and 1.5 cm wide3 cm long and 1.5 cm wideRoughly the size and shapeRoughly the size and shape

Attached to the cornu of the uterusAttached to the cornu of the uterusBy the ovarian ligament (ovarii propium lig)By the ovarian ligament (ovarii propium lig)

Divided intoDivided into -- a vascular medullaa vascular medulla-- cortexcortex

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