Obstetrics and gynecology. Anatomy of the female pelvis (the most important)

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Obstetrics and gynecology. Anatomy of the female pelvis (the most important)

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4. Anatomy of the female pelvis

The structure of the bone pelvis of a woman is very important in obstetrics, since the pelvis serves as the birth canal through which the fetus is being born. The pelvis consists of four bones: two pelvic bones, the sacrum and the coccyx.

Pelvic (innominate) bone It consists of three fused bones: the ilium, pubic and ischium. The ilium consists of a body and a wing, expanded upwards and ending in a crest. In front, the crest has two protrusions - the anteroupper and anteroinferior awns, behind there are posterior superior and posterior inferior awns. The ischium consists of a body and two branches. The upper branch goes from the body down and ends with the ischial tuberosity. The lower branch is directed anteriorly and upward. On the back surface of it there is a protrusion - the ischial spine. The pubic bone has a body, upper and lower branches. On the upper edge of the upper branch of the pubic bone there is a sharp crest, which ends in front with a pubic tubercle.

Sacrum consists of five fused vertebrae. On the anterior surface of the base of the sacrum, a protrusion is the sacral promontory (promontorium). The top of the sacrum is movably connected to the coccyx, which consists of four or five undeveloped fused vertebrae. There are two sections of the pelvis: the large and small pelvis, between them there is a boundary, or nameless line. The large pelvis is available for external examination and measurement, unlike the small pelvis. In the small pelvis, an entrance, a cavity and an exit are distinguished. In the pelvic cavity there are narrow and wide parts. Accordingly, four planes of the small pelvis are conditionally distinguished. The plane of entry into the small pelvis is the boundary between the large and small pelvis. At the entrance to the pelvis, the largest size is the transverse.

In the cavity of the small pelvis, the plane of the wide part of the cavity of the small pelvis is conditionally distinguished, in which the direct and transverse dimensions are equal, and the plane of the narrow part of the cavity of the small pelvis, where the direct dimensions are somewhat larger than the transverse ones. In the plane of the exit of the small pelvis and the plane of the narrow part of the small pelvis, the direct size prevails over the transverse. In obstetric terms, the following dimensions of the small pelvis are important: true conjugate, diagonal conjugate and direct size of the pelvic outlet. The true, or obstetric, conjugate is 11 cm.

The diagonal conjugate is determined during vaginal examination, it is equal to 12,5-13 cm. The direct size of the exit of the small pelvis is 9,5 cm. During childbirth, when the fetus passes through the small pelvis, this size increases by 1,5-2 cm due to the deviation of the apex coccyx backwards. The soft tissues of the pelvis cover the bone pelvis from the outer and inner surfaces and are represented by ligaments that strengthen the joints of the pelvis, as well as muscles. Important in obstetrics are the muscles located in the outlet of the pelvis. They close the bottom of the bone canal of the small pelvis and form the pelvic floor.

Obstetric (anterior) perineum called that part of the pelvic floor, which is located between the anus and the posterior commissure of the labia. The part of the pelvic floor between the anus and the coccyx is called the posterior perineum.

Author: Ivanov A.I.

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