Xiu Xiu Jiang Email: janet418@sina.com.cn Ai Xia Liu Email: wcumszzy@yahoo.com.cn Telephone...

Xiu Xiu JiangEmail: janet418@sina.com.cn

Ai Xia LiuEmail:

wcumszzy@yahoo.com.cn

Telephone (office): 87061501-1839

Women’s Hospital, School of Medicine, Zhejiang University

Anatomy of the Female Reproductive

System

Jiang Xiu XiuWomen’s hospital, School of Medicine,

Zhejiang University

Outline Bony pelvis Pelvic floor External genitalia Internal genitalia Vascular, lymphatic and

nervous system Adjacent organs

Bony Pelvis

Front view Rear view

Pelvis

A basin-shaped ring Latin word “basin”

To bear the weight of the upper body when

sitting and standing

To contain and protect the pelvic organs

Pelvis child-bearing and child-birth function in women.

Female Male

Key factors of bony pelvis

------ related to child-birth

Size

Shape

Joint (movement )

Ligament (relaxation)

Anatomy of the Bony Pelvis

Bones

Joints

Ligaments

Three planes of the pelvis

Types of the female pelvis

Sacrum (1#) : 5 fused vertebrae

Coxae : ilium (2#) Ischium (3#) pubis (4#)

Coccyx : 3 fused cartilaginous bones

Bones

sacral promontory

• superiormost portion of the sacrum

• border of the pelvic inlet • can be touched • bone marker

Bones sacral promontory

Sacrum : 5 fused vertebrae

Coccyx : 4 fused cartilaginous bones

Ischium (3#)

Coxae : ilium (2#) pubis (4#)

Bones

tuberosity

ischial tuberosity

--- marks the lateral boundary of the pelvic outlet.

Joints

Sacro-iliac joint (SI)

- minimal motion

Sacro-coccygeal joint (SC)

- slightly moveable (forward and backward).

Symphysis pubis - slightly movable

JointsSymphysis pubis

Greek word “growing together”

• Absorb shock during walking.

• Delivery of baby.

gap of the symphysis pubis

non-pregnant: 4-5mm

Pregnant: less than 9mm

JointsDiastasis of the symphysis pubis result from:

rapid birth; forceps delivery; prenatal;

symptom:pelvic girdle pain --- involving 45% of all pregnant women and 25% of all w

omen postpartum

symphysiotomy

LigamentsSacro-iliac jointAnterior sacroiliac ligament Interosseous sacroiliac ligament Posterior sacroiliac ligament Sacrotuberous ligament

Sacro-coccygeal jointanterior sacrococcygeal ligament posterior sacrococcygeal ligament lateral sacrococcygeal ligaments Intercornual sacrococcygeal ligament

Ligaments

1. Extend from the lateral border of the sacrum and coccyx to the ischial spine

2. A thin, triangular ligament 3. With sacrotuberous ligament,

Closes off the greater sciatic notch to form the greater sciatic foramen and closes off the lesser sciatic notch to form the lesser sciatic foramen

Sacrospinous ligament

Ligaments

Function- to prevent posterior rotation of the ilium

with respect to the sacrum - Fixation site for pelvic organ prolapse

Sacrospinous ligament

sacrospinous ligament suspension

the vaginal apex is suspended posteriorly and laterally to the ligament on either side or both sides

-Extend from the posterior aspect of the lower 3 sacral vertebrae to the ischial tuberosity- It is flat, and triangular in form; narrower in the middle than at the ends.

LigamentsSacrotuberous ligament

Boundary of pelvis

Border line posterior upper border of sacral promontory lateraliliopectineal line anteriorupper border of pubis

False pelvis ( pelvis major ) ---above the border line and has no obstetric importance.

True pelvis ( pelvis minor ) ---below the border line and related to the child -birth The bone delivery canal of childbirth

Boundary of pelvisThe female bony pelvis is divided into:

Planes of True Pelvis

• inlet

• outlet

• mid-cavity

Planes of True Pelvis

pelvic inlet is heart-shape,

bounded by . posteriorly upper border of sacral promontory

. laterally: iliopectineal line

. anteriorly: upper border of pubis

anteroposterior about 11cm.

transverse about 13cm

oblique about 12.75cm

Mid-cavity It is a segment, the boundaries of which are:

the roof is the plane of pelvic inlet, the floor is the plane of the plane of pelvic outlet, anterior - the shorter symphysis pubis, posterior - the longer sacrum.

o Interspinous diameter = 10 cm between the tips of ischial spines.

Planes of True Pelvis

Pelvic outlet: 2 triangular planes with 1 base which is the intertuberous diameter

Planes of True Pelvis

Anterior sagittal plane: apex - the lower border of the symphysis pubis.laterally: the ischiopubic arch

Posterior sagittal plane: apex - the tip of the coccyx.Laterally - sacrotuberous ligament

Diameters of pelvic outlet

Planes of True Pelvis

Antero-posterior diameter =11.5cm

from Sacro-coccygeal joint to the lower border of symphysis pubis.

Transverse diameters (Bituberous diameter) = 9 cm between the inner aspects of the ischial tuberosities.

Anterior sagittal diameter = 6 cm from the lower border of the symphysis pubis to the centre of the bituberous

diameter.

Posterior sagittal diameter = 8.5 cm from Sacro-coccygeal joint to the centre of the bituberous diameter.

Caldwell- Moloy Classificationof Pelvic Types (1933) Four types of female pelves were described. Actually, the majority of pelvis are mixed types.

Gynaecoid pelvis

Ideal shape, best chances for normal vaginal delivery.

1. It is the normal female type. 2. Inlet is slightly transverse oval. 3. Sacrum is wide with average concavity and inclination. 4. Side walls are straight with blunt ischial spines. 5. Sacro-sciatic notch is wide. 6. Subpubic angle is 90-100o.

Anthropoid pelvis

1. It is ape-like type. 2. All anteroposterior diameters are long. 3. All transverse diameters are short. 4. Sacrum is long and narrow. 5. Sacro-sciatic notch is wide. 6. Subpubic angle is narrow (<900 )7. prominent ischial spines

Android pelvis

1. It is a male type. 2. Inlet is triangular or heart-shaped with

anterior narrow apex. 3. Side walls are converging (funnel pelvis)4. Projecting ischial spines. 5. Sacro-sciatic notch is narrow. 6. Subpubic angle is narrow <90o

Platypelloid pelvis

1. It is a flat female type. 2. All anteroposterior diameters are short. 3. All transverse diameters are long. 4. Sacro-sciatic notch is narrow. 5. Subpubic angle is wide

Pelvic floor

Pelvic floor The tissues closing down the pelvic outlet

(muscles and fasciae)Function- providing support for pelvic organs, e.g. the bladder,

rectum, the uterus. - maintenance of continence

Anterior part (urogenital triangle) urethra and vagina pass throughPosterior part (anal triangle) rectum pass through

Pelvic floor

Outer layer

Bulbocavernosus muscle ( 球海绵体肌 )

Ischiocavernosus muscle ( 坐骨海绵体肌 )

Superficial transverse perineal muscle ( 会阴浅横肌 )

External anal sphincter ( 肛门外括约肌 )

mid layer

urogenital diaphragm ( 泌尿生殖膈 )

Pelvic floor

Inner layer (pelvic diaphragm 盆膈 ) the main support of the pelvic floor formed by the levator ani and coccygenus

muscles and covering fasciae. Levator ani: （肛提肌 )

pubococcygenus ( 耻尾肌 ),

iliococcygenus ( 髂尾肌 ),

puborectalis ( 坐尾肌 )

PC

IC

Levator aniPubococcygenus (PC ) -a hammock-like muscle -stretches from the pubic bone to the coccyx (tail bone) -controls urine flow and position the baby's head during childbirth.

Iliococcygenus (IC)- arises from the ischial spine, super ramus of the pubis, and is attached to the

coccyx - Help for vaginal contraction

Puborectalis (PR) sphincter ani externus- arise from the lower part of the symphysis pubis,and the superior fascia of the

urogenital diaphragm , meet with the corresponding fibers of the opposite side around the lower part of the rectum, and form for it a strong sling.

- Relaxation reduces the angle between rectum and anus, allowing defecation in conjunction with relaxation of the internal and external sphincters.

Pelvic floor Perineumgeneral conception: the tissues closing down the pelvic

outlet

Clinical conception: the tissues between vaginal and

anus.

- thickness: 3-4cm

- the outlayer support for pelvic floor

SUMMARY Bones Joints Ligaments planes of the pelvis

Types of the female pelvis Pelvice floor

END