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Xiu Xiu Jiang Email: [email protected] Ai Xia Liu Email: [email protected] Telephone (office): 87061501-1839 Women’s Hospital, School of Medicine,

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Xiu Xiu Jiang Email: [email protected] Ai Xia Liu Email: [email protected] Telephone (office): 87061501-1839 Womens Hospital, School of Medicine, Zhejiang [email protected]@yahoo.com.cn Slide 2 Anatomy of the Female Reproductive System Jiang Xiu Xiu Womens hospital, School of Medicine, Zhejiang University Slide 3 Outline Bony pelvis Pelvic floor External genitalia Internal genitalia Vascular, lymphatic and nervous system Adjacent organs Slide 4 Bony Pelvis Front view Rear view Slide 5 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 Slide 6 Slide 7 Slide 8 Pelvis child-bearing and child-birth function in women. Female Male Slide 9 Key factors of bony pelvis ------ related to child-birth Size Shape Joint (movement ) Ligament (relaxation) Slide 10 Anatomy of the Bony Pelvis Bones Joints Ligaments Three planes of the pelvis Types of the female pelvis Slide 11 Slide 12 Sacrum (1#) : 5 fused vertebrae Coxae : ilium (2#) Ischium (3#) pubis (4#) Coccyx : 3 fused cartilaginous bones Bones Slide 13 sacral promontory superiormost portion of the sacrumsacrum border of the pelvic inletpelvic inlet can be touched bone marker Bones sacral promontory Sacrum : 5 fused vertebrae Coccyx : 4 fused cartilaginous bones Slide 14 Ischium (3#) Coxae : ilium (2#) pubis (4#) Bones tuberosity ischial tuberosity --- marks the lateral boundary of the pelvic outlet. Slide 15 Joints Sacro-iliac joint (SI) - minimal motion Sacro-coccygeal joint (SC) - slightly moveable (forward and backward). Symphysis pubis - slightly movable Slide 16 Joints Symphysis 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 Slide 17 Joints Diastasis 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 women postpartum symphysiotomy Slide 18 Ligaments Sacro-iliac joint Anterior sacroiliac ligament Interosseous sacroiliac ligament Posterior sacroiliac ligament Sacrotuberous ligament Sacro-coccygeal joint anterior sacrococcygeal ligament posterior sacrococcygeal ligament lateral sacrococcygeal ligaments Intercornual sacrococcygeal ligament Slide 19 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 Slide 20 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 Slide 21 - 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. Ligaments Sacrotuberous ligament Slide 22 Boundary of pelvis Border line posterior upper border of sacral promontory lateral iliopectineal line anterior upper border of pubis Slide 23 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 pelvis The female bony pelvis is divided into: Slide 24 Planes of True Pelvis inlet outlet mid-cavity Slide 25 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 Slide 26 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 Slide 27 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 Slide 28 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. Slide 29 Caldwell- Moloy Classification of Pelvic Types (1933) Four types of female pelves were described. Actually, the majority of pelvis are mixed types. Slide 30 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 90-100 o. Slide 31 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 (

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