Xiu Xiu JiangEmail: [email protected]
Ai Xia LiuEmail:
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
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