This is a very short summary of some of the important points in the lecture. It is not a complete representation, because of the extensive of graphics and images to illustrate a point, some things will be left to be updated later.
Read from Dr. Nilesh’s lecture.
Anatomical position of bony pelvis
- ASIS & Symphysis is on the same coronal plane
- Tip of coccyx & upper margin of symphysis in the same horizontal plane
- So INLET makes an angle of 60 degree with transverse plane
- directed forward
Stages in delivery
- STAGE 1
- cervical dilatation
- starts with onset of true labour pain and ends with full dilatation of the cervix
- STAGE 2
- expulsion of fetus
- Stages
- Descent
- uterine contractions & retractions
- unfolding of fetus
- Engagement
- head engages in the oblique/transverse diameter of the inlet
- suboccopito-bregmatic diameter
- transverse diameter of inlet
- should be more than 9.5cm
- if less cannot accomodate fetal head engagement will fail –> cephalo-pelvic disproportion
- Increased flexion
- Internal rotation
- Extension
- STAGE 3
- expulsion of placenta & membranes
Observe the diameters of the pelvic inlet & outlet. What are the conjugates related to pelvic diameter?
- Anatomical conjugate
- anteroposterior conjugate diameter
- extends from the upper margin of the pubic symphysis to the middle of the sacral promontory
- Obstetrical conjugate
- shortest diameter through which foetal head must pass in it’s course throught the inlet
- measured from middle of back of pubic symphysis to the sacral promontory
- Diagonal conjugate
- anteroposterior diameter of inlet as measured par vaginum
- inability to palpate the sacral promontory suggests that the conjugate diameter of the inlet is adequate for parturition
- palpated means contracted pelvis
- distance between the lower margin of pubic symphysis & sacral promontory
- Subtraction of diagonal conjugate by 1.5cm gives approximate measurement of anatomical conjugate
Pelvis
- Female pelvis inlet: oval
- diameter longer
- transverse widest
- suprapubic angle: 90 degree
- Accomodate gap between thumb & index
- greater sciatic notch: wider
- pelvic cavity: long, conical
- sacrum: short wide
- Male pelvis inlet: heart shaped
- subpubic angle: acute angle
- accomodate gap between index & middle finger
- greater sciatic notch: narrow fish-hook appearance
- pelvic cavity: short, cylindrical
- sacrum: long narrow
Classification of shape of pelvic inlet
- Gynaecoid
- rounded
- Android
- heart shaped (male)
- Anthropoid
- long, narrow, oval
- Platypelloid (flat)
- avoid, long axis tranverse
- like a flat bowl
Supports of the uterus
- Pelvic muscles
- Ligaments
Muscles forming perineal body
Perineal body maintains integrity and should never be torn. If torn, can cause uterus/rectal prolapse. These muscles are supplied by the pudendal nerve.
- levator ani (internal)
- bulbospongiosus (external)
- sphincter ani externus
- transverse perineal
- deep & superficial
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