THE PELVIS

TYPES
1. GYNAECOID PELVIS occurs in only 40 percent of
white women. It is the normal female pelvis and the
most favourable for labour.
2. ANDROID PELVIS, pelvis with male characteristic
and is said to predispose to deep transverse arrest.
3. ANTHROPOID PELVIS, in which there is slight
increase in the antero-posterior diameter of the pelvis.
It encourages an occipitoposterior position.
4. PLATYPELLOID PELVIS, slightly flattened pelvis, is
also associated with an increased risk of
obstructed labour.
 BONY PELVIS

•Hip bone (Ilium,

ischium and pubis)
•Sacrum
•Coccyx
Joined anteriorly by
pubic symphysis
Posteriorly by sacro
-iliac joint
GYNAECOID PELVIS
The pelvic brim;
the pelvic brim lies in one plane
bounded

in front by the sympheses pubis ,

on each side by the upper margin of
the pubic bone , the ilio -pectinial line
and the ala of the sacrum and

posteriorly by the promontory of the

sacrum.

The brim is oval in shape with the

transverse diameter (13.5cm) slightly
greater than the antero-posterior
diameter (11cm).
The pelvic cavity ; this is some time described in terms of an
imaginary plane bounded

in front by the middle of sympheses pubis ,

on each sides by the pubic bone , the obturater fascia and the inner
aspect of the ischeal bone and

posteriorly by the junction of the second and third peice of the

sacrum .

the ischeal spines lie slightly below this plane .The pudendal nerve
passes behind and below the ischial spine on each side.

In the gynecoid pelvis this cavity is circular and roomy because the
sacrum is inclinated bach ward , is well curved and the sacrosciatic
notches are wide . the cavity is almost round as the transverse and
antro posterior diameter are similar at 12cm.
The pelvic outlet ;

it is roughly diamond shaped and is bounded

in front by the lower margin of the symphesis pubis ,

on each side by the desending ramus of the pubic

bone ,the ischeal tuberosity and the sacrotuberous
ligament and

posteriorly by the last peice of the sacrum ( not the

coccyx , which is mobile ).

Unlike the brim, the outlet does not have boundaries

which lie in a single plane, but an imaginary plane of
the outlet is described ,passing from the lower
margin of the symphesis pubis to the last peice of
the sacrum .
The shape of the outlet is ovale
with the long axis in the
anteroposterior diameter is
13.5cm while the transverse
diameter is 11cm.

During pregnancy the

ligaments of the sacroiliac
joints and the symphesis
pubis become softened and
there is slightly increased
mobility at these joints.

The sacrococcygeal joint allows

the coccyx to move freely
backwards during delivery.
CLINICAL EXAMINATION OF THE PELVIS
A pelvic examination is some time made early in
pregnancy to;
1.Confirm the diagnosis of pregnancy and its duration.
2.To exclude abnormalities of the pelvic organs and
3.To assess the capacity of the pelvis.

If the patient had miscarriage previously, it is wise to

postpone any internal examination until later.

In any case , a further pelvic examination is usually

performed at about 36 weeks , when a better
assessment of pelvic cavity can be made , since at that
time the pelvic floor is more relaxed , and the size of
the fetal head can also be related to that of the pelvic
brim at this time .
VAGINAL ASSESSMENT OF THE
PELVIS
THE BRIM
The sacral promontory can not be
reached with an examining finger in a
normal pelvis unless the patient is
anesthetised.

If it can be felt it is considerably

reduced, and in such case it may be
possible to estimate the diagonal
conjugate with the exploring finger. This
is distance between the promontory and
the lower margin of the symphysis
pubis.

The true conjugate may be derived by

subtracting 1.5 cm from the diagonal
conjugate.
THE PELVIC CAVITY
On vaginal examination a general idea of the capacity of the
pelvic cavity can be gained;

1. The anterior surface of the sacrum is palpated from above

downwards; noting weather it is straight or concave.

2. The position of the ischial spines may be assessed by palpation

of the sacrospinous ligaments, which should be of a length that
will accommodate three finger breadths.

3. the spines are some time unduly prominent but it is the distance
between them rather than their prominence that matters .
THE PELVIC OUTLET

The inter tuberous diameter can be

determined by external palpation,

but vaginal examination gives the best

assessment of the width of the sub
pubic arch and of the position of the
sacrum.
THE PELVIC FLOOR

Although this is not part of the

bony pelvis it is mentioned
here because it forms part of
the birth canal and plays an
important part in the
mechanism of labour.

The two levator ani muscles,

with their fascia form a
musculofascial gutter during
the second stage of labour.