True pelvis

The true pelvis is cylindrical in shape and

has an inlet, a wall, and an outlet.
The inlet is open while the pelvic floor
closes the outlet and separates the pelvic
cavity, above, from the perineum, below.

Pelvic Inlet
Circular, heart shaped, opening between
the abdominal cavity and the pelvic cavity
through which structures traverse between
the abdomen and pelvic cavity.
It is completely surrounded by bones and
joints.
The sacral promontory protrudes into the
inlet forming its posterior margin in the
midline.

Pelvic Inlet
On either side of the promontory, the
margin is formed by the alae of the
sacrum.
The margin of the pelvic inlet then crosses
the sacro-iliac joint and continues along
the linea terminalis (i.e. the arcuate line,
the pecten pubis or pectineal line, and the
pubic crest) to the pubic symphysis.

Pelvic inlet
Structures pass between the pelvic cavity
and the abdomen through the pelvic inlet.
During childbirth, the fetus passes through
the pelvic inlet from the abdomen, into
which the uterus has expanded during
pregnancy; and then passes through the
pelvic outlet.

Pelvic Walls
The walls of the pelvic cavity consist of the
sacrum, the coccyx, the pelvic bones
inferior to the linea terminalis, two
ligaments, and two muscles.

Ligaments
Sacrospinous and Sacrotuberous
ligaments are important architectural
elements of the walls because they link
each pelvic bone to the sacrum and
coccyx.
They stabilize the sacrum on the pelvic
bones by resisting the upward tilting of the
inferior aspect of the sacrum

 The Sacrospinous ligament

triangular shaped
its apex attached to the ischial spine and its
base attached to the related margins of the
sacrum and the coccyx.

 The sacrotuberous ligament

is also triangular in shape and is superficial to the
sacrospinous ligament.
Its base has a broad attachment that extends from
the posterior superior iliac spine of the pelvic bone,
along the dorsal aspect and the lateral margin of the
sacrum, and onto the dorsolateral surface of the
coccyx.
Laterally, the apex of the ligament is attached to the
medial margin of the ischial tuberosity.

Foramen
These ligaments convert the greater and
lesser sciatic notches of the pelvic bone
into foramina.
The greater sciatic foramen lies superior to
the sacrospinous ligament and the ischial
spine.
The lesser sciatic foramen lies inferior to the
ischial spine and sacrospinous ligament
between the sacrospinous and sacrotuberous
ligaments.

Muscles
Obturator internus
is a flat, fan-shaped muscle that originates from
the deep surface of the obturator membrane and
from associated regions of the pelvic bone that
surround the obturator foramen.
The muscle fibers converge to form a tendon that
leaves the pelvic cavity through the lesser sciatic
foramen, makes a 90 bend around the ischium
between the ischial spine and ischial tuberosity,
passes posteriorly, and crosses the hip joint to
insert on the greater trochanter of the femur.

 Piriformis
is triangular in shape and originates in the
bridges of bone between the four anterior sacral
foramina.
It passes laterally through the greater sciatic
foramen, crosses the posterosuperior aspect of
the hip joint, and inserts on the greater trochanter
of the femur above the insertion of the obturator
internus muscle
A large part of the posterolateral wall of the pelvic
cavity is formed by the piriformis

 In addition, this muscle separates the greater

sciatic foramen into two regions, one above the
muscle and one below.
Vessels and nerves coursing between the pelvic
cavity and the gluteal region pass through these
two regions.

Pelvic outlet
The diamond shaped pelvic outlet is
formed by both bone and ligaments
It is limited anteriorly in the midline by the
pubic symphysis.
On each side, the inferior margin of the
pelvic bone projects posteriorly and
laterally from the pubic symphysis to end
in the ischial tuberosity.

Pelvic outlet
Together, these elements construct the
pubic arch, which forms the margin of the
anterior half of the pelvic outlet.
The sacrotuberous ligament continues this
margin posteriorly from the ischial
tuberosity to the coccyx and sacrum.
The pubic symphysis, ischial tuberosities,
and coccyx can all be palpated.

 Terminal parts of the urinary and

gastrointestinal tracts and the vagina pass
through the pelvic outlet.
The area enclosed by the boundaries of
the pelvic outlet and below the pelvic floor
is the perineum.

Clinical Significance
Changes with Pregnancy
During pregnancy, the symphysis pubis and the
ligaments of the sacroiliac and sacrococcygeal joints
undergo softening in response to hormones, thus
increasing the mobility and increasing the potential size
of the pelvis during childbirth.
The hormones responsible are estrogen and
progesterone produced by the ovary and the placenta.
An additional hormone, called relaxin, produced by these
organs can also have a relaxing effect on the pelvic
ligaments.

Clinical Significance
Pelvic measurements in obstetrics
The diagonal conjugate between the promontory
and the midpoint of the pubic symphysis (11 cm)
The maximum transverse diameter of the inlet (11.5
cm)
The bispinous diameter the distance between
ischial spines (9 cm)
The sagittal outlet the distance between the tip of
the coccyx and the inferior margin of the pubic
symphysis (10 cm)

 Clinical pelvimetry
Can be obtained using plain radiographs
and computed tomography scans.
Both techniques use ionizing radiation and
even a low dose carries a potential risk to the
mother and fetus.

magnetic resonance imaging carries no

radiation risk for the fetus or mother