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The Female Pelvis in Point of Obstetrics from Considerations of Obstetrics the Female Pelvis Is Divided Into Two Parts: Large and Small Pelvis

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The Female Pelvis in Point of Obstetrics from Considerations of Obstetrics the Female Pelvis Is Divided Into Two Parts: Large and Small Pelvis Women’s pelvis. Fetus as object of births. 1. Relevance of the topic: The topic is major in obstetrics. Without it, further study of obstetric discipline, mastering many topics of physiological and pathological obstetrics is impossible. Knowledge of the anatomy of the pelvis, the ability to measure its size allows you to assess the correspondence between the size of the birth canal and the fetal head, ie to predict the course and outcome of childbirth. 2. Specific goals: -To know the structure of a woman's pelvis, the boundaries and dimensions of the pelvic planes - To classify the main external and additional dimensions of the pelvis - To measure the external dimensions of the pelvis - To set the size of the true conjugate - To know the structure of the fetal skull, the location of sutures, temples - To determine the size of the head and torso of the fetus - To interpret the signs of fetal maturity. 3. The basic level of expertise, skills, abilities, required for learning the topic (interdisciplinary integration ) Names of previous disciplines Skills acquired 1. Normal anatomy Knowledge of female anatomy, genitals, structure of a woman's pelvis, types of bone connections, musculo-fascial systems, blood supply to the female genitals. 2. Pediatrics Knowledge of the structure of the newborn, placement of tendrils, age norms of their closing 4. Tasks for independent work during preparation to the lesson and in the lesson. 4.1. A list of basic terms, parameters, characteristics that a student must learn during preparation to the lesson. Term Definition 1. Distantia spinarum The distance between the anterior spines of iliac bones - 25 cm 2. Distantia cristarum The distance between the most distant points of the iliac crests is 28 cm. 3. Distantia trochanterica The distance between the large swivels of the femurs is 31 cm. 4. Conjugata externa The direct size of the pelvis is 20 cm. 4.2.Theoretical questions for the lesson. 1. What is the pelvic inlet? 2. What is obstetrical outlet? 3. What is Michaelis rhomboid? 4. What is Soloviov's index? 5. What is small oblique diameter of the fetal skull? 6. What is the suboccipitofrontal diameter of the fetal skull? 7. What is large oblique diameter of the fetal skull? 8. What is the frontooccipital diameter of the fetal skull? 9. What is the vertical diameter of the fetal skull? 10. What is the biparietal diameter of the fetal skull? 11. What is small transverse diameter of the fetal skull? 4.3. Practical activities (tasks) to be performed on the lesson 1. To describe the Obstetric conjugate. 2. To describe the Diagonal conjugate. 3. To describe the True conjugate. 4.4Topic content: The Female Pelvis in Point of Obstetrics From considerations of obstetrics the female pelvis is divided into two parts: large and small pelvis. The border between them goes along the nameless line (linea innominata). The large pelvis is bounded by the wings of ilia on either side, by the spine – from behind, and there is no wall from the front. The small pelvis is formed by the pubic bones branches from the front, on the sides – by parts of the bones forming the femoral fossa, from behind – by the sacral and pelvic bones Bones of pelvis (а: 1 - innominate bone; 2 - sacrum, 3 - coccyx) and joints (b: 1- sacroiliac joints; 2 - symphysis pubis; 3 - sacrococcygeal joint) During delivery the small pelvis as a dense bone tunnel limits and defines the dimensions, form, and direction of the parturient canal, to which the fetus goes and must conform, changing its own configuration. Pelvis measuring is the most important method of pelvis examination. Most internal dimensions of the pelvis are inaccessible for measurement, therefore usually its external dimensions are measured, by which the internal ones are evaluated. The pelvis is measured with the help of a pelvimeter. Usually there are measured the four main dimensions of the pelvis: three transversal and one straight. Distantia spinarum is the distance between the anterosuperior axes of the ilia. This dimension makes 25 cm. Distantia cristarum is the distance between the most distant points of the iliac crests; it makes 28 cm on average. Distantia trochanterica is the distance between the greater trochanters. This dimension makes 31 cm. Conjugata externa (external conjugate) is the straight dimension of the pelvis. The woman is put on her side; the leg lying below is bent in the hip and knee joints, the other leg is straightened. The end of the pelvimeter is set in the middle of the superior-external border of the symphysis, the other end is pressed to the subsacral fossa, which is situated between the process of the fifth lumbar vertebra and the beginning of the first sacral vertebra. The external conjugate makes 20 cm External sizes of pelvis: а - transverse: 1 - distantia cristarum; 2 - spinarum; 3 - trochanterica; b – conjugata externa Dimensions of the small pelvis are of great importance in obstetric practice since the course and completion of delivery depend on them. But most dimensions of the small pelvis can not be measured directly. The large pelvis is not of big importance for the birth of a child, but it is possible to judge about the form and size of the small pelvis by its dimensions. The small pelvis cavity is the space between its walls, limited from above and from below by the area of brim and the area of pelvic outlet. It looks like a cylinder truncated from the front backwards in such a way that the anterior part (directed to the womb) is three times as low as the posterior one (directed to the sacral bone). There are differentiated four planes in the small pelvis cavity: the area of brim, the pelvic plane of greatest dimensions, the third parallel pelvic plane, and the area of pelvic outlet. The planes of the small pelvis and their dimensions Obstetrically it is divided into 4 planes: the 1st is plan of pelvic inlet the 2nd is plane of mid cavity (plane of great pelvic dimensions) the 3rd is plane of obstetrical outlet (plane of least pelvic dimensions) the 4th is plan of anatomical outlet. a) The plan of pelvic inlet (area of brim) is limited from behind with the promontory of the sacral bone, on the sides – with the terminal lines of the hip bones, from the front – with the upper margin of the pubic bone and symphysis. There are differentiated four dimensions. Straight dimension – the distance from the promontory of the sacral bone to the most protrudent point of the superointernal margin of the symphysis, it is also called the true or obstetric conjugate (conjugata vera), makes 11 cm. There is also distinguished the anatomic conjugate (conjugata anatomica) – the distance from the promontory of the sacral bone to the upper margin of the symphysis, it is by 0.3 cm larger than the obstetric one. Transversal dimension – the distance between the most distant points of the arcuate lines of the hip bones (linea innominata); it makes 13 cm. Oblique dimension (left and right) – the distance from the left sacroiliac joint (articulatio sacroiliaca) to the right iliopubic eminence (eminentia iliopubica) and vice versa; it makes 12 cm; b) the plane of mid cavity (pelvic plane of greatest dimensions) is limited from behind by the junction of the II and III sacral vertebrae, from the sides – by the middle of the femoral fossae, from the front – by the middle of the internal surface of the symphysis. In the pelvic plane of greatest dimensions two dimensions are differentiated – straight and transversal. Straight dimension – from the projection of the junction of the II and III sacral vertebrae to the middle of the internal surface of the symphysis; it makes 12.5 cm. Transversal dimension – between the middles of the femoral fossae; it makes 12.5 cm ; c) the plane of obstetrical outlet third parallel pelvic plane is limited from the front by the inferior margin of the symphysis, from behind – by the sacrococcygeal joint, from the sides – by the axes of the ischial bones. There are differentiated two dimensions of the third parallel pelvic plane – straight and transversal. Straight dimension – from the sacrococcygeal joint to the middle of the inferior margin of the pubic symphysis; it makes 11 cm. Transversal dimension – between the internal surfaces of ischial bones axes; it makes 10.5 cm; d) the plan of anatomical outlet area of pelvic outlet is limited from the front by the inferior margin of the symphysis, from behind – by the pelvic bone apex, from the sides – by the internal surfaces of the ishial tuberosities. The dimensions of the area of pelvic outlet are straight and transversal. Straight dimension – the distance from the middle of the inferior margin of the symphysis to the pelvic bone apex; it makes 9.5 cm (during delivery, when the fetal head is being born, the pelvic bone reclines by 1.5 cm and the straight dimension increases to 11 cm). Transversal dimension – the distance between the internal surfaces of the ishial tuberosities; it makes 11 cm. The dimensions of the pelvic outlet can be measured directly. For this purpose the pregnant is put on her back, the legs are bent in the hip and knee joints, moved sideways and pulled to the stomach. The measurement is conducted with a measuring tape or a special pelvimeter. The straight dimension is measured between the mentioned above landmarks. To measure the transversal dimension one should add 1.5 am to the obtained distance between the internal surfaces of the ishial tuberosities (9.5 cm), taking into account the thickness of the soft tissues. Planes of pelvis (a: 1- inlet, 2 – cavity, 3 - obstetrical outlet, 4 - anatomical outlet) and providing line of pelvis (b) The line, which goes in the middle of all the straight dimensions of the planes, is called the axis of pelvis (plane of pelvic canal).
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