THE BONY

PELVIS
Dr. Dodi S, SpOG

THE BONY PELVIS

a. Pelvic anatomy
b. Pelvic joints
c. Planes & diameters of the pelvis
d. Pelvic shapes
e. Pelvic size and its clinical estimation

a. PELVIC ANATOMY

b. PELVIC JOINTS
- Symphysis pubis
- Sacroiliac joints
- Relaxation of the pelvic joints
( especially during pregnancy)

PLANES AND DIAMETER OF THE PELVIS

HAVING 4 IMAGINARY PLANES :
1. The plane of the pelvic inlet ( Superior strait )
2. The plane of the pelvic outlet ( Inferior strait )
3. The plane of the mid pelvis ( least pelvic dimensions )
4. The plane of greatest pelvic dimensions
( Has no obstetrical significance ,
it is not considered further)

HODGE PLANE
I

= Pelvic inlet

II

Hodge I through lower margin of

the symphysis

III

Hodge I through ischial spine

IV

Hodge I through the tip of

coccygis

PELVIC SHAPES
CALDWELL - MOLOY CLASSIFICATION (1933 - 34)

Gynecoid pelvis
Android pelvis
Anthropoid pelvis
Platypelloid pelvis

GYNECOID PELVIS
- Almost 50% of white women (Todd Collection study)
- Ascertained the frequency of the four parent pelvic types
by study of Todds Collection ( Caldwell & CoWorkers,1939)

ANDROID PELVIS
- 1/3 of pure type pelvis ( white women), 1/6 non white women
- The extreme android pelvis presages poor prognosis for vaginal
delivery
- The frequency of difficult forceps operations increases

ANTHROPOID PELVIS
- 1/4 pure type pelvis in white women and nearly
1 1/2 of those in non white women

PLATYPELLOID PELVIS
- Rarest of the pure varieties ( < 3% )

INTERMEDIATE TYPE PELVIS

- Mixed type
- More frequent than pure types

CALDWELL
MOLOY

PELVIC SIZE AND ITS CLINICAL ESTIMATION

- Pelvic inlet measurements
- Diagonal conjugate
- Engagement : - with engagement, the fetal head
serves as an internal pelvimeter to demonstrate
that the pelvic inlet is ample for that fetus.

PELVIC INLET
- Obstetrical conjugate ( normal > 10 cm)
- Diagonal conjugate
CD - 1.5 to 2 cm = True conjugate

PELVIC OUTLET MEASUREMENTS

( diameter between the ischial tuberosities )
Called as :
- Biischial diameter, Inter tuberous diameter, Transverse
diameter of the outlet
- The shape of the sub pubic arch also can be evaluated
at the same time by palpating the pubic rami from the
sub pubic region toward the ischial tuberosities.
- Estimated by placing a closed fist against the
perineum between the ischial tuberosities, after fist
measuring the width of the closed fist ( usually > 8 cm )

MID PELVIS ESTIMATION

- Clinical estimation of mid pelvis capacity by any
direct form of measurement is not possible Suspicion contracted pelvis in this region :
- Ischial spines are quite prominent
- The side walls are felt to converge
- The concavity of the sacrum is very shallow
- Ischial diameter of the outlet < 8 cm

 Outer measurement
Distantia spinarum
Distantia cristarum
External conjugate (Baudelaque)
Vaginal examination

 95 % of all labors is in vertex presentation and most

commonly ascertained by abdominal palpation and
confirmed by vaginal examination
Majority of cases the vertex enters the pelvis with the
sagittal suture in the transverse pelvic diameter
The fetus enters the pelvis in the Left Occiput
Transverse Position / LOT (40% of labors) & 20% ROT.
The head either enters the pelvis with the occiput
rotated 45o anteriorly from the transverse position

 20 % of all labors the fetus enters the pelvis in an

Occiput Posterior (OP) position.
The ROP is slightly more common than LOP and
posterior positions are more often associated with a
narrow forepelvis
The head either enters the pelvis with the occiput
rotated 45o anteriorly from the transverse position

THE CARDINAL MOVEMENTS OF LABOR ARE :

ENGAGEMENT
DESCENT
FLEXION
INTERNAL ROTATION
EXTENSION
EXTERNAL ROTATION
EXPULSION

ENGAGEMENT
The biparietal diameter, the greatest transverse
diameter of the fetal head in occiput presentations,
passes through the pelvic inlet is designated
engagement (during the last few weeks of pregnancy)
A normal sized head usually does not engage with
its sagittal suture directed anteroposteriorly.
Instead, the fetal head usually enters the pelvic inlet
either in the transverse diameter or in one of the
oblique diameters.

ASYNCLITISM

Although the fetal heads tends to accommodate to the

transverse axis of the pelvic inlet, the sagittal suture , while
remaining parallel to that axis, may not lie exactly midway
between the symphysis and sacral promontory

The sagittal suture frequently is deflected either

posteriorly toward the promontory or anteriorly toward
the symphysis.
Such lateral deflection of the head to a more anterior or
posterior position in the pelvis is called asynclitism

Moderate degrees of asynclitism are the rule in normal

labor, but if severe , may lead to CPD

DESCENT
In nulliparas, engagement may take place before the onset
of labor and further descent may not follow until the onset
of second stage. In multiparous women, descent usually
begins with engagement.
Descent is brought about by one or more of four forces :
Pressure of the amniotic fluid
Direct pressure of the fundus upon the breech with
contractions
Bearing down efforts with the abdominal muscles
Extensions and straightening of the fetal body