CH 8 The Female pelvis and reproductive organs Dr. Areefa Albahri Midwifery department

Introduction Pelvis Pelvic bones Pelvic ligament Pelvic floor Female & male reproductive system

Pelvis

Pelvis Bony pelvis 2 Innominate bone coccyx Ischail spine sacrum Symphsis pubis

Sacro-coccygeal joint Pelvis Joints Sacro-iliac joint Sacro-coccygeal joint Symphysis pubica

Pelvis Ligaments Sacrospinous ligament Extend from the lateral border of the sacrum and coccyx to the spine of the ischium Sacrotuberous ligament Extend from the posterior aspect of the lower 3 sacral vertebrae to the ischial tuberosity

Ligaments Sacrospinous ligament  lateralaspect of the sacrum to ischial spines Sacrotuberous ligament  lateral aspect of the sacrum to inner aspect of ischial tuberosity Sacroiliac ligament  medial surface of the ilium to sacrum lliolumbar ligament  iliac crest to transv lumbar vertebra

Pelvis Pelvic divisions (iliopectineal line False pelvis (pelvis major) Ture pelvis (pelvis minor) Bony birth canal the Pelvic inlet, the pelvic out let and the pelvic cavity Ture pelvis is located below the iliopectineal line, bounded anteriorly by the pubic bones, posteriorly by the sacrum and coccyx, laterally by the ischium and a small segment of the ilium.

Pelvis Types of pelvis The gynecoid type Typical female pelvis found in more 50% of women Rounded—slightly oval inlet Good sacral curve Ischial spines are not prominent sub-Pubic angle is 90 degree

The platypelloid type oval inlet (kidney shap). Reduce anteroposterior diameter and increase transferese diameter 3% of women Pelvic brim TD >>>APD  kidney shape Sacral promontory pushed forwards Problem in desecnt

The anthropoid type long, narrow, oval inlet. extended and narrow anteroposterior diameter is longer. wide sacrosciatic notch. long , narrow sacrum. Straight side walls. 25% white women & 50% nonwhite Pelvic brim APD > TD Long & narrow pelvic canal with long sacrum Straight pelvic sidewalls Labor not always difficult occiptoanterior or occiptoposterior labor persist

The android type Resemble the male pelvis (heart shape) Typical male pelvis found in 1/3 white women 1/6 non-white Pelvic brim is heart shaped Pelvis funnels from above downwards (convergent sidewalls) Narrow pubic arch Prominent spines

Male & female pelvis

WHAT IS THE PELVIC BRIM? It is the inlet of the pelvis which divides the pelvic cavity into false & true pelvis It is formed by the sacral promontory, ala of the sacrum, sacroiliac joint, line of the ilium, iliopubic eminence, pictineal line of the pubis, pubic crest & symphesis pubis

4 - Illiopectineal line- 5- Illiopectineal eminence 1 - Sacral Promotory 2 - Sacral ala (wing) 3 - Sacral iliac joint 4 - Illiopectineal line- 5- Illiopectineal eminence 6- Superior pubic ramus 7- Body of pubic bone 8- Symphysis pubis The pelvic girdle, consisting of a hip bone, serves to attach a lower limb to the axial skeleton. The hip bone articulates posteriorly at the sacroiliac joint with the sacrum, which is part of the axial skeleton. The right and left hip bones converge anteriorly and articulate with each other at the pubic symphysis. The combination of the hip bone, the sacrum, and the coccyx forms the pelvis. The pelvis has a pronounced anterior tilt. The primary function of the pelvis is to support the upper body and transfer body weight to the lower limbs. It also serves as the site of attachment for multiple muscles. The hip bone consists of three regions: the ilium, ischium, and pubis. The ilium forms the large, fan-like region of the hip bone. The superior margin of this area is the iliac crest. Located at either end of the iliac crest are the anterior superior and posterior superior iliac spines. Inferior to these are the anterior inferior and posterior inferior iliac spines. The auricular surface of the ilium articulates with the sacrum to form the sacroiliac joint. The medial surface of the upper ilium forms the iliac fossa, with the arcuate line marking the inferior limit of this area. The posterior margin of the ilium has the large greater sciatic notch. The posterolateral portion of the hip bone is the ischium. It has the expanded ischial tuberosity, which supports body weight when sitting. The ischial ramus projects anteriorly and superiorly. The posterior margin of the ischium has the shallow lesser sciatic notch and the ischial spine, which separates the greater and lesser sciatic notches. The pubis forms the anterior portion of the hip bone. The body of the pubis articulates with the pubis of the opposite hip bone at the pubic symphysis. The superior margin of the pubic body has the pubic tubercle. The pubis is joined to the ilium by the superior pubic ramus, the superior surface of which forms the pectineal line. The inferior pubic ramus projects inferiorly and laterally. The pubic arch is formed by the pubic symphysis, the bodies of the adjacent pubic bones, and the two inferior pubic rami. The inferior pubic ramus joins the ischial ramus to form the ischiopubic ramus. The subpubic angle is formed by the medial convergence of the right and left ischiopubic rami. The lateral side of the hip bone has the cup-like acetabulum, which is part of the hip joint. The large anterior opening is the obturator foramen. The sacroiliac joint is supported by the anterior and posterior sacroiliac ligaments. The sacrum is also joined to the hip bone by the sacrospinous ligament, which attaches to the ischial spine, and the sacrotuberous ligament, which attaches to the ischial tuberosity. The sacrospinous and sacrotuberous ligaments contribute to the formation of the greater and lesser sciatic foramina. The broad space of the upper pelvis is the greater pelvis, and the narrow, inferior space is the lesser pelvis. These areas are separated by the pelvic brim (pelvic inlet). The inferior opening of the pelvis is the pelvic outlet. Compared to the male, the female pelvis is wider to accommodate childbirth, has a larger subpubic angle, and a broader greater sciatic notch.

pelvic brim: pelvic inlet (Cavity); the dividing line between the greater and lesser pelvic regions; formed by the superior margin of the pubic symphysis, the pectineal lines of each pubis, the arcuate lines of each ilium, and the sacral promontory pelvic girdle: hip girdle; consists of a single hip bone, which attaches a lower limb to the sacrum pelvic outlet: inferior opening of the lesser pelvis; formed by the inferior margin of the pubic symphysis, right and left ischiopubic rami and sacrotuberous ligaments, and the tip of the coccyx pelvis: ring of bone consisting of the right and left hip bones, the sacrum, and the coccyx

THE BONY PELVIS The brim is oval in shape: Antroposterior diameter (true conjugate) 11. 11.5 cm Transverse diameter ------ 12.5-13.5 cm The pelvic cavity The pelvic canal is curved , the post wall is longer than the anterior …………. 12 The most roomy zone with almost round shape TD---13.5 APD----12

Pelvic floor The tissues closing down the pelvic outlet (muscles and fasciae) suspend and support the pelvic organs, such as uterus and bladder and rectum Posterior part (urogenital triangle) urethra and vagina pass through Anterior part (anal triangle) rectum pass through

Pelvic floor Tissues Outer layer mid layer urogenital diaphragm Bulbocavernosus muscle Ischiocavernosus muscle Superficial transverse perineal muscle External anal sphincter mid layer urogenital diaphragm

Pelvic floor 3. Perineum general conception: the tissues closing down the pelvic outlet Clinical conception: the tissues between vagina and anus.

The female reproductive system The female reproductive system consists of the external genitalia, known collectively as the vulva and the internal reproductive organs: the vagina, the uterus, two uterine tubes and two ovaries. In the non-pregnant state, the internal reproductive organs are situated within the true pelvis. The vulva The vulva includes the mons pubis, labia majora, labia minora, clitoris and the perineum

External genitalia mons pubis Clitotis Urethral orifice Perineal body Labium majus Clitotis Urethral orifice Labium minus Vaginal vestibule Vaginal orifice Perineal body Anus

External genitalia Labia majora The venous drainage is extensive and forms a plexus with numerous anastomoses. Vulva hematoma Vaginal vestibule Bordered by the labia minora laterally, by the hymenal ring inferiorly.

Internal genitalia Vagina strong canal of muscle (7.5cm) extend from the uterus to the vestibule of the external genitalia. its long axis is almost parallel with that of the lower part of the sacrum. the anterior wall of the vagina is 1.5-2cm shorter than the posterior wall.

vaginal fornix the circular cul-de-sac formed around the cervix 4 regions: the anterior fornix, the posterior fornix and 2 lateral fornices. Wall structure mucosal layer (stratified squamous epithelium) muscular layer (3 layer) submucous area ( with a dense plexus of veins and lymphatics)

Uterus The uterus is a hollow pear-shaped muscular organ located in the true pelvis between the bladder and the rectum. The position of the uterus within the true pelvis is one of anteversion and anteflexion that it bends forwards upon itself. When the woman is standing, the uterus is in an almost horizontal position with the fundus resting on the bladder.

normal normal normal Retroversion Retroflexion Anterflexion

Uterus Function The main function of the uterus is to nourish the developing fetus prior to birth. It prepares for pregnancy each month and following pregnancy expels the products of conception.

The uterus has three layers: the endometrium the myometrium the perimetrium, of which the myometrium, the middle muscle layer, is by far the thickest.

1. The endometrium forms a lining of ciliated epithelium (mucous membrane) on a base of connective tissue or stroma. In the uterine cavity, this endometrium is constantly changing in thickness throughout the menstrual cycle Called as compact layer { response to hormone periodically]

2. The myometrium is thick in the upper part of the uterus and is sparser in the isthmus and cervix. Its fibers run in all directions and interlace to surround the blood vessels and lymphatics that pass to and from the endometrium. In the cervix, the muscle fibers are embedded in collagen fibres, which enable it to stretch in labour.

The perimetrium is a double serous membrane, an extension of the peritoneum, which is draped over the fundus and the anterior surface of the uterus to the level of the internal os.

Cervix lower 1/3 of uterus. connects uterus to vagina via endocervical canal External os:os is a small round opening at the lower end of the cervix Internal os: is the narrow opening between the isthmus and the cervix. Cervix connected with the uterus by endocervical canal

Uterine malformations: Double uterus with duplication of body of uterus, cervix and vagina. Duplication of uterus and cervix with single vagina. Duplication of uterus with single cervix and vagina.

Internal genitalia Ligaments Broad ligament Round ligament Cardinal ligament Utero-sacral ligament

Fallopian tubes also known as fallopian tubes, oviducts and salpinges, are two very fine tubes leading from the ovaries into the uterus Function The uterine tube propels the ovum towards the uterus, receives the spermatozoa as they travel upwards and provides a site for fertilization. It supplies the fertilized ovum with nutrition during its continued journey to the uterus.

Fallopian tubes Anatomy Interstitial portion:1.25 cm long Isthmic portion: narrow its 2.5 cm from the uterus Ampulla: wide is 5 cm long Fimbria: funnel-shaped mouth which is attached to the ovary.

Ovary The ovaries are components of the female reproductive system and the endocrine system. Function The ovaries produce oocytes and the hormones oestrogen and progesterone.

Relations •Anterior to the ovaries are the broad ligaments. •Posterior to the ovaries are the intestines. •Lateral to the ovaries are the infundibulopelvic ligaments and the side walls of the pelvis. •Superior to the ovaries lie the uterine tubes. •Medial to the ovaries lie the ovarian ligaments and the uterus.

Structure of ovary Covered by cuboid or low columnar epithelium Consist of a cortex and a medulla Cortex: oocytes in various stages of maturity. Medulla: fibers, smooth muscle cells, blood vessel, nerves.

Vessel and nerve and lymph Blood vessel The ovarian artery Orginated as branches of the abdominal aorta, (left: left renal artery). Turn over the common iliac artery and ureter,descend into the pelvis. Enter into ovary through the mesovarium

Vessel and nerve and lymph The uterine artery a terminal branch of the hypogastric artery Cross the ureter near the cervix (2cm) Ascend along the lateral border of the uterus uterine body branch and cervix-vagina branch

Vessel and nerve and lymph Vaginal artery Internal Pudendal artery

Vessel and nerve and lymph External genitalia superfical inguinal gland deep inguinal gland

Vessel and nerve and lymph Pelvic lymph iliac lymph common iliac, internal iliac and external iliac Anterior Sacral lymph Lumbar lymph: abdominal aorta

Adjacent organs Urethra Urinary bladder Ureter Rectum Vermiform appendix Adjacent : close or neigbour

Male reproductive system The male hormones The control of the male gonads is similar to that in the female, but it is not cyclical. The hypothalamus produces gonadotrophin-releasing factors. These stimulate the anterior pituitary gland to produce FSH and luteinizing hormone (LH).

FSH acts on the seminiferous tubules to bring about the production of sperm, whereas LH acts on the interstitial cells that produce testosterone. Testosterone is responsible for the secondary sex characteristics: deepening of the voice, growth of the genitalia and growth of hair on the chest, pubis, axilla and face.

Formation of the spermatozoa Production of sperm begins at puberty and continues throughout adult life. Spermatogenesis takes place in the seminiferous tubules under the influence of FSH and testosterone. The process of maturation is a lengthy one and takes some weeks. The mature sperm are stored in the epididymis and the deferent duct until ejaculation. If this does not happen, they degenerate and are reabsorbed. At each ejaculation, 2–4 mL of semen is deposited in the vagina.

The seminal fluid contains about 100 million sperm/mL, of which 20–25% are likely to be abnormal. The remainder move at a speed of 2–3 mm/min. The individual spermatozoon has a head, a body and a long, mobile tail that lashes to propel the sperm along The tip of the head is covered by an acrosome; this contains enzymes to dissolve the covering of the oocyte in order to penetrate it.

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