Pelvis, pelvic floor & fetal skull
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What is the ideal shaped pelvis to have for a normal birth?
What are the functions of the pelvis?
- Support for pelvic organs
- Enables upright posture
- Attachment of lower limbs
- Allows movement
- Has mechanisms necessary to facilitate fetal descent
What are the four irregular shaped bones of the pelvis?
- 2 innonimate bones
Name the three parts of the innonimate bones of the pelvis.
What is the optimal angle of the pubic arch to aid fetal descent?
Name the bony prominences of the ilium.
- Anterior superior iliac spine
- Anterior inferior iliac spine
- Posterior superior iliac spine
- Posterior inferior iliac spine
Name the bony prominence of the ischium.
Which are the two arms of the pubic bone and where do they meet?
- Superior ramus - attaches to ilium
- Inferior ramus - attaches to ischium
- Meet at symphysis pubis
What bony prominence of the pelvis do you sit on?
How many vertebrae does the sacrum consist of?
5 fused vertebrae perforated by 4 sets of foramina through which sacral nerves pass
How many vertebrae does the coccyx consist of?
4 fused vertebrae
How many pelvic joints are there? Name these joints.
- 4 -
- 2 sacroiliac joints
- 1 sacrococcygeal joint
- 1 symphysis pubis
Name the pelvic ligaments.
- Sacroiliac ligaments
- Sacrotuberous ligaments
- Sacrospinous ligament
What happens to pelvic ligaments during pregnancy?
Ligaments do not possess ability to stretch. However, hormones in pregnancy allow the ligaments to soften to allow the joints to give in preparation for birth. Overstretching can cause pelvic pain (symphysis pubis disorder)
Name the three canals that perforate the pelvic floor muscles.
What are the functions of the pelvic floor?
- Support pelvic organs
- Voluntary muscle control of micturition, defacation and intercourse
- Allows for changes in intra-abdominal pressure, e.g. coughing, sneezing
What are the six layers of the pelvic floor?
- Pelvic peritoneum
- Pelvic fascia
- Deep muscle layer
- Superficial muscle layer
- Subcutaneous fat
Name the muscles in the superficial layer of the pelvic floor.
- Bulbocavernosus - surrounds vagina and urethra
- Transverse perineal muscles
- Ischiocavernosus - surrounds bulbocavernosus
- External anal sphincter - surrounds anus
- External urethral sphincter - surrounds urethra
Name the muscles in the deep layer of the pelvic floor.
- Pubococcygeus - first deep muscle surrounding anus. Controls micturiction and defaction.
- Iliococcygeus - next to pubococcygeal muscles
- Ischiococcygeus - next layer
- These are all referred to as levator ani muscles.
Name the factors contributing to poor pelvic floor muscles in women.
- Heavy lifting
- Excessive coughing
- Lack of fitness
How deep are the deep pelvic floor muscles?
What are the functions of the fetal skull?
- To protect brain
- To allow moulding for passage of fetus through birth canal
Name and describe the four sutures on the fetal skull.
- Lamdoidal - separates occiput from parietal bones
- Sagittal - separates two parietal bones
- Coronal - separates two frontal bones from parietal bones
- Frontal - separates two frontal bones
Name and describe the bones that make up the fetal skull.
- Frontal bones - front of skull
- Parietal bones - main body of skull
- Temporal bones - form side and base of skull
- Occiput - back of the skull
What are the two fontanelles and where are they located?
- Anterior fontanelle (bregma) - at junction of sagittal, coronal and frontal sutures
- Posterior fontanelle (lambda) - at junction of sagittal and lamdoidal sutures
Describe the moulding of the fetal skull during the second stage of labour.
The frontal and occipital bones move underneath the parietal bones, decreasing the shape and diameter by 1.5cm.
What is caput succedaneum?
Oedematous swelling in connective tissue of scalp, caused by increased pressure on cervix for a prolonged time. It crosses suture lines and usually resolves fairly quickly.
What is cephalhaematoma?
Bleeding between periosteum & bone of skull, caused by exerted pressure against maternal pelvis. Does not resolve as quickly as caput succedaneum, but takes around 48 hours to appear. Does not cross suture lines.
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