Slide Anatomi Panggul-1

ANATOMY OF

THE REPRODUCTIVE TRACT

dr. H. Wawang S Sukarya, SpOG (K-FM), MARS

Department of Obstetrics & Gynecology

SCHOOL OF MEDICINE, PADJADJARAN UNIVERSITY

HASAN SADIKIN GENERAL HOSPITAL

TEXTBOOKS :

• F.Garry Cunningham, Norman F.Gant, Kenneth J Leveno, Larry C Gilstrap III, John C Hauth, Katharine D Wenstrom. Williams Obstetrics, 21st ed. ; 2001.

• Ralph C. Benson. Current Obstetrics & Gynecologic Diagnosis & Treatment, 4th ed ; 1982.

1. EXTERNAL GENERATIVE ORGANS

2. INTERNAL GENERATIVE ORGANS

3. THE BONY PELVIS

1. EXTERNAL GENERATIVE ORGANS a. Mons Pubis b. Labia majora (length 7-8 cm, width 2-3 cm, thickness 1-1.5 cm) c. Labia minora d. Clitoris (erectile) e. Vestibule (urethral opening, vestibular bulbs, vaginal opening and hymen) f. Vagina (anterior wall : 6-8 cm; posterior wall : 7 - 10 cm) g. Perineum

PERINEUM

- THE PELVIC DIAGRAM CONSIST OF

- Levator ani muscles - Cocccygeus muscles

- THE UROGENITAL DIAGRAM

- THE EXTERNAL ANAL SPHINCTER MUSCLES

- THE INTERNAL ANAL SPHINCTER MUSCLES

PERINEAL BODY

2. INTERNAL GENERATIVE ORGAN

a. Uterus

b. Uterine Cervix

c. Body of the uterus

d. Oviducts (Fallopian tubes)

e. Ovaries

f. Embryological Remnants

g. Surgical anatomyWill be discussed in the special chapter

a. UTERUS (anterior flat, posterior convex)

- Isthmus (Internal Cervical OS - Endometrial cavity)

- Cornua

- Fundus

Before puberty : Length 2.5 - 3.5 cm

Adult (nulliparous) : Length 6 - 8 cm, weight 50 - 70 gram

Multiparous : Length 9 - 10 cm, weight > 80 gram

PREMENARCHAL GIRL

- Body uterus : Length of the cervix = 1 : 2

NULLIPAROUS WOMEN

- Body uterus : Length of the cervix = 1 : 1

MULTIPAROUS WOMEN

- Total length of the organ : Length of the cervix = 3 : 1

b. UTERINE CERVIX

C. BODY OF THE UTERUS

- Composed of serosal, muscular & mucosal layers

endometrium

THREE FUNDAMENTAL PHASES- Menstrual- Proliferative ( follicular )- Seceretory ( Luteal )

myometrium

LIGAMENTS- The broad ligaments- Infundibulo pelvic ligament (suspensory of the ovary)- Cardinal ligament - Mackenrodt ligament- The round ligament- Utero sacral ligament

POSITION OF UTERUS- Blood vessels- Lymphatics- Innervation ( Superior and inferior hypo gastric plexus, Nervi erigentes, common iliac nerves, hypo gastric ganglion).

d. OVIDUCTS ( length 8 - 14 cm )

- Narrowest portion (isthmus) : diameter 2 - 3 mm- Widest portion (ampulla) : diameter 5 - 8 mm

4 PORTIONS :- Interstitial- Isthmus- Ampulla- Infundibulum

e. OVARIES ( Cortex, Medulla )

Childbearing years :

- Length 2.5 - 5 cm , Breadth 1.5 - 3 cm, Thickness 0.6 - 1.5 cm

AFTER MENOPAUSE :

- Ovarian size diminishes remarkably

THE BONY PELVIS

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)

PELVIC SHAPES

CALDWELL - MOLOY CLASSIFICATION (1933 - 34)

Gynecoid pelvis

Android pelvis

Anthropoid pelvis

Platypelloid pelvis

CALDWELL MOLOY

GYNECOID PELVIS- Almost 50% of white women (Todd’ Collection study)- Ascertained the frequency of the four parent pelvic types by study of Todd’s 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

PELVIC SIZE AND ITS CLINICAL ESTIMATION

- Pelvic inlet measurements

- Diagonal conjugate

- Engagerment : - with engagerment, 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

TENG...

KYU

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