YouTube transcript (5Km0iOj_RxM) — Transcript

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1. 0:06Hi everyone, here in this lecture I am going to
2. 0:10deal about maternal pelvis. And this is the
3. 0:13important topic for practical purpose in all the
4. 0:16nursing courses. So, the maternal pelvis is a gynecoid
5. 0:19type in which the pelvic brim is rounded structure,
6. 0:23which is formed anteriorly by the symphysis pubis
7. 0:27posteriorly by the sacrum and the coccyx and
8. 0:30laterally it is formed by two hip bones and hip
9. 0:33bone is formed by three bones, which is fused
10. 0:36later on and these are
11. 0:38the superior portion, it is formed by the ilium
12. 0:43the lower or inferior portion is formed by ischium and
13. 0:47the anterior portion is formed by pubic bone.
14. 0:50So, this is termed as pelvic girdle because it
15. 0:54create contact between an axial skeletal system with
16. 0:58the appendicular skeletal system. So, here in this
17. 1:01lecture, I'm going to deal about the various
18. 1:04aspects of the maternal pelvis in which there are the
19. 1:07bones, joints, ligaments, the diameters which are
20. 1:12showing the relationship with the fetus So, let's
21. 1:15have a look on the bones. There are the two
22. 1:19Hip bones which are formed by the ilium ischium and
23. 1:24the pubic bone. So, first we talked about the
24. 1:27ilium. So ilium forms the flared part which is
25. 1:31present on the superior aspect and its superior
26. 1:35border is form the iliac crest, which ends at the
27. 1:40blunt end and it is termed as anterior superior
28. 1:43iliac spine and just below to that is the another
29. 1:47spine is anterior inferior iliac spine and
30. 1:51posteriorly this iliac crest ends at the posterior
31. 1:56superior iliac spine and lower it ends with the
32. 2:00posterior inferior iliac spine and there is a
33. 2:06notch on the posterior aspect and this notch is
34. 2:09termed as greater sciatic notch through which
35. 2:12the greatest nerve in our body that the sciatic
36. 2:15nerve passes on the posterior aspect there is a
37. 2:19roughened area and it is termed as iliac tuberosity
38. 2:23and this part gives attachment for the various
39. 2:26muscles. Then, the medial or the anterior surface
40. 2:31forms a depressed portion, which is termed as
41. 2:35iliac fossa. And inferior to iliac fossa
42. 2:40is
43. 2:41one line which runs superiorly or anteriorly. And
44. 2:45it is the arcuate line later on it has got a
45. 2:49clinical significance because it forms important
46. 2:52landmark in pelvic brim and medially there is an
47. 2:56articulating area in this ilium, which
48. 2:59articulates with the sacrum and form the strongest
49. 3:02joint in the body, that the sacral iliac joint
50. 3:07this ilium has got two part the superior part is
51. 3:11termed as Ala and the inferior part is termed as
52. 3:16body which attaches with the ischium. So, the next
53. 3:21part comes the ischium, Ischium has got two parts, the
54. 3:27body which consists of the roughened portion, and
55. 3:31it is termed as ischial tuberosity. And superior
56. 3:35to that is or anterior to that is the ramus and this
57. 3:41ramus and the pubic bone forms a opening. And
58. 3:45this is termed as obturator foramen, which is covered
59. 3:48by the obturator membrane through which blood
60. 3:50vessels and nerve passes and posterior to ischium is one
61. 3:57projection is there and it is termed as ischial
62. 4:00spine and it has got clinical significance through
63. 4:04which you can easily assess the station of head.
64. 4:08The anterior hip bone is formed by pubic bone and
65. 4:12pubic bone has got three parts, the superior ramus
66. 4:17the inferior ramus and the body part. The body
67. 4:21part where the two rami are meet together. The
68. 4:25anterior border of the pubic bone is the pubic
69. 4:28crest slightly lateral to that is the pubic
70. 4:34tubercle and from pubic tubercle there is a line
71. 4:38which runs posteriorly or laterally is the pectineal
72. 4:42line which later on merges with this arcuate line
73. 4:45and form iliopectineal line. Together the three
74. 4:50bones hip bone, that is the pubic ischium or ilium
75. 4:55forms a cup or socket like structure. And this is
76. 4:59the acetabulum and this is a socket like structure through
77. 5:04which the head of the femur is attaches or
78. 5:07articulate with it. So, that you can easily move
79. 5:10your limb in any of the direction and there is a
80. 5:13notch over here and it is termed as acetabular
81. 5:17notch through which blood vessels and nerves
82. 5:19enters or exit. So, here we have seen the three
83. 5:24hip bones and it is formed by the ilium that is
84. 5:29the superior flared part ischium that is the
85. 5:33inferior and posterior part through which you can
86. 5:36easily sit and the anterior portion which is
87. 5:39formed by the 2 pubic bone. Then comes the
88. 5:44posterior aspect of pelvic bone, which is the part
89. 5:47of axial skeletal system that is the sacrum and
90. 5:52the sacrum is the triangle shaped bone and the
91. 5:56sacrum is formed by five fused vertebra, and the
92. 6:00anterior border is smooth and curved. And in
93. 6:05female, this bone is wider or shorter posteriorly
94. 6:11it is more roughened area, because it gives
95. 6:14attachment for the various muscles. The superior
96. 6:18broader part of the sacrum is termed as base and
97. 6:22the inferior narrow portion is termed as a apex on
98. 6:27this superior part, there is anteriorly projected
99. 6:31structure and it is termed as sacral promontory
100. 6:35and posteriorly there are two articulating surface
101. 6:38area which attaches to the lumbar vertebra and
102. 6:42forms lumbosacral joint and on the lateral
103. 6:47aspects, there are two auricular shaped structure
104. 6:50which extends laterally from sacral promontory,
105. 6:53these are termed as sacral ala anteriorly there
106. 6:58are four transverse line and these transverse lines
107. 7:04showing the fusion of vertebral bodies of sacrum.
108. 7:08And at the end of these transverse line, there are the
109. 7:12four pair of anterior foramina and these
110. 7:16foramina are continuation with the posterior
111. 7:19foramina through which blood vessels or nerve
112. 7:22enter or exit posteriorly on the medial
113. 7:26aspect in the sacrum there is a sacral crest and
114. 7:31it is formed by the fusion of the spinous process of
115. 7:35the sacral vertebra and it gives attachment for
116. 7:38the ligaments or the muscles at the apex part of
117. 7:41the sacrum there is one opening and it is termed
118. 7:44as sacral hiatus and it is continuation with the
119. 7:49sacral canal and this sacral canal is continuous
120. 7:51with the vertebral column. And on the either side
121. 7:55of this hiatus or opening are the two projection
122. 7:59and it is an attachment for the ligaments to connect
123. 8:01it with the coccyx. So, it is a triangular shaped
124. 8:06bone & it forms a part of axial skeletal system
125. 8:11which connect the sacrum to the ilium and form the
126. 8:14strongest joint sacroiliac joint and lower to that
127. 8:20is one triangular-shaped bone is termed as coccyx
128. 8:24and it is formed by 4 fused vertebra and this
129. 8:27coccyx is attaches to the sacrum by the
130. 8:31sacrococcygeal joint. So, the broader part of this coccyx
131. 8:35is termed as base and the pointed end portion is
132. 8:40termed as apex. On the posterior aspect, there
133. 8:44are the coccygeal cornua and this cornua attaches
134. 8:47with a ligament with the sacrum and in female
135. 8:52this coccyx is directed inferiorly and this
136. 8:57joint is more flexible in females. So that fetus
137. 9:01can easily pass through it. So here in this model,
138. 9:05we have seen the bones and the bones are the two
139. 9:08hip bones ilium ischium and the pubic bone and
140. 9:13posteriorly there is one sacrum and one coccyx now
141. 9:17comes the joint and joints are the point where the
142. 9:20two bones meet together. And there is one symphysis pubis
143. 9:24and it is present in between the two pubic
144. 9:29bone and there are the paired sacroiliac joint. So
145. 9:34it articulates the sacrum with the ilium on both
146. 9:38sides. So it is the strongest joint in the body
147. 9:41sacroiliac joint and there is one sacrococcygeal joint
148. 9:45which is more flexible in female as it
149. 9:48provides room to the pelvic outlet so that fetus
150. 9:52can easily pass through it. Next comes the
151. 9:54ligaments and these are the structure which helps
152. 9:57the joints together and there is One inter pubic
153. 10:01ligament, which attaches or which is present in
154. 10:05between the two pubic bone and it is
155. 10:07fibrocartilaginous disc. There are the various
156. 10:11sacral iliac ligament, which are present on the
157. 10:14anterior and the posterior aspect, which held the
158. 10:17sacroiliac joint together. And there is sacrococcygeal
159. 10:22ligament, which attaches the sacrum to the
160. 10:26coccyx, and it is also present on the anterior or
161. 10:29the posterior aspect and another 2 are the
162. 10:35sacrotuberous ligament, and it extends from the sacrum
163. 10:40to the ischial tuberosity. So, sacrotuberous
164. 10:42ligament,
165. 10:43and there are the sacrospinous ligament, which
166. 10:47attaches the sacrum to the ischial spine on the
167. 10:51both side. So, these are the ligaments there is
168. 10:55very limited movement in between the joints in non
169. 10:58pregnant state, but at the time of pregnancy
170. 11:00because of the release of hormones causes the
171. 11:03ligaments to be softened and increases the
172. 11:06presenting diameter of the pelvis so that the
173. 11:09fetus can easily accommodate the pelvic canal and
174. 11:13it can easily pass through it. Next comes the
175. 11:17difference between false pelvis and true pelvis.
176. 11:20And in false pelvis, there is no exact pelvic
177. 11:23measurement. And it is bounded posteriorly by the
178. 11:27lumbar vertebra, laterally by the iliac crest and
179. 11:32the iliac fossa, or anteriorly by the anterior
180. 11:35abdominal wall. So, you can't measure it
181. 11:38precisely, but it gives support to the uterus at
182. 11:41the time of pregnancy. But in the true pelvis, it
183. 11:45has got the exact pelvic measurement and it has
184. 11:50three parts that is the pelvic brim. So I'm
185. 11:54pointing the marks. So this area is termed as the
186. 11:59pelvic brim or the inlet. Then comes the cavity
187. 12:03and it is round structure and forms the curved
188. 12:06canal and the last bony region is termed as pelvic
189. 12:10outlet. First we deal about the pelvic brim or the
190. 12:14inlet and this is the area where the fetus come
191. 12:18in contact with the maternal pelvis. So there are
192. 12:21the various bony points on this, and these are
193. 12:25termed as landmarks. So from anterior to posterior,
194. 12:29there are the nine landmarks and these are upper
195. 12:33border of symphysis pubis, pubic crest, pubic
196. 12:38tubercle, pectineal line, iliopectineal eminence,
197. 12:45iliopectineal line, sacroiliac joint, anterior
198. 12:50border of sacral ala, and the sacral promontory.
199. 12:54So these nine landmarks are same in both sides.
200. 12:57And this area is termed as pelvic brim or inlet.
201. 13:02The next comes the pelvic cavity, and it is rounded
202. 13:06structure, which is bounded above by the pelvic
203. 13:09brim and below by the obstetrical outlet. And
204. 13:14the last bony part is the pelvic outlet. So here
205. 13:18we'll discuss about the diameter of these all
206. 13:21three parts. So, in pelvic brim, there are the
207. 13:25three diameters and these are anterior posterior
208. 13:28diameter, transverse diameter, and the oblique
209. 13:32diameter. So, in the anterior-posterior diameter,
210. 13:36there are the again three diameters and these are true
211. 13:40conjugate or you can say anatomical conjugate, the
212. 13:46obstetric conjugate and the diagonal conjugate.
213. 13:49So, first we deal the true or anatomical conjugate
214. 13:53and this is the distance between the midpoint of
215. 13:56sacral promontory till the upper border of
216. 14:00symphysis pubis and this measures about 11
217. 14:03centimeter then comes the obstetric conjugate and the
218. 14:09obstetric conjugate is the exact space available for
219. 14:12the fetus to pass through the pelvic brim and enters into
220. 14:16the pelvic cavity. So this point extends from
221. 14:19midpoint of sacral promontory to the midline of
222. 14:26symphysis pubis, where a projection is there in
223. 14:30the middle till the point ends up. So this
224. 14:34distance is about 10 centimeters. Next comes the
225. 14:38diagonal conjugate and this is the distance from
226. 14:42midpoint of sacral promontory, till the lower
227. 14:46border of the symphysis pubis
228. 14:47Here it is. So it is about 12 centimeters.
229. 14:53So this diagonal conjugate has got clinical
230. 14:55significance because you can easily measure it
231. 14:57through bimanual examination. The next diameter in
232. 15:01pelvic brim is the oblique diameter and these are
233. 15:04the two right and left, right indicate the right
234. 15:09side of the maternal pelvis and it starts from
235. 15:12right sacroiliac joint till the opposite side of
236. 15:15iliopectineal eminence, it means the left side. So,
237. 15:19it is about 12 centimeter and the left oblique
238. 15:23diameter extends from left sacroiliac joint till
239. 15:27right iliopectineal eminence. So, these are
240. 15:30the same both side left and right. The third
241. 15:34diameter is transverse diameter and the transverse
242. 15:37diameter extends from the farthest point between
243. 15:41the 2 iliopectineal line. So, it is the widest
244. 15:45diameter in pelvic brim This measures about 13
245. 15:48centimeter. Next comes the pelvic cavity. This
246. 15:53cavity is formed by a curved canal in which the
247. 15:57anterior depth is about 4 centimeter which is
248. 16:00formed by symphysis pubis, and its posterior depth
249. 16:04is formed by sacrum and coccyx which is curved and
250. 16:08it is about 12 centimeter So, all together it form
251. 16:12the curved canal and it is round in structure. Its
252. 16:17anterior posterior diameter extends from the
253. 16:21junction of second or third sacral vertebra, here
254. 16:25it is, till the midpoint of symphysis pubis, here
255. 16:32it is the midpoint of symphysis pubis and this
256. 16:35measuring about 12 centimeter it's transverse
257. 16:39diameter or oblique diameter cannot be measured
258. 16:42exactly because the points are overlying to the
259. 16:45soft tissues. So you can say roughly the overall
260. 16:50diameter of this pelvic cavity is about 12
261. 16:52centimeter. Next comes the last bony part that is
262. 16:57the pelvic outlet in which there are the two
263. 17:00conjugates. And these are obstetrical conjugate
264. 17:03and anatomical conjugate. And in obstetrical
265. 17:07conjugate, there are the two diameters and the
266. 17:11anterior posterior diameter in obstetrical
267. 17:13conjugate extends from the tip of sacrum to the
268. 17:18lower border of symphysis pubis. So it is the
269. 17:21anterior posterior diameter and it is about 11
270. 17:25centimeter. The transverse diameter of obstetrical
271. 17:30conjugate is bispinous diameter, and it extends
272. 17:35in between the two ischial spines, and it is about
273. 17:3810.5 centimeter. In the true or anatomical
274. 17:43conjugate, the anterior posterior diameter extends
275. 17:47from the tip of coccyx till the lower border of
276. 17:51symphysis pubis and it measures about 13
277. 17:54centimeter and its transverse diameter extend in
278. 17:58between the inner border of ischial tuberosity and
279. 18:02it is about 11 centimeter. So, the obstetrical
280. 18:06conjugate has clinical importance because this
281. 18:08is the exact pelvic outlet through which the
282. 18:11fetus must pass. So, here in this video, we have
283. 18:15seen the practical aspect of maternal pelvis. And
284. 18:19this pelvic bone forms a bridge between the axial
285. 18:23skeletal system with the appendicular skeletal
286. 18:25system, and here, the sacrum and the coccyx forms the
287. 18:29axial skeletal system part and the femur, which
288. 18:32attaches with the acetabulum forms the part of
289. 18:35appendicular skeletal system. So, these three hip
290. 18:38bones form a bridge like structure, which create a
291. 18:41contact between axial with the appendicular
292. 18:43skeletal system and it also protects the female
293. 18:47internal genital organs which lies inside the
294. 18:49pelvic cavity. So thank you for watching this
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