31. The female pelvis and pelvic floor for KEATS

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  • Female pelvis and pelvic floor

  • Course: Biosciences for Midwifery Practice 4KNIW001

  • Lecturer: Rebecca Daley, Florence Nightingale Faculty of Nursing, Midwifery & Palliative Care

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Learning Outcomes

  • Identify bones and joints of the pelvis.

  • Define pelvic brim, cavity, and outlet; explain their significance in labour and birth.

  • Identify pelvic floor muscles.

  • Understand physiological changes during childbearing.

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Preparation for Session

  1. Complete learning activities prior to the teaching day:

    • Watch HELM videos:

      • The Maternal Pelvis (9 min)

      • Pelvic Joints (3 min)

      • Pelvic Ligaments (4 min)

      • Landmarks of Pelvic Brim, Cavity, and Outlet (6 min)

      • Diameters of the Pelvis (3 min)

    • Complete eLFH module "Introduction to the Pelvic Floor during Pregnancy."

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Introduction

  • Fetus navigates the maternal pelvis during vaginal birth.

  • Knowledge of female pelvis and pelvic floor is crucial for understanding labour physiology.

  • Landmarks help to identify fetal position and descent.

  • Pelvic floor muscles assist in fetal rotation during descent through birth canal.

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Female Pelvis

  • Strong bony structure articulating with lumbar vertebrae and femoral heads.

  • Provides movement and protects pelvic organs.

  • Muscles support bladder, vagina, uterus, and rectum.

  • Four bones: two pelvic bones, one sacrum, one coccyx.

  • Four joints: two sacroiliac joints, symphysis pubis, and sacrococcygeal joint.

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Pelvic Girdle

  • Pelvic bones unite at the symphysis pubis and sacroiliac joints.

  • Acetabulum forms part of the hip joint with femur head.

  • Ilium is the superior part; ischium forms the inferior part.

  • Ischial tuberosities felt when sitting; ischial spines define fetal descent.

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True & False Pelvis

  • Pelvis divided into false pelvis above iliopectineal line and true pelvis below.

  • True pelvis important for vaginal birth; includes brim, cavity, and outlet.

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Pelvic Brim

  • Oval shape; significant landmarks include sacral promontory and symphysis pubis.

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Pelvic Cavity

  • Extends from brim to outlet; has a circular shape with a slight inclination.

  • Fetus follows the curve of Carus during vaginal birth.

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Pelvic Outlet

  • Ovoid/diamond shaped; landmarks include symphysis pubis and ischial spines.

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Pelvic Diameters

  • Four principal diameters:

    • Anteroposterior diameter

    • Transverse diameter

    • Two oblique diameters.

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Pelvic Conjugates

  • Anatomical conjugate (~12cm) and obstetric conjugate (~11cm).

  • Diagonal conjugate (~13cm) can be estimated vaginally.

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Pelvic Floor

  • Strong structure to support pelvic contents during upright posture; involved in various functions.

  • Consists of two layers of muscles, ligaments, and connective tissue.

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Deep Muscle Layer (Levator Ani)

  • Muscles support pelvic organs and resist intraabdominal pressure; supplied by pudendal arteries and sacral nerves.

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Superficial Muscle Layer

  • Includes ischiocavernosus, bulbocavernosus, and transverse perineal muscles, as well as sphincters.

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Perineal Body

  • Vital area where many muscles join; involved in vaginal birth and defecation; commonly torn during childbirth.

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Perineal Trauma

  • Types of tears during childbirth:

    • 1st degree: skin only.

    • 2nd degree: perineal muscles.

    • 3rd degree: involves anal sphincter.

    • 4th degree: involves sphincter complex and anal epithelium.

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Physiological Changes During Pregnancy

  • Progesterone relaxes pelvic ligaments; may increase dimensions but cause pain.

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Postnatal Changes

  • Ligaments tighten; pelvic muscles need recovery post-birth to support pelvic function and prevent long-term issues.

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Pelvic Girdle Pain (PGP)

  • Pain in pelvis that affects mobility; formerly called symphysis pubis dysfunction; affects quality of life.

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Incontinence

  • Up to 60% of women experience urinary incontinence during pregnancy; pelvic floor exercises can reduce this risk.

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Pelvic Floor Exercises

  • Importance of educating women about pelvic exercises; referral pathways for those at risk of pelvic floor dysfunction.

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Consolidating Your Learning

  • Suggested core learning activities post-teaching include reading specified chapters and viewing recommended videos.

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References

  • A list of key references related to midwifery, anatomy, physiology, and pelvic health.

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Contact Information

  • Rebecca Daley, Lecturer in Midwifery Education, King's College London.