Anatomy of woman pelvis

Anatomy, Abdomen and Pelvis, Female Pelvic Cavity - StatPearls

Introduction

The pelvic cavity is a bowl-like structure that sits below the abdominal cavity. The true pelvis, or lesser pelvis, lies below the pelvic brim (Figure 1). This landmark begins at the level of the sacral promontory posteriorly and the pubic symphysis anteriorly. The space below contains the bladder, rectum, and part of the descending colon. In females, the pelvis also houses the uterus, fallopian tubes, and ovaries. Knowledge of anatomy unique to females is essential for all clinicians, especially those in the field of obstetrics and gynecology. 

Structure and Function

The uterus sits in the center of the female pelvic cavity (Figure 2.) The most common position of the uterus in the pelvic cavity is anteverted and anteflexed.[1] "Version" refers to the angle between the cervix and the vagina. An anteverted uterus appears "tipped forward" in the pelvic cavity. A retroverted uterus is "tipped backward. " Retroversion is a normal variant but can lead to dyspareunia. Additionally, retroversion of a gravid uterus correlates with higher rates of vaginal bleeding and spontaneous abortion.[2]

"Flexion" is the term for the angle between the cervix and uterine body. Anteflexed means the uterus is bent forward. Retroflexed means the uterus bends backward. Occasionally, retroflexion is seen after cesarean section and may be due to scar tissue that attaches the uterine body to the abdominal wall, causing the fundus to bend posteriorly.[3] However, the data supporting this theory is limited. 

Anterior to the uterus is the bladder, with rectum located posteriorly. Between the uterus and the rectum is the recto-uterine space, also known as the posterior cul-de-sac. It is a potential space prone to fluid collection. Small amounts of physiologic fluid accumulate during ovulation and menses. Pathologic causes of fluid collection in the recto-uterine pouch include pelvic abscesses, drop metastasis from gastrointestinal malignancies, and endometriosis. In certain situations, if fluid accumulation is severe, this space can be drained by performing a culdocentesis, which is accomplished by inserting a needle through the posterior fornix of the upper vagina to access the posterior cul-de-sac.

The posterior cul-de-sac communicates with the retroperitoneal space of the abdomen via the right and left epiploic gutters. The right gutter leads to the hepatorenal space, also known as Morrison's pouch. The right epiploic gutter also allows the spread of pelvic pathogens into the subphrenic space. Occasionally infection of the subphrenic space can occur, leading to adhesions on the capsule of the liver. This pathology is known as Fitz-Curtis-Hugh syndrome or gonococcal perihepatitis.

The left epiploic gutter leads to the splenorenal pouch. Due to the leftward position of the rectum, pelvic pathology is less likely to spread to the abdomen via the left epiploic communication.[4]

Embryology

The organs of the female reproductive tract each have a unique embryological origin. The exact embryological timeline in which these organs develop is still open to debate because most embryologic studies use animal models with different gestational ages. However, there is a consensus that the ovaries are the first to develop. They arise from the surface of the mesonephros at the gonadal ridge.[5] Later in development, the ovaries descend into the pelvis with guidance from the gubernaculum. The inferior aspect of the gubernaculum subsequently becomes the round ligament of the uterus and terminates at the labia majora. 

In females, the absence of a Y chromosome allows the uterus to form. It derives from the Müllerian ducts, also known as the paramesonephric ducts. These ducts fuse to form the uterus, fallopian tubes, and cervix. Some studies suggest that the paramesonephric ducts also give rise to the upper vagina while other studies indicate that the vagina exclusively derives from the urogenital sinus epithelium.[6] In males, a substance coded for on the Y chromosome, known as the anti-Mullerian hormone, prevents the formation of internal female reproductive organs.

Blood Supply and Lymphatics

Arterial

The anterior branch of the internal iliac artery supplies most of the female reproductive organs. The uterine artery supplies the majority of the uterus (Figure 3). The lower uterine segment has a dual blood supply that includes branches of the vaginal artery. The ovaries are an exception because they receive blood from the ovarian arteries, which descend from the abdominal aorta.

The superior vesicle artery supplies the upper bladder. In females, the vaginal artery supplies the lower bladder. Both arteries are also branches of the anterior branch of the internal iliac artery. 

The rectum receives vascular supply via three vessels. The superior rectal artery is the terminal branch of the inferior mesenteric artery. The middle rectal is a branch of the internal iliac artery. The inferior rectal is a branch of the pudendal artery.  

Venous

The venous supply of pelvic organs follows the arterial supply. The uterine vein receives blood from the uterus and drains into the internal iliac vein. The ovarian veins receive blood from the ovaries. The right ovarian vein drains its contents directly into the inferior vena cava, while the left ovarian vein drainage is into the left renal vein. The increased length of the left ovarian vein makes it more susceptible to compression, especially during pregnancy.[7] Ovarian vein compression can lead to pelvic venous compression syndrome. The resulting pelvic vasculature congestion is a cause of chronic pelvic pain and may occur in non-pregnant patients as well.

The left-sided venous supply is also unique because the left internal iliac artery travels from its right-sided origin at the inferior vena cava towards a leftward destination in the pelvis. The longer path makes the left internal iliac more prone to compression and may explain why venous thromboembolism in pregnancy most commonly occur in the left iliac and iliofemoral veins.[8] Additionally, the leftward position of the sigmoid colon causes a gravid uterus to tip toward the right, which is thought to increase the risk of iliac vessel compression further.

Lymphatics

The lymphatic network of the pelvis is complex but is essential to understand when staging and treating gynecologic malignancies. Generally, the pelvic organs drain into the internal and external iliac lymph nodes (Figure 5).

The lymphatic drainage of the uterus is more complicated and remains somewhat ambiguous.[9] Some researchers suggest it may involve pelvic and para-aortic lymph nodes.[10] A more recent study from 2017 suggests that the uterus has two primary routes of lymphatic drainage, an upper pathway that drains to the external iliac and/or obturator lymph nodes and a lower pathway that drains to the internal iliac and/or presacral lymph nodes.[11]

The ovaries are an exception to the other female pelvic organs because they do not drain to pelvic lymph nodes. Their lymphatic drainage follows their blood supply; therefore they drain directly to the paraaortic lymph nodes. 

Nerves

The female reproductive organs have both autonomic and sensory innervation. Beginning with the autonomic nervous system, sympathetic fibers exit at the level of T10 to L2 to form the superior hypogastric plexus, which divides into the left and right hypogastric nerve at approximately the level of the sacral promontory. The parasympathetic nerve fibers exit at the level of S2 to 4 and meet up with the sympathetic nervous system at the right and left hypogastric nerves. The right and left hypogastric nerves then migrate inferiorly to form the inferior hypogastric plexus. After this point, the nerve fibers follow blood vessels to their target organs. The inferior hypogastric plexus also receives sensory information from the uterus.

The ovarian nerve innervates the ovary. Although previously thought only to contain sensory fibers, recent animal studies suggest this nerve also carries autonomic fibers that may play a role in hormone secretion and constriction of ovarian vessels.[12][13][14] Recent studies suggest that the cervix and upper vagina also have autonomic innervation; however, the role of autonomic innervation in this region remains unclear. [15][16] Sensory innervation to the cervix and upper vagina has been more widely studied and receives supply by the pelvic splanchnic nerves. The pudendal nerve supplies the sensory innervation of the lower vagina. Pudendal nerve blocks can be used to provide local pain relief to laboring women by using the ischial spines as landmarks. Although once the treatment of choice for labor pain, it is no longer commonly used due to the widespread use of epidural anesthesia.[17]

Muscles

The inferior border of the pelvic cavity is the pelvic diaphragm. It is made up of a group of muscles. From posterior to anterior, these muscles include:

• Piriformis

• Coccygeus

• Iliococcygeus

• Pubococcygeus

• Puborectalis

The fibers of the iliococcygeus, pubococcygeus, and puborectalis make up the levator ani muscle. Because of its proximity to the vagina, the pubococcygeus and puborectalis are the most commonly injured muscles during vaginal deliveries. [18] The obturator internus muscles make up the peripheral borders of the pelvis but are not among the muscles of the pelvic floor. 

Ligaments

Three ligaments anchor the uterus. The uterosacral ligament supports the uterus posteriorly, and the pubocervical ligament anchors the uterus anteriorly. The transverse cervical ligament supports the uterus laterally. Unlike the anterior and posterior planes that contain the bladder and rectum respectively, the lateral plane lacks supporting structures other than the transverse cervical ligament. It is for this reason that this ligament also has the name of the "cardinal" ligament. The transverse ligament also differs from other supporting ligaments of the uterus because it is the only ligament that contains a vasculature structure, the uterine artery. 

The ovary also has ligamentous support. The utero-ovarian ligament, also known as the ovarian ligament, extends from the ovary to the uterine body. The ovary is supported superiorly by the infundibulopelvic ligament, also known as the suspensory ligament of the ovary. This ligament descends from the lateral aspect of the abdominal wall and contains the ovarian neurovascular bundle.

The broad ligament overlies the uterus, fallopian tubes, and ovaries. It is the inferior most extension of the parietal peritoneum and has three divisions based on location. The lateral most aspect of the broad ligament is the "mesovarium" and overlies the ovaries. The "mesosalpinx" covers the fallopian tubes. The largest portion of the broad ligament is the "mesometrium" and overlies the uterus.  

Physiologic Variants

The uterine and ovarian arteries supply the majority of the female reproductive tract. The uterine artery, like many pelvic arteries, has a variable presentation. It most commonly arises from the anterior branch of the internal iliac artery and shares a common trunk with the obliterated umbilical artery.[19] One study that analyzed imaging from 218 patients reported this presentation in 80.7 % of cases.[20] The same study reported the uterine artery branched directly off of the internal iliac in 13. 6% of cases, making this the most common variation. The second and third most common variations they found were direct branching from the superior gluteal artery and internal pudendal artery, respectively. These variations are necessary to be aware of during surgery as well as during uterine artery embolization. 

Ovarian artery variants are less common, but case reports exist that detail unique aberrations. One case report found an aberrant ovarian artery arising from the external iliac artery.[21] Another study reported an ovarian artery that branched directly from the common iliac artery.[22] These variations are thought to be due to abnormal descent of the ovaries into the pelvis during embryological development and may also correlate to other differences.[23]

Surgical Considerations

Several anatomical relationships are essential for surgeons to be aware of when operating in the female pelvis. For example, during a cesarean section, the bladder should always be identified to avoid iatrogenic cystotomy. This cautionary measure is especially the case in patients that have had a prior cesarean section because scar tissue can cause the bladder to adhere to the anterior uterine wall.

During any uterine surgery, identification of the uterine artery is vital. If cut, massive bleeding can ensue. During abdominal hysterectomies, the uterine artery is typically “skeletonized” so that its path along the uterus is clearly identifiable to the operating team. 

If hemorrhage does occur, knowledge of pelvic vasculature becomes crucial. If the bleeding vessel cannot be clearly identified, the internal iliac should be clamped below the origin of the superior gluteal artery. This method is preferred so that necrosis of the gluteal muscle does not occur.  

When operating deeper in the female pelvis, identification of the ureter is also crucial. There are three major locations where this structure may exist. Beginning superiorly, the ureters descend into the pelvis posterior to the infundibulopelvic ligaments. The ureters maintain this relationship until approximately the level of the iliac vessels, where they begin to travel more medially.

As the ureters continue to travel inferiorly, the next important landmark is the transverse cervical ligament. The ureters dive under this structure. Awareness of this relationship is of considerable importance when performing a hysterectomy. A popular pneumonic used by medical students is, "water under the bridge." 

After passing under the transverse cervical ligament, the ureters continue to travel medially toward the bladder. Their insertion into the inferior aspect of the bladder is the third major location they should undergo positive identification intraoperatively. The insertion points are also visible from inside the bladder itself, during cystoscopy; this is sometimes performed after pelvic surgery if an injury to the bladder is suspected. 

Injury to the bladder can also occur during pelvic surgery from the vaginal approach. When operating in this plane, injury to the rectum is also a possibility because at this level the rectum is directly posterior to the vagina (Figure 6. ) Avoiding bladder and rectal injury becomes increasingly difficult if the patient has pelvic organ prolapse, such as cystocele or rectocele.

When performing surgery on the fallopian tubes, such as during a tubal ligation or tubal anastomosis, the location of the round ligament should be determined. Due to the similarity in structure and location, the round ligament can be mistaken for a fallopian tube. Unlike the round ligaments, however, the fallopian tubes have fimbriae, a characteristic can be used to differentiate between these two structures intraoperatively.

Clinical Significance

Clinical correlates related to female pelvic anatomy can be summarized as follows:

• The standard position of the uterus is anteverted and anteflexed. Abnormal positioning of the uterus is associated with pathology. Retroversion, for example, is a cause of dyspareunia. Additionally, retroversion of a gravid uterus is associated with higher rates of spontaneous abortion.

• The posterior cul-de-sac, located between the uterus and the rectum, is a potential space prone to fluid collection. Physiologic fluid accumulates during menses and ovulation. If fluid collection is pathologic, this space can undergo drainage via culdocentesis.

• The posterior cul-de-sac communicates with the abdomen via the left and right epiploic gutters, which allows the spread of pelvic pathogens into the abdominal cavity. Due to the leftward position of the rectum, infections usual take the path of the right epiploic gutter. The right epiploic gutter leads to potential spaces surrounding the liver. These include the hepatorenal space, also known as Morrison’s pouch, and the subphrenic space. Infection of the subphrenic space secondary to a gonococcal pelvic infection is termed Fitz-Curtis-Hugh syndrome or gonococcal perihepatitis.

• The increased length of the left ovarian vein makes it more susceptible to compression, especially during pregnancy. Compression of this vessel sometimes leads to pelvic venous compression syndrome and is a cause of chronic pelvic pain in both pregnant and non-pregnant patients.

• Venous thromboembolism in pregnancy is most commonly left-sided and occur in the iliofemoral vessels, which is thought to be because of pelvic vessel engorgement in combination with the increased path the left iliac vein takes across the pelvis. These factors make this vessel more susceptible to compression by a gravid uterus.

• Understanding the lymphatic drainage of the female reproductive tract is important when tracking the spread of gynecologic malignancies. Generally, the female reproductive organs drain to the internal and external iliac lymph nodes. A notable exception is the ovaries, which drain to the paraaortic lymph nodes.

• The pudendal nerve receives sensory innervation to the lower vagina. Historically, pudendal nerve blocks were used to alleviate labor pains. However, pudendal nerve blocks are no longer commonly practiced due to the wide-spread use of epidural anesthesia.

• The muscles of the pelvic floor are susceptible to injury during vaginal deliveries. The most commonly injured muscles are the pubococcygeus and puborectalis muscles due to their proximity to the vagina.

• The pelvic vasculature contains many physiologic variants that are important for surgeons to know. Interventional radiologists should also be knowledgeable of variants, particularly during uterine artery embolization to treat fibroids. The uterine artery most commonly arises from the anterior branch of the internal iliac and shares a trunk with the obliterated umbilical artery. The most common variation is direct branching from the internal iliac.

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Figure

Compilation of 6 images detailing anatomy of female pelvic cavity. Contributed by Gray's Anatomy Plates (Public Domain)

References

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Anatomy, Function of Bones, Muscles, Ligaments

What is the female pelvis?

The pelvis is the lower part of the torso. It’s located between the abdomen and the legs. This area provides support for the intestines and also contains the bladder and reproductive organs.

There are some structural differences between the female and the male pelvis. Most of these differences involve providing enough space for a baby to develop and pass through the birth canal of the female pelvis. As a result, the female pelvis is generally broader and wider than the male pelvis.

Below, learn more about the bones, muscles, and organs of the female pelvis.

Female pelvis anatomy and function

Female pelvis bones

Hip bones

There are two hip bones, one on the left side of the body and the other on the right. Together, they form the part of the pelvis called the pelvic girdle.

The hip bones join to the upper part of the skeleton through attachment at the sacrum. Each hip bone is made of three smaller bones that fuse together during adolescence:

• Ilium. The largest part of the hip bone, the ilium, is broad and fan-shaped. You can feel the arches of these bones when you put your hands on your hips.
• Pubis. The pubis bone of each hip bone connects to the other at a joint called the pubis symphysis.
• Ischium. When you sit down, most of your body weight falls on these bones. This is why they’re sometimes called sit bones.

The ilium, pubis, and ischium of each hip bone come together to form the acetabulum, where the head of the thigh bone (femur) attaches.

Sacrum

The sacrum is connected to the lower part of the vertebrae. It’s actually made up of five vertebrae that have fused together. The sacrum is quite thick and helps to support body weight.

Coccyx

The coccyx is sometimes called the tailbone. It’s connected to the bottom of the sacrum supported by several ligaments.

The coccyx is made up of four vertebrae that have fused into a triangle-like shape.

Female pelvis muscles

Levator ani muscles

The levator ani muscles are the largest group of muscles in the pelvis. They have several functions, including helping to support the pelvic organs.

The levator ani muscles consist of three separate muscles:

• Puborectalis. This muscle is responsible for holding in urine and feces. It relaxes when you urinate or have a bowel movement.
• Pubococcygeus. This muscle makes up most of the levator ani muscles. It originates at the pubis bone and connects to the coccyx.
• Iliococcygeus. The iliococcygeus has thinner fibers and serves to lift the pelvic floor as well as the anal canal.

Coccygeus

This small pelvic floor muscle originates at the ischium and connects to the sacrum and coccyx.

Female pelvis organs

Uterus

The uterus is a thick-walled, hollow organ where a baby develops during pregnancy.

During the reproductive years, the lining of the uterus sheds every month during menstruation if you don’t become pregnant.

Ovaries

There are two ovaries located on either side of the uterus. The ovaries produce eggs and also release hormones, such estrogen and progesterone.

Fallopian tubes

The fallopian tubes connect each ovary to the uterus. Specialized cells in the fallopian tubes use hair-like structures called cilia to help direct eggs from the ovaries toward the uterus.

Cervix

The cervix connects the uterus to the vagina. It’s able to widen, allowing sperm to pass into the uterus.

In addition, thick mucus produced in the cervix can help to prevent bacteria from reaching the uterus.

Vagina

The vagina connects the cervix to the exterior female genitalia. It’s also called the birth canal, as the baby passes through the vagina during delivery.

Rectum

The rectum is the lowest part of the large intestine. Feces collects here until exiting through the anus.

Bladder

The bladder is the organ that collects and stores urine until it’s released. Urine reaches the bladder through tubes called ureters that connect to the kidneys.

Urethra

The urethra is the tube that urine travels through to exit the body from the bladder. The female urethra is much shorter than the male urethra.

Female pelvis ligaments

Broad ligament

The broad ligament supports the uterus, fallopian tubes, and ovaries. It extends to both sides of the pelvic wall.

The broad ligament can be further divided into three components that are linked to different parts of the female reproductive organs:

• mesometrium, which supports the uterus
• mesovarium, which supports the ovaries
• mesosalpinx, which supports the fallopian tubes

Uterine ligaments

Uterine ligaments provide additional support for the uterus. Some of the main uterine ligaments include:

• the round ligament
• cardinal ligaments
• pubocervical ligaments
• uterosacral ligaments

Ovarian ligaments

The ovarian ligaments support the ovaries. There are two main ovarian ligaments:

• the ovarian ligament
• the suspensory ligament of the ovary

Female pelvis diagram

Explore this interactive 3-D diagram to learn more about the female pelvis:

Female pelvis conditions

The pelvis contains a large number of organs, bones, muscles, and ligaments, so many conditions can affect the entire pelvis or parts within it.

Some conditions that can affect the female pelvis as a whole include:

• Pelvic inflammatory disease (PID). PID is an infection that occurs in the female reproductive system. While it’s often caused by a sexually transmitted infection, other infections can also cause PID. Untreated PID can lead to complications, such as infertility or ectopic pregnancy.
• Pelvic organ prolapse. Pelvic organ prolapse occurs when the muscles in the pelvis can no longer support its organs, such as the bladder, uterus, or rectum. This can cause one or more of these organs to press down on the vagina. In some cases, this can cause a bulge to form outside of the vagina.
• Endometriosis. Endometriosis occurs when the tissue that lines the inside walls of the uterus (endometrium) begins to grow outside of the uterus. The ovaries, fallopian tubes, and other tissues in the pelvis are typically affected by the condition. Endometriosis can lead to complications, including infertility or ovarian cancer.

Symptoms of a pelvic condition

Some common symptoms of a pelvic condition can include:

• pain in the lower abdomen or pelvis
• a feeling of pressure or fullness in the pelvis
• unusual or foul-smelling vaginal discharge
• pain during sex
• bleeding in between periods
• painful cramping during or before periods
• pain during bowel movements or when urinating
• a burning feeling when urinating

Tips for a healthy pelvis

The female pelvis is a complex, important part of the body. Follow these tips to keep it in good health:

Stay on top of your reproductive health

See a gynecologist for a yearly health screen. Things like pelvic exams and Pap smears can aid in identifying pelvic conditions or infections early.

You can get a free or low-cost pelvic exam at your local Planned Parenthood clinic.

Practice safe sex

Use barriers — such as condoms or dental dams — during sexual activity, especially with a new partner, to avoid infections that could lead to PID.

Try pelvic floor exercises

These types of exercises can help to strengthen the muscles in the pelvis, including those around the bladder and vagina.

Stronger pelvic floor muscles can aid in preventing things like incontinence or organ prolapse. Here’s how to get started.

Never ignore unusual symptoms

If you’re experiencing anything unusual in your pelvic area, such as bleeding between periods or unexplained pelvic pain, make an appointment with your doctor. Left untreated, some pelvic conditions can have lasting impacts on your health and fertility.

Pelvis / Female Anatomy

Pelvis

The small pelvis is the lower half of the pelvis of a woman, in which the uterus with appendages, the bladder and rectum, blood vessels and nerves are located. The organs of the small pelvis are fixed to the walls of the pelvis with the help of ligaments and fascia. For ease of understanding, this design can be compared to a suspension bridge.

Front and back - bridge supports (pubis and sacrum). A bridge (vagina) is stretched between them. Ropes (bundles) stretch from the upper part of the supports to the bridge. From the back support (sacrum) - sacro-uterine ligaments. From the anterior support (pubis) - pubo-urethral ligaments.

The bridge (vagina) can be compared to the membrane of a trampoline, and the ligaments of the pelvis to its springs.

The bladder lies on the anterior wall of the vagina like in a hammock.

The main pelvic fascia is the pubocervical fascia. This is a connective tissue sheet between the anterior wall of the vagina and the bladder. This fascia is the hammock, trampoline, or suspension bridge. She fascia is stretched from front to back with the help of the described ligaments, and on the sides is attached to the walls of the pelvis.

Defects in the ligamentous and/or fascial structures that occur during childbirth lead to various types of prolapse of the pelvic organs.

The most important supporting ligament is the sacro-uterine, which fixes the entire structure from above. With its defect, the connection between the bridge and its rear support is lost. The pubocervical fascia, having lost support from above, breaks away from the walls of the pelvis. There is a prolapse of the uterus and the anterior wall of the vagina. Therefore, the most common type of prolapse (omission) is anteroapical (a combination of prolapse of the uterus and the anterior wall of the vagina).

The pubo-urethral ligament plays an important role in the urinary continence mechanism. It fixes the urethra in the middle third, limits its mobility. A defect in this ligament causes abnormal mobility of the urethra and disrupts the mechanism of urinary retention.

Corresponding to this anatomical organ:

• Diseases
  • Endometriosis
  • Uterine prolapse
  • Rectocele
• Operations
  • Infiltrate resection
  • Surgery for complications
  • Enterocele correction
  • Rectocele correction
  • Correction of the entrance to the vagina
  • Laparoscopic sacrovaginopexy
  • OPUR
  • Sacrospinal hysteropexy

3.

Structure of the bone pelvis women is of great importance in obstetrics, since the pelvis serves as the birth canal, to which the born one advances fetus. The pelvis is made up of four bones: two pelvic, sacrum and coccyx.

Pelvic (innominate) bone consists of three fused bones: iliac, pubic and ischial. The pelvic bones are connected by paired, almost motionless sacroiliac joint, inactive semi-joint - symphysis and movable sacrococcygeal joints. Pelvic joints strengthened strong ligaments, have cartilaginous interlayers. The ilium is composed from the body and wing, expanded upwards and ending in a comb. Front the crest has two protrusions - anterior-upper and anteroinferior spine, behind there are posterior superior and posterior inferior awns. The ischium consists of the body and two branches. The upper branch goes down from the body and ends at the ischial tuberosity. The lower branch is directed anteriorly and up. On the back surface it has protrusion - ischial spine. Pubic bone has a body, upper and lower branches. On the upper edge of the superior ramus of the pubic bone passes a sharp ridge, which in front ends with a pubic tubercle.

Sacrum consists of five fused vertebrae. On the front surface of the base of the sacrum - sacral cape (promontorium). tip sacrum is movably connected to coccyx , consisting of four to five undeveloped fused vertebrae. Distinguish two pelvis: large and small pelvis, between they pass the border, or nameless line. Large pelvis available for outdoor research and measurement as opposed to small pelvis. By the size of the large pelvis judge the size of the small pelvis. In small The pelvis has an entrance, a cavity and an exit. AT the pelvic cavity is narrow and wide parts. Accordingly, conditionally allocate four planes of the small pelvis. The plane of entry into the small pelvis is boundary between the pelvis and pelvis. At the entrance to the pelvis, the largest size is transverse. In the cavity of the small pelvis conditionally allocate a plane wide part of the pelvic cavity, in which direct and transverse dimensions are equal, and the plane of the narrow part of the cavity of the small pelvis, where the direct dimensions are several more transverse. In the exit plane small pelvis and the plane of the narrow part small pelvis straight size prevails above the cross. in obstetrics the following dimensions are important small pelvis: true conjugate, diagonal conjugate and direct size pelvic outlet. True, or obstetric, conjugate is a direct the size of the entrance to the small pelvis. This distance from the cape of the sacrum to the most prominent point on the inner surface of the pubic joints. Normally, it is 11 cm. The diagonal conjugate is determined during vaginal examination. it the distance between the sacral cape and the lower edge of the symphysis. Normally, it is 12.5–13 cm. Straight exit size small the pelvis runs from the top of the coccyx to the bottom edges of the symphysis and is equal to 9. 5 cm. In progress childbirth during the passage of the fetus through the small pelvis, this size increases by 1.5–2 cm due to deviation of the tip of the coccyx posteriorly. The soft tissues of the pelvis cover bone pelvis with external and internal surfaces and are represented by bundles, which strengthen the joints of the pelvis, and also muscles. Importance in obstetrics have muscles located at the outlet of the pelvis. They close down bony canal of the small pelvis and form pelvic floor.

The obstetric (anterior) perineum refers to that part of the pelvic floor that located between the anus and the posterior commissure labia. Part of the pelvic floor between anus and coccyx called back crotch . Muscles of the pelvic floor along with fascia form three layers. These three layers can stretch and form a wide pipe - a continuation of the bone birth channel, which plays an important role in expulsion of the fetus during childbirth. Most powerful is the top (inner) layer of pelvic floor muscles, which from the paired muscle that lifts the rear passage, and is called the pelvic diaphragm. The middle layer of muscles is represented by the genitourinary diaphragm, lower (outer) - several superficial muscles converging in tendon center of the perineum: bulbous-spongy, ischiocavernosus, superficial transverse muscle perineum and external sphincter rectum. The pelvic floor performs the most important functions, being a support for internal and other abdominal organs cavities. Pelvic muscle weakness the bottom leads to the omission and prolapse of the genital organs, bladder, rectum