Bulgarian names and surnames. Bulgarian surnames

It forms a generic the channel through which the fetus moves. Not favorable conditions intrauterine development, diseases transferred to childhood and inperiod of puberty, can lead to disruption of the structure and developmentpelvis The pelvis can be deformed as a result of injuries, tumors, various exostoses. Differences in the structure of the female and male pelvis begin to appear during puberty and become pronounced in adulthood. The bones of the female pelvis are thinner, smoother and less massive than the bones of the husband pelvis. The plane of entrance to the pelvis in women has a transverse oval shape, while in men it has the shape of a card heart (due to the strong protrusion of the promontory).

Anatomically, the female pelvis is lower, wider and larger in volume. The pubic symphysis in the female pelvis is shorter than the male one. The sacrum in women is wider, the sacral cavity is moderately concave. The pelvic cavity in women in outline approaches a cylinder, and in men it narrows funnel-shaped downwards. The pubic angle is wider (90-100°) than in men (70-75°). The coccyx protrudes anteriorly less than in the male pelvis. The ischial bones in the female pelvis are parallel to each other, and in the male pelvis they converge.

All of the above features are very great importance during the birth act, Pelvis adult woman consists of 4 bones: two pelvic, one sacral and one coccygeal, firmly connected to each other,

Hip bone, or nameless (os coxae, os innominatum), consists of up to 16— 18 years old from 3 bones connected by cartilage in the acetabulum area(acetabulum): iliac (os ileum), sciatic (os ischii) and pubis (os pubis ). After puberty, the cartilages fuse together and a solid bone mass is formed - the pelvic bone.

On ilium distinguish between the upper section - the wing and the lower section - the body.At the place of their connection, an inflection is formed, called an arcuate or be-zimyanny line ( linea arcuata, innominata ). On the ilium should bemark a number of projections that are important to the obstetrician. The upper one is thickenedthe far edge of the wing is the iliac crest ( Christa Iliaca ) - has an archedcurved shape, serves to attach the broad abdominal muscles. Frontdi it ends with the anterior superior iliac spine ( spina iliaca anterior superior ), and behind - the posterior superior iliac spine ( spina iliaca posterior superior ). These two spines are important for determining the size of the pelvis.Ischium forms the lower and posterior thirds of the pelvic bone. Sheconsists of a body involved in the formation of the acetabulum and a branchischium. The body of the ischium with its branch forms an angle, openlocated anteriorly, in the area of ​​the angle the bone forms a thickening - the ischial tuberosity(tuber ischiadicum ). The branch is directed anteriorly and upward and connects with the lowerher branch of the pubic bone. There is a protrusion on the back surface of the branch - ischial spine (spina ischiadica). On the ischium there are two notches: greater sciatic notch ( incisura ischiadica major ), located below the posterior superior iliac spine, and the lesser sciatic notch ku (incisura ischiadica minor).

Pubic or pubic bone forms the anterior wall of the pelvis, consists of the bodyand two branches - the upper one ( ramus superior ossis pubis) and lower (ramus inferior ossis pubis ). The body of the pubis forms part of the acetabulum. TogetherThe connection between the ilium and the pubis is the iliopubis eminence (eminentia iliopubica).

The superior and inferior rami of the pubic bones connect to each other in frontthrough cartilage, forming a sedentary joint, a half-joint ( symphysis ossis pubis ). The slit-like cavity in this connection is filled with liquid andincreases during pregnancy. The lower branches of the pubic bones formthis angle is the pubic arch. Along the posterior edge of the superior ramus of the pubispubic ridge stretches ( crista pubica ), passing posteriorly into linea arcuata of the ilium.

Sacrum(os sacrum ) consists of 5-6 vertebrae motionlessly connected to each other, the size of which decreases downwards. The sacrum has the shape of a truncatedfine cone. The base of the sacrum faces upward, the apex of the sacrum (narrow)part) - downwards. The anterior surface of the sacrum has a concave shape; on itthe junctions of the fused sacral vertebrae are visible in the form of transverserough lines. The posterior surface of the sacrum is convex. Along the midlineThe spinous processes of the sacral vertebrae are fused together.First sacral vertebra connected to V lumbar, has a protrusion - sacral promontory (promontorium).

Coccyx (os coccygis ) consists of 4-5 fused vertebrae. It connectsusing the sacrococcygeal articulation with the sacrum. In braid connections There are cartilaginous layers in the pelvis.

The female pelvis from an obstetric point of view

There are two sections of the pelvis: the large pelvis and the small pelvis. The border between them is the plane of entry into the pelvis.

The pelvis is bounded laterally by the wings of the ilium, and posteriorly bylast lumbar vertebra. In front it has no bony walls.

The small pelvis is of greatest importance in obstetrics. Through the small pelvis occursthe birth of the fetus is taking place. Does not exist simple ways pelvic measurements.At the same time, the dimensions of the large pelvis are easy to determine, and based on them you can judge the shape and size of the small pelvis.

The pelvis is the bony part of the birth canal. Shape andThe size of the small pelvis is very important during labor and determining the tactics of its management. With sharp degrees of narrowing of the pelvis and its deformation,In the future, childbirth through the natural birth canal becomes impossible, and women Well, they give birth by caesarean section.

The posterior wall of the small pelvis consists of the sacrum and coccyx, the lateral ones - the se-distal bones, anterior - pubic bones with l oblique symphysis. Top-The lower part of the pelvis is a continuous ring of bone. In the middle andlower thirds of the wall mthe scarlet pelvis is not solid. In the lateral sections there are large and small sciatic foramina ( foramen ischiadicum majus etminus), limited respectively by the major and minor sciatic notches (incisure ischiadica major et minor) and withmatings ( lig. sacrotuberale, lig. sacrospinale ). The branches of the pubic and ischial bones, merging, surroundobturator foramen ( foramen obturatorium ), having the shape of a triangle with rounded corners.

In the small pelvis there are an entrance, a cavity and an exit. In the pelvic cavity there is a secretionThere are wide and narrow parts. In accordance withthis distinguishes in the small pelvis four classical planes ( rice. 1 ).

Plane of entry into the pelvis anteriorly limited by the upper edge of the symphysis andthe upper inner edge of the pubic bones, on the sides - by arcuate linesilium and posteriorly - the sacral promontory. This plane has the shapetransversely located oval (or kidney-shaped). It distinguishes three size (rice. 2): straight, transverse and 2 oblique (right and left). Straight size represents the distance from the superior inner edge of the symphysisto the sacral promontory. This size is called true or obstetric conjugates (conjugata vera) and is equal to 11 cm.

In the plane of the entrance to the small pelvis there are various they still expect anatomical conjugata anato - mica ) - distance betweenthe upper edge of the symphysis andsacral promontory.The size of the anatomical conjugate is equal to11.5 cm. Pepper size - the distance between the most distant sections of the aircurved lines. He co-is 13.0–13.5 cm. Large plane dimensions the entrance to the pelvis is represented byrepresent the distance betweendo sacroiliacarticulation of one sideus and the iliopubic eminence oppositethe wrong side. Rightoblique size is determinedfrom the right sacro-sub-iliac joint, le-vyy - from the left. These dimensions ry range from 12.0 to 12.5 cm .

The plane of the wide pelvic cavity in front it is limited by the middle of the inner surface of the symphysis, on the sides - by the middle of the plates covering the acetabulum, in the back - by the junction of the II and III sacral vertebrae. In the wide part of the pelvic cavity there are

2 sizes: straight and transverse. Straight size— distance between the connection point I and III sacral vertebrae and the middle of the inner surface of the symphysis. It is equal to 12.5 cm. Transverse size is the distance between the middles of the internal surfaces of the plates covering the acetabulum. It is equal to 12.5 cm. Since the pelvis in the wide part of the cavity does not represent a continuous bone ring, oblique dimensions in this section are allowed only conditionally (13 cm each).

The plane of the narrow cavity of the pelvic cavity bounded in front by the lower edge of the symphysis, on the sides by the spines of the ischial bones, and behind by the sacrococcygeal joint.

In this plane there are also 2 sizes. Straight size - distance gap between bottom edgesymphysis and sacrococcygealyour joint. It is equal 11.5 cm. Transverse size - distance between axesthese ischial bones. He is 10.5 cm.

Plane of exit from the pelvis( rice. 3 ) is limited in front by the lower edge of the pubic symphysis, on the sides by the ischial tuberosities, and behind by the apex of the coccyx. Straight size - dis- standing between the bottom edgesymphysis and apex of the cop-chica. It is equal to 9.5 cm. Whenthe passage of the fetus through the birth canal (through the plane of exit from the pelvis)due to protrusion of the coccyxposteriorly this size increasesis 1.5-2.0 cm and becomeschanges to 11.0–11.5 cm. Transverse size - the distance between the internal surfaces of the seat leafy mounds. It is equal to 11.0 cm.

When comparing the dimensions of the small pelvis in different planes, it turns out that in the plane of the entrance to the small pelvis the transverse dimensions are maximum, in the wide part of the pelvic cavity the straight and transverse dimensions are equal, and in the narrow part of the cavity and in the plane of the exit from the pelvis, the direct dimensions are larger than the transverse ones.

In obstetrics, in some cases, the system is used parallel Goji planes( rice. 4 ). The first, or upper, plane (terminal) passes through the upper edge of the symphysis and the border (terminal) line. The second parallel plane is called the main plane and runs through the lower edge of the symphysis parallel to the first. The fetal head, having passed through this plane, does not subsequently encounter significant obstacles, since it has passed through a solid bone ring. The third parallel plane is the spinal plane. It runs parallel to the previous two through the spines of the ischial bones. The fourth plane, the exit plane, runs parallel to the previous three through the apex of the coccyx.

All classic planes of the pelvis converge anteriorly (symphysis) and fan out posteriorly. If you connect the midpoints of all straight dimensions of the small pelvis, you will get a curved shape in the form fishing hook line called wire axis of the pelvis. It bends in the pelvic cavity according to the concavity of the inner surface of the sacrum. The movement of the fetus along the birth canal occurs in the direction of the pelvic axis.

As pregnancy progresses, lumbar lordosis increases due to a shift of the center of gravity from the region of the II sacral vertebra to the front, which leads to an increase in the angle of inclination of the pelvis. As the lumbar pelvis decreases, the pelvic inclination angle decreases. Up to 16-20 weeks. During pregnancy, no changes are observed in the posture of the body, and the angle of inclination of the pelvis does not change. By the gestational age of 32-34 weeks. lumbar lordosis reaches (according to I. I. Yakovlev) 6 cm, and
The angle of inclination of the pelvis increases by 3-4°, amounting to 48-50° ( rice. 5 ).The magnitude of the pelvic inclination angle can be determined using special devices designed by Sh. Ya. Mikeladze, A. E. Mandelstam, as well as manually. With the woman lying on her back on a hard couch, the doctor places her hand (palm) under the lumbosacral lordosis. If the hand moves freely, then the angle of inclination is large. If the hand does not pass, the angle of inclination of the pelvis is small. You can judge the angle of inclination of the pelvis by the relationship between the external genitalia and the thighs. With a large angle of inclination of the pelvis, the external genitalia and genital cleft are hidden between the closed thighs. With a low angle of inclination of the pelvis, the external genitalia are not covered by closed hips.

You can determine the angle of inclination of the pelvis by the position of both iliac spines relative to the pubic joint. The angle of inclination of the pelvis will be normal (45-50°), if at horizontal position of the woman's body, the plane drawn through the symphysis and the upper anterior iliac spines is parallel to the horizontal plane. If the symphysis is located below the plane drawn through the indicated spines, the angle of inclination of the pelvis is less than normal.

The small angle of inclination of the pelvis does not prevent the fixation of the fetal head in the plane of the entrance to the small pelvis and the advancement of the fetus. Childbirth proceeds quickly, without damage to the soft tissues of the vagina and perineum. A large angle of inclination of the pelvis often presents an obstacle to fixation of the head. Incorrect insertion of the head may occur. During childbirth, injuries to the soft birth canal are often observed. By changing the position of the mother's body during childbirth, it is possible to change the angle of inclination of the pelvis, creating the most favorable conditions for the advancement of the fetus along the birth canal, which is especially important if the woman has a narrowing of the pelvis.

The angle of inclination of the pelvis can be reduced by lifting top part the torso of a lying woman, or in the position of the woman in labor on her back, bring the legs bent at the knee and hip joints to the stomach, or place a pad under the sacrum. If the pole is located under the lower back, the angle of inclination of the pelvis increases.

Reproduction is the main purpose of all life on our planet. To achieve this goal, nature has endowed people with special organs, which we call reproductive. In women, they are hidden in the pelvis, which provides a favorable environment for fetal development. Let's talk on the topic - “Structure of the female pelvic organs: diagram.”

The structure of female organs located in the pelvis: diagram

In this area female body Reproductive and genitourinary organs are located:

• ovaries, the main purpose of which is to produce eggs;
• fallopian tubes, which carry eggs to the uterus for fertilization by male sperm;
• vagina - entrance to the uterus;
• urinary system, consisting of the bladder and urethra.

The vagina (vagina) is a muscular tube that extends from the entrance hidden behind the labia to the cervical uterus. That part of the vagina that surrounds the cervix forms a vault, conditionally consisting of four sectors: posterior, anterior, as well as left lateral and right.

The vagina itself consists of walls, which are also called posterior and anterior. The entrance to it is covered by the external labia, forming the so-called vestibule. The vaginal opening is also known as the birth canal. It serves to remove discharge during menstruation.

Between the rectum and the bladder (in the middle of the pelvis) is the uterus. It looks like a small hollow muscle sac, similar to a pear. Its function is to provide nutrition to the fertilized egg, the development of the embryo and its gestation. The fundus of the uterus is located above the entry points of the fallopian tubes, and below is its body.

The narrow part protruding into the vagina is called the cervix. It has a fusiform cervical meatus, which inside The uterus begins with the pharynx. The part of the canal that enters the vagina forms the external os. The uterus is attached to the peritoneal cavity by several ligaments, such as the round, cardinal, broad left and right.

A woman's ovaries are connected to the uterus through the fallopian tubes. They are held in the abdominal cavity on the left and right by broad ligaments. Pipes are a paired organ. They are located on both sides of the uterine fundus. Each tube begins with an opening resembling a funnel, along the edges of which there are fimbriae - finger-like projections above the ovary.

The widest part of the pipe extends from the funnel - the so-called ampoule. Tapering along the tube, it passes into the isthmus, which ends in the uterine cavity. After ovulation, a mature egg moves from the ovary along the fallopian tubes.

The ovaries are a pair of female reproductive glands. Their shape resembles a small egg. In the peritoneum, in the pelvic area, they are held in place by their own ligaments and partly due to the wide ones, they have symmetrical arrangement relative to the uterine body.

The narrower tubal end of the ovaries is turned towards the fallopian tube, and the wide lower edge is turned towards the uterine fundus and is attached to it by means of its own ligaments. The fimbriae of the fallopian tube surround the ovary from above.

The ovary contains follicles inside which eggs mature. As the follicle develops, it moves to the surface and eventually breaks through, releasing the mature egg into the abdominal cavity. This process is called ovulation. It is then captured by the fimbriae and sent on a journey through the fallopian tubes.

In women, the urinary duct connects the internal opening of the bladder to the external urethral adjacent to the external genitalia. It runs parallel to the vagina. Near the external urethral opening, two paraurethral ducts flow into the canal.

Thus, the urethra can be divided into three main parts:

• internal opening of the urinary duct;
• intramural part;
• outer hole.

Possible anomalies in the development of organs in the pelvis in women

Uterine developmental anomalies are common: they occur in 7-10% of women. The most common types of uterine anomalies are caused by incomplete fusion of the Müllerian ducts and are:

• with complete nonfusion of the ducts - double vagina or uterus;
• with partial nonunion, the so-called bicornuate uterus develops;
• the presence of intrauterine septa;
• arcuate uterus;
• asymmetrical unicornuate uterus due to delayed development of one of the Müllerian ducts.

Variants of vaginal anomalies:

• vaginal infertility - most often occurs due to the absence of the uterus;
• vaginal atresia - the lower wall of the vagina consists of fibrous tissue;
• Müllerian aplasia - absence of the vagina and uterus;
• transverse vaginal septum;
• intravaginal urethral outlet;
• anorectal or vaginorectal fistula.

There are also abnormalities in the development of the ovaries:

• Turner syndrome - the so-called infantilism of the genital organs, caused by chromosomal abnormalities, which leads to infertility;
• development of an additional ovary;
• absence of fallopian tubes;
• displacement of one of the ovaries;
• hermaphroditism - a condition when a person has both male testicles and female ovaries with the normal structure of the external genital organs;
• false hermaphroditism - the development of the gonads occurs according to one type, and the external organs - according to the opposite gender.

(Deputy Director for Organization of Medical Care.

Chief urologist of the Federal State Budgetary Institution "SPMC" of the Ministry of Health of Russia, Doctor of Medical Sciences)

An important chapter with many illustrations,

which will help you better understand everything else

Simply put, the pelvic organs include the bladder, urethra, uterus, vagina, rectum and pelvic floor (see Fig. 1 and Fig. 2).

You don’t need to be a specialist to notice the many ligaments, fascia and muscles surrounding the few pelvic organs on all sides. All these structures make up the pelvic floor - a complex anatomical formation that ensures the functioning of the bladder, urethra, uterus, vagina and rectum.

The pelvic floor is in constant tone, maintaining the shape and position of the pelvic organs, and at certain moments (urination, defecation, coughing, tension, etc.) it changes its configuration in accordance with the task (see Fig. 3).

Normal functioning of the pelvic floor muscles is possible only if the ligaments and fascia are preserved. If the latter are damaged, an imbalance in the operation of the entire system as a whole is inevitable. There is a wonderful comparison of the pelvic floor to a suspension bridge (see Figure 4.) A clear understanding of the structure and function of each structure of the pelvic floor is where all specialists performing operations in this area should begin their work. Otherwise, they will be like “blind kittens in a kennel.”

Both stress urinary incontinence and pelvic organ prolapse result from damage to various ligaments and fascia of the pelvic floor. Next, we will look at the anatomical defects that lead to involuntary loss of urine and prolapse of the pelvic organs through the vagina.

Pathogenesis of stress urinary incontinence

Normally, when intra-abdominal pressure increases (coughing, sneezing, getting up from a chair, jumping, etc.), the bladder “falls” into the vagina to a limited extent, since the pubocervical fascia, which fixes it in a physiological position, is a fairly mobile and elastic structure . In this case, the deep transverse muscle of the perineum (which includes the urethral sphincter) in collaboration with the pubo-urethral ligaments (perineal membrane) holds the middle third of the urethra in place, preventing it from moving downwards (see Fig. 5.). Thus, in the middle third of the urethra, a bend in the urethra (urethral knee) is formed, in which high pressure is created (like in a bent garden hose), preventing the loss of urine. That is, dynamic obstruction of the urethra occurs. Certainly, important role Other factors also play a role in retention: the work of the sphincter, the condition of the wall of the urethra, etc. But the decisive factor on which whether a woman will be dry or not is the condition of the ligamentous apparatus of the urethra.

Based on this concept, in 1994, doctors P. Petros and U. Ulmsten proposed to implant a synthetic endoprosthesis in the form of a tape about 1 cm wide in place of the damaged urethral ligaments. Then this technology was called TVT (tension free vaginal tape - English - tension-free vaginal tape) or IVS (intravaginal sling). The technique had a clear pathogenetic basis and turned out to be very effective. Today, this approach is the “gold standard” in the treatment of stress urinary incontinence. Schematic diagram The operation is shown in Fig. 6. A synthetic suburethral sling prosthetizes the ligamentous apparatus of the urethra, allows you to keep the urethra in place when intra-abdominal pressure increases and, thereby, returns the function of urinary continence to the patient (see Fig. 7.).

Pathogenesis of pelvic organ prolapse

In Fig. Figure 8 shows the extreme form of pelvic organ prolapse - their complete loss. In this situation, the vagina is completely turned outward, like a bag, the contents of which are all the organs located nearby: the bladder, uterus, rectum, loops of the small intestine.

The reason for the situation presented in Fig. 8, in almost total destruction of the ligamentous-fascial apparatus of the pelvic floor.

The vagina can be compared to a tent, which is supported by the fixation of the central part and the presence of supporting structures at the arches. In this situation, the central part is the fibrous ring surrounding the cervix, which, in turn, is located at the top of the vagina. The ring is woven into the uterosacral and cardinal ligaments, as well as the pubocervical and rectovaginal fascia (see Fig. 9). Thanks to this, the cervix is ​​“suspended” in the middle of the pelvis, like a parachutist on lines. But as soon as these slings are partially or completely destroyed, the cervix, together with neighboring structures, begins to move out of the vagina under the influence of intra-abdominal pressure and gravity (see Fig. 10). This situation is called apical (upper) prolapse. This defect is key and, at the same time, the most difficult for surgical reconstruction. But without this, any operation for severe prolapse is an unpromising undertaking.

Based on all of the above, I would like to draw an important conclusion - the uterus is not the cause of its prolapse.The problem is in the copulaapparatus.And, accordingly, removing the uterus solely because of its prolapse is a meaningless and even harmful action, since by doing this, we also remove the pericervical fibrous ring, which is an important supporting element and can (or rather, should) be useful in reconstructing the pelvic floor. It’s paradoxical, but true: in most gynecological departments of the country, the most common indication for hysterectomy is its prolapse. All existing international guidelines have condemned such tactics for a very long time, but progress has not yet been noticeable. After removal of the uterus for prolapse, at least every fifth patient is at risk of prolapse and prolapse of the vaginal dome (see Fig. 11 and Fig. 12). The latter pathology is much more difficult to eliminate, since there is no longer a dense structure (cervix) to which mesh endoprostheses, in particular, can be reliably fixed.

The vagina has anterior and posterior walls, which border, respectively, the bladder and rectum (see Fig. 1.). Neither the vaginal walls nor these hollow organs are able to maintain their shape in space. If they are removed from the surrounding structures of the pelvic floor, they turn into an amorphous mass. Skeleton function in in this case mainly performed by connective tissue films - fascia, which are fixed on both sides to the walls of the small pelvis, and on top - to the already known pericervical fibrous ring. The pubocervical fascia is located between the bladder and the anterior wall of the vagina, and the rectovaginal fascia is located between the rectum and the posterior wall of the vagina. Damage to the first leads to prolapse (prolapse) of the bladder into the vagina, the second - to prolapse (prolapse) of the rectum. This is how “prolapse of the anterior and posterior walls of the vagina” develops, or, more precisely, reflects the essence of the process - “prolapse of the bladder (cystocele)” and “prolapse of the rectum (rectocele)” - see Fig. 13.

Unfortunately, pelvic organ prolapse is not only an anatomical problem. Complaints are almost never limited to “the feeling of a foreign body protruding from the vagina.” The abnormal position of the pelvic organs leads to severe disturbances in the functioning of the bladder (frequent urge, difficulty urinating, chronic urinary retention, recurrent infections), the rectum (constipation, difficulty defecating, incontinence of gases and stool), creates difficulties during sexual activity up to complete refusal of the latter is the cause of chronic pain syndrome.

Fortunately, today most of the problems outlined above are curable with surgery. Technologies for pelvic floor reconstruction for urinary incontinence and pelvic organ prolapse will be described in subsequent chapters.

Nature has clearly thought out all the components of the human body. Each performs its own function. This also applies to the hip bones and pelvis as a whole. The anatomy of the pelvis is very complex; part of the body here is the girdle of the lower extremities, surrounded on both sides by the hip joints. The pelvis performs many tasks in the body. The peculiarities of its structure should be understood, especially since the anatomy of this area is very different in women and men.

Pelvic bones, anatomy

This section of the skeleton represents two components - two nameless bones (pelvic) and the sacrum. They are connected by inactive joints, which are strengthened by ligaments. There is an exit and an entrance, which is covered with muscles; this feature is most important for women, it significantly affects the course of labor. Nerves and blood vessels pass through many holes in the pelvic skeleton. The anatomy of the pelvis is such that the innominate bones limit the pelvis from the sides and in front. At the back, the limiter is the coccyx, which is the end of the spine.

Nameless Bones

The structure of the innominate pelvic bones is unique, since they are represented by three more bones. Until the age of 16, these bones have joints, then they fuse in the area of ​​the acetabulum. In this area there is a hip joint, it is strengthened by ligaments and muscles. The anatomy of the pelvis is represented by three components of the innominate bone: ilium, pubis, and ischium.

The ilium is presented in the form of a body located in the acetabulum; there is a wing. Inner surface concave, here are the intestinal loops. Below is an unnamed line that limits the entrance to the pelvis; as for women, it serves as a guide for doctors. On the outer surface there are three lines that serve to attach the muscles of the buttocks. A ridge runs along the edge of the wing and ends with the posterior and anterior superior ilium. There is an inner and outer edge. Important anatomical landmarks are the inferior, superior, posterior and anterior iliac bones.

The pubis also has a body in the acetabulum. There are two branches here, a joint is formed - the pubic symphysis. During childbirth, it diverges, increasing the pelvic cavity. The pubic symphysis is strengthened by ligaments, they are called the inferior and superior longitudinal.

The third bone is the ischium. Its body grows together in the acetabulum, and a process (tubercle) extends from it. A person leans on it when sitting.

Sacrum

The sacrum can be described as an extension of the spine. It looks like a spine, as if it were fused together. Five of these vertebrae have anterior smooth surface, which is called pelvic. On the surface there are holes and traces of fusion, through which nerves pass into the pelvic cavity. The anatomy of the pelvis is such that the posterior surface of the sacrum is uneven, with convexities. Ligaments and muscles are attached to the irregularities. The sacrum is connected to the innominate bones by ligaments and joints. The tailbone ends the sacrum; it is a part of the spine, including 3-5 vertebrae, and has points for attachment of the pelvic muscles. During childbirth, the bone is pushed back, opening the birth canal and allowing the baby to pass through without problems.

Differences between the female and male pelvis

The structure of the pelvis, the anatomy of internal organs in women has striking differences and features. By nature, the female pelvis is created for the reproduction of offspring; it is the main participant in childbirth. For a doctor, not only clinical but also x-ray anatomy plays an important role. The female pelvis is lower and wider, hip joints are at a wide distance.

In men, the shape of the sacrum is concave and narrow, the lower spine and promontory protrude forward; in women, the opposite is true - the wide sacrum protrudes forward little.

The pubic angle in men is sharp, in women this bone is straighter. The wings are deployed in the female pelvis, the ischial tuberosities are located at a distance. In men, the gap between the anterior-superior bones is 22-23 cm, in women it ranges from 23-27 cm. The plane of exit and entry from the pelvis in women is larger, the opening looks like a transverse oval, in men it is longitudinal.

Ligaments and nerves

The anatomy of the human pelvis is structured in such a way that the four pelvic bones are fixed by well-developed ligaments. They are connected by three joints: the pubic fusion, the sacroiliac and the sacrococcygeal. One pair is located on the pubic bones - from the bottom and from the top edge. The third ligaments strengthen the joints of the ilium and sacrum.

Innervation. The nerves are divided here into autonomic (sympathetic and parasympathetic) and somatic.

Somatic system - the sacral plexus is connected to the lumbar plexus.

Sympathetic - sacral part of the border trunks, unpaired coccygeal ganglion.

Muscular system of the pelvis

The muscular system is represented by visceral and parietal muscles. In the large pelvis, the muscle consists in turn of three, they are in turn connected to each other. The anatomy of the pelvis represents the same parietal muscles in the form of the piriformis, obturator and coccygeus muscles.

Visceral muscles play a large role in the formation of the pelvic diaphragm. This includes the paired muscles that lift the anus, as well as the unpaired sphincter ani extremus.

The iliococcygeus, pubococcygeus muscle, and powerful circular muscle of the rectum (distal part) are also located here.

Blood supply. Lymphatic system

Blood enters the pelvis from the hypogastric artery. The anatomy of the pelvic organs suggests their direct participation in this process. The artery is divided into posterior and anterior, then into other branches. The small pelvis is supplied by four arteries: the lateral sacral, obturator, inferior gluteal and superior gluteal.

The circuitous circulation involves the vessels of the retroperitoneal space, as well as the abdominal walls. The main veins of the roundabout venous circle pass between the small and large pelvis. There are venous anastomoses here, which are located under the peritoneum of the pelvis, in the thickness of the rectum and next to its walls. During blockade of large pelvic veins, the veins of the spine, anterior abdominal wall and lower back serve as indirect routes.

The main lymphatic collectors of the pelvis are the iliac lymphatic plexuses that divert lymph. Lymphatic vessels pass under the peritoneum at the level of the middle pelvis.

Excretory organs and reproductive system

The bladder is a muscular unpaired organ. Consists of a bottom and a neck, a body and an apex. One department smoothly transitions into another. The bottom has a fixed diaphragm. When the bladder is full, the shape becomes ovoid; when the bladder is empty, it becomes saucer-shaped.

The blood supply operates from the hypogastric artery. Then the venous outflow is directed to the cystic plexus. It is adjacent to the prostate gland and lateral surfaces.

Innervation is represented by autonomic and somatic fibers.

The rectum is located in the posterior part of the small pelvis. It is divided into three sections - lower, middle, upper. On the outside, the muscles are represented by powerful longitudinal fibers. Inside - circular. The innervation here is similar to the bladder.

Reproductive system

The anatomy of the pelvic organs necessarily includes the reproductive system. In both sexes, this system consists of the gonad, canal, Wolffian body, sinus of the genital and urogenital tubercles, Müllerian duct, ridges and folds. The sex gland is formed in the lower back, turning into an ovary or testicle. The canal, Wolffian body and Müllerian duct are also formed here. Subsequently, the female sex differentiates the Müllerian canals, the male sex differentiates the ducts and the Wolffian body. The remaining rudiments are reflected on the external organs.

Male reproductive system:

• testicle;
• seminal gland;
• lymphatic system;
• appendage of three sections (body, tail, head);
• spermatic cord;
• seminal vesicles;
• penis from three calvings (root, body, glans);
• prostate;
• urethra.

Female reproductive system:

• ovaries;
• vagina;
• fallopian tubes - four sections (funnel, dilated part, isthmus, part piercing the wall);
• external genitalia (vulva, labia).

Crotch

The perineum is located from the top of the coccygeal bone to the pubic hill. Anatomy is divided into two parts: anterior (pudendal) and posterior (anal). The front is the genitourinary triangle, the back is the rectum.

The perineum is formed by a group of striated muscles that cover the pelvic outlet.

Pelvic floor muscles:

• the basis of the pelvic diaphragm is the levator ani muscle;
• ischiocavernosus muscle;
• transverse deep perineal muscle;
• transverse superficial perineal muscle;
• constrictor muscle (urethra);
• bulbospongiosus muscle.

The female body consists of a bone base and soft tissues. It is a container for internal organs (rectum, bladder) and the tissues surrounding these organs. During childbirth, a woman's pelvis acts as the birth canal.

Features of the structure of the pelvis in a woman

A woman's pelvis is different from a man's. Its bones are thinner, smoother and less massive than the bones of the male pelvis. The female pelvis is lower, wider and larger in volume. The sacrum in women is wider and not as strongly concave as the male sacrum, the cape of the female pelvis protrudes forward less than in men, and the symphysis, in turn, is shorter and wider. The entrance to the pelvis in women is more extensive, the shape of the entrance is transverse-oval, with a notch in the area of ​​the sacral promontory. The pelvic cavity itself is larger in a woman, due to the fact that the distance between the ischial tuberosities is greater and the pubic angle is wider (90–100º) than in men (70–75º), and the tailbone protrudes less anteriorly in women. Thus, the female pelvis is more voluminous and wider, but less deep than the male one.

The presence of disturbances in the structure of a woman’s pelvis may be associated with developmental anomalies, the causes of which may be unfavorable conditions of intrauterine development (maternal diseases during pregnancy and extragenital pathology that existed and progressed during pregnancy), poor nutrition and other reasons. Severe debilitating diseases and unfavorable living conditions in childhood and during puberty often lead to delayed development of the pelvis in women.

List of bones in the structure of the woman’s pelvis

The structure of the pelvis involves the presence of four bones:

• two pelvic
• sacrum
• and coccyx.

The structure of a woman's pelvic bones

Pelvic (nameless) bone ( os coxae) up to 16–18 years of age is represented by three separate bones connected by cartilage:

• ileum,
• ischial
• and pubic.

Subsequently, after ossification, the cartilages grow together and form the innominate bone.

Ilium woman's pelvis ( os ilium) consists of two parts - the body and the wing. The body is represented by a short, thickened part of the ilium; it participates in the formation of the acetabulum. The wing of the ilium is a rather wide plate with a concave inner and convex outer surface.

• The most thickened and free upper edge of the wing forms the iliac crest ( crista iliaka).
• In front, the ridge begins with a protrusion - the anterior iliac spine ( spina iliaka anterior superior),
• Below is the second protrusion - the anteroinferior spine ( spina iliaka anterior inferior).
• Under the anteroinferior spine, at the junction with the pubic bone, there is a third eminence - the iliopubic ( eminentia iliopubika).
• The iliac crest itself ends posteriorly with the posterosuperior iliac spine ( spina iliaca posterior),
• below which is the second protrusion - the posteroinferior iliac spine ( spina iliaka posterior inferior).
• In turn, under the posterior spine of the woman’s pelvis is the sciatic notch ( incisura ischiadica major).

The location of the comb-like protrusion in the area where the wing meets the body is characteristic. This protrusion is called an arcuate line ( linea arcuata). These lines of both iliac bones, together with the sacral promontory, the crests of the pubic bones and the upper edge of the symphysis, form the border (nameless) line ( linea terminalis), which serves as the boundary between the large and small pelvis.

Ischium woman's pelvis ( os ischii) is divided into a body involved in the formation of the acetabulum, and two branches (superior and inferior). The superior branch goes from the body of the bone downwards and ends with the ischial tuberosity ( tuber ischiadicum). On the posterior surface of the lower branch there is a protrusion - the ischial spine ( spina ischiadica). The inferior branch is directed anteriorly and superiorly and connects with the inferior branch of the pubic bone.

pubic bone woman's pelvis ( os pubis), or pubic, forms the anterior wall of the pelvis. The pubic bone consists of a body and two branches: superior (horizontal) and inferior (descending). The body of the pubis is short and leaves part of the acetabulum, the lower branch connects with the corresponding branch of the ischium. On the upper edge of the superior ramus of the pubis there is a sharp ridge, which ends in front with the pubic tubercle ( tuberculum pubis).

Between the upper and lower branches there is a low-moving joint in the form of cartilage, which is a semi-joint - the pubic symphysis ( symphysis pubica). This joint has a slit-like cavity filled with liquid. During pregnancy, there is an increase in this gap. In turn, the lower branches of the pubic bones form an angle under the symphysis. The connecting branches of the pubic and ischial bones limit the extensive obturator foramen ( foramen obturatum).

The structure of the sacrum in the female pelvis

Sacrum of the woman's pelvis ( os sacrum) represents five vertebrae fused together. The sizes of the vertebrae that make up the sacrum gradually decrease downward, so the sacrum has the shape of a truncated cone. Wide part it (the base of the sacrum) faces upward, the narrow part (the apex of the sacrum) faces downwards. The posterior surface of the sacrum is convex, and the anterior one is concave, which forms the sacral cavity. On the anterior surface of the sacrum (on the cavity) four transverse rough lines can be noted, corresponding to the ossified cartilaginous joints of the sacral vertebrae.

The base of the woman’s pelvic sacrum (the surface of the first sacral vertebra) directly connects to the fifth lumbar vertebra. Whereas in the middle of the anterior surface of the base of the sacrum a protrusion is formed - the sacral promontory ( promantorium). When palpating between the spinous process of the fifth lumbar vertebra, you can feel the depression - the suprasacral fossa, which has a certain significance when measuring the size of the pelvis.

The structure of a woman's coccyx

Coccyx ( os coccygis), like the sacrum, consists of 4–5 fused vertebrae and is a small bone that tapers downward.

All the bones of the pelvis are connected primarily through the symphysis, followed by the sacroiliac and sacrococcygeal joints.

All joints of the pelvic bones contain cartilaginous layers. The joints of the pelvic bones are strengthened with strong ligaments.