This document provides an overview of female pelvic anatomy including the bones of the pelvis, pelvic spaces and landmarks, vasculature, lymphatic drainage, and innervation. Key points include the sacrum and coccyx forming the back of the pelvis, the true and false pelvis divided by the linea terminalis, important ligaments such as the sacrotuberous and sacrospinous, branches of the internal iliac artery including the uterine artery, lymphatic drainage pathways, and the four main pelvic spaces - retro pubic, para vesical, pouch of Douglas, and para rectal. A comprehensive understanding of pelvic anatomy is important for avoiding injuries during gynecological
1. Female Pelvic
Applied Anatomy
Dr. SHASHWAT JANI
M.S. ( GYNEC )
DIPLOMA IN ADVANCED ENDOSCOPY.
Assistant Professor Smt. N.H.L. MUNICIPAL
MEDICAL COLLEGE , AHMEDABAD.
Mob : +91 99099 44160.
E-mail : drshashwatjani@gmail.com
2. Basic Facts of Anatomy
do not Change
But our understanding does…
Exploration of specific anatomic relationships and the
development of new clinical and surgical correlation
continue to evolve….
3. Comprehensive understanding of
Anatomy is essential for ..
Avoiding visceral injuries : About 75 % iatrogenic
injuries to ureter result from Gynecological
surgeries….
Understanding of interrelation ship of Bony pelvis,
ligaments , muscles, fasciae , nerves , blood vessels
and pelvic viscera for safe and effective management
of Pelvic floor Disorders.
Understanding and managing the normal and
abnormal Obstetric conditions.
5. Nomenclature used here reflects current slandered
nomenclature according to
the Nomina Anatomica*.
*International Anatomical Nomenclature Committee: Edinburg, Scotland.
(founded in 1989)
6. Female Pelvis : Evolvement
•Forms a bony ring through with body weight is transmitted to lower
extremities.
•Adopts to child bearing.
20. Four Ligaments
Inguinal Ligament
• Important for repair of Inguial Hernia
Cooper’s Ligament
• Frequently used in Bladder suspension
procedures.
Sacrospinous Ligament
• For Vaginal Suspension
Sacrotubourous Ligament
42. The external iliac artery lies lateral to external iliac
vein.
The inferior epigastric artery is the only branch of
external iliac artery.
The inferior epigastric vein drains into the external
iliac vein.
43. Vasclar Anatomy :
Internal Iliac
The internal iliac ( Hypogastric )artery divides into
anterior and posterior divisions.
46. Uterine Artery
The uterine artery is the first branch of anterior division
of internal iliac artery. It originates about 6”(six
inches) distal to the bifurcation of common iliac artery
47. Internal Iliac & Uterine A.
Thus, there is sufficient length of internal artery
available for ligation. After giving out uterine artery,
the internal iliac artery continues further as obliterated
hypogastric artery.
The uterine artery traverses through the Para rectal
space and crosses above the ureter from lateral to
medial side to enter the uterus.
50. Uterine Artery & Vein
The Uterine vein, contrary to popular belief, comes
from below the ureter to join the internal iliac vein.
Thus, the ureter lies in the fork with the uterine artery
above and the uterine vein below.
51. SPACES
There are four important spaces:
Retro pubic space
Para vesical space
Pouch of Douglas
Para rectal space
52. Para rectal space
The Para rectal space lies…
lateral to the ureter
medial to the internal iliac vessels.
It continues downwards upto the levator ani muscle.
The only structures crossing this space are
Uterine artery
Uterine vein.
53. Pararectal space
ureter
Internal Iliac A.
Obliterate umbilical A.
Uterine A
Exterrnal Iliac vs.
54. Paravesical space
The paravesical space lies medial to the obliterated
hypogastric artery and is bounded caudally by the
pubic bone.
The retro pubic space can be entered through this
space.
56. Retro pubic space
The retro pubic space is bounded by the obliterated
hypogastric artery on either side, the pubic
symphysis anteriorly and the urinary bladder
posteriorly.
57. Pouch of Douglas
The pouch of Douglas is bounded by cardinal and
uterosacral ligaments on either side, the uterus
anteriorly and rectum posteriorly.
58. The veins run in the uterosacral and cardinal
ligaments. Likewise, the lymphatics also run in these
ligaments along the veins. Hence, the ligaments are
cut as laterally as possible in cancer surgery.
The small veins run in the paracolpos.
59. The circumflex iliac vein, which drains into external
iliac vein from medially, is very liable to get damaged
during nodal dissection.
The obturator artery and vein run parallel to the
obturator nerve.
The obturator nerve originates at the bifurcation of
common iliac vessels and then runs caudally between
the external and internal iliac vessels.
61. Lymphatics
Lymphatics from cervix and upper vagina go along
the paracolpos and cardinal ligament and drain into
the ileo-obturator nodes. The obturator node is the
first echelon of spread from the cervical cancers.
Lymphatics from the ovaries go along the infundibulo-pelvic
ligaments and drain into the Para-aortic group
of nodes.