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  <head>
    <title>079-01 Bony pelvis, pelvic walls, pelvic floor, fascia, vessels, and nerves</title>
    <ownerName>Integrated Medical Foundations</ownerName>
  </head>
  <body>
    <outline text="Bony pelvis, walls, floor, fascia, vessels, and nerves">
      <outline text="The pelvic ring">
        <outline text="Hip bone: ilium, ischium, pubis fused at acetabulum"/>
        <outline text="Symphysis anteriorly, sacroiliac joints posteriorly">
          <outline text="Closed ring: one break, look for another"/>
        </outline>
        <outline text="Brim separates greater from lesser pelvis">
          <outline text="Inlet in plane of brim"/>
          <outline text="Outlet: pubic arch, tuberosities, sacrotuberous, coccyx"/>
        </outline>
        <outline text="Sacrospinous, sacrotuberous ligaments">
          <outline text="Convert notches into foramina"/>
          <outline text="Resist sacral rotation"/>
        </outline>
        <outline text="Sacroiliac joint: synovial front, posterior syndesmosis">
          <outline text="Weight wedges sacrum between ilia"/>
        </outline>
        <outline text="Ring injury by force and stability">
          <outline text="AP compression opens symphysis and sacroiliac"/>
          <outline text="Lateral compression buckles hemipelvis"/>
          <outline text="Vertical shear disrupts posterior support"/>
          <outline text="Bleeding from bone, venous plexuses, arteries"/>
          <outline text="Assess urethra, bladder, rectum, plexus, vessels"/>
        </outline>
        <outline text="Symphysis: secondary cartilaginous joint">
          <outline text="Pregnancy widening modest, trauma destabilises"/>
        </outline>
      </outline>
      <outline text="Dimensions and variation">
        <outline text="Inlet, midpelvis, outlet influence childbirth">
          <outline text="No single measurement predicts birth mechanics"/>
          <outline text="Moulding, position, soft tissue, uterine force"/>
        </outline>
        <outline text="Sex-associated average differences overlap">
          <outline text="Age, ancestry, stature, activity, nutrition"/>
          <outline text="Answer a clinical question, not identity"/>
        </outline>
        <outline text="Obstetric conjugate not directly measurable">
          <outline text="Diagonal conjugate estimates it"/>
        </outline>
        <outline text="Interspinous distance: midpelvic transverse"/>
      </outline>
      <outline text="Lateral and posterior walls">
        <outline text="Lateral: obturator membrane, obturator internus">
          <outline text="Obturator canal to medial thigh"/>
        </outline>
        <outline text="Posterior: sacrum, coccyx, piriformis, ligaments"/>
        <outline text="Piriformis divides greater sciatic foramen">
          <outline text="Superior gluteal vessels and nerve above"/>
          <outline text="Sciatic, inferior gluteal, pudendal below"/>
        </outline>
        <outline text="Pudendal nerve curves round ischial spine">
          <outline text="Enables nerve block"/>
          <outline text="Vulnerable in childbirth and surgery"/>
        </outline>
      </outline>
      <outline text="Pelvic diaphragm">
        <outline text="Levator ani and coccygeus with fascia"/>
        <outline text="Puborectalis, pubococcygeus, iliococcygeus"/>
        <outline text="Puborectalis sling at anorectal junction">
          <outline text="Keeps anorectal angle at rest"/>
          <outline text="Relaxes during defecation"/>
        </outline>
        <outline text="Levator supports viscera, resists pressure"/>
        <outline text="Hiatus: urethra, vagina, anorectal canal">
          <outline text="Necessary weak region, changes with loading"/>
        </outline>
        <outline text="Sacral plexus branches, pudendal to sphincters"/>
        <outline text="Excess tone: pain, voiding difficulty"/>
        <outline text="Weakness: prolapse, incontinence"/>
      </outline>
      <outline text="Endopelvic fascia and support">
        <outline text="Parietal fascia on walls, visceral on organs"/>
        <outline text="Loose planes permit filling and dissection">
          <outline text="Also transmit vessels and spread"/>
        </outline>
        <outline text="Cardinal, uterosacral: cervix and upper vagina"/>
        <outline text="Puboprostatic, pubovesical: bladder neck"/>
        <outline text="Perineal body: central fibromuscular node">
          <outline text="Injury weakens posterior wall and continence"/>
        </outline>
        <outline text="Prolapse: multi-component support failure">
          <outline text="Descent does not map perfectly to symptoms"/>
          <outline text="Repair integrated support, not one defect"/>
        </outline>
      </outline>
      <outline text="Internal iliac vessels">
        <outline text="Posterior division: iliolumbar, lateral sacral, superior gluteal"/>
        <outline text="Anterior division: viscera, perineum, gluteal region"/>
        <outline text="Extensive anastomoses across midline"/>
        <outline text="Uterine artery crosses above ureter"/>
        <outline text="Corona mortis crosses superior pubic ramus"/>
        <outline text="Valveless venous plexuses">
          <outline text="Communicate with vertebral plexus"/>
          <outline text="Collapse poorly, bleeding diffuse"/>
        </outline>
      </outline>
      <outline text="Somatic and autonomic nerves">
        <outline text="Sacral plexus on piriformis">
          <outline text="Masses, childbirth, surgery affect many nerves"/>
        </outline>
        <outline text="Sympathetics via hypogastric plexuses"/>
        <outline text="Pelvic splanchnic nerves S2 to S4, parasympathetic"/>
        <outline text="Pudendal nerve S2 to S4, somatic">
          <outline text="Do not confuse despite shared roots"/>
        </outline>
        <outline text="Pelvic pain line">
          <outline text="Above: sympathetic, thoracolumbar levels"/>
          <outline text="Below: parasympathetic, sacral levels"/>
        </outline>
      </outline>
      <outline text="Pelvic spaces">
        <outline text="Retropubic space: surgical access"/>
        <outline text="Paravesical, pararectal: vessels, nerves, ureters"/>
        <outline text="Presacral: autonomic plexus, vessels"/>
        <outline text="Extraperitoneal bleeding spreads widely"/>
        <outline text="Infection and tumour follow fascial planes"/>
        <outline text="Imaging defines sidewall, floor, peritoneum, ureter"/>
      </outline>
    </outline>
  </body>
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