Pelvic Outlet

A. General features. The pelvic outlet is defined by the coccyx, ischial tuberosities, inferior pubic ramus, and pubic symphysis. It is closed by the pelvic diaphragm and the urogenital diaphragm.

B. Measurements of the pelvic outlet

1. Transverse diameter is the distance between the ischial tuberosities.

2. Interspinous diameter is the distance between the ischial spines. If the inter-spinous diameter is < 9.5 cm, the ischial spines may present a barrier to delivery of an infant.

V. SUPPORT OF THE PELVIC ORGANS. The pelvic organs are supported by the following muscles and ligaments:

A. The pelvic diaphragm (floor) is composed of the coccygeus muscle and the levator ani muscles (iliococcygeus, pubococcygeus, and puborectalis). The puborectalis forms a U-shaped sling around the anorectal junction, causing a 90° perineal flexure. This muscle is important in maintaining fecal continence.

B. The urogenital diaphragm is composed of the deep transverse perineal muscle and the sphincter urethra muscle.

C. The transverse cervical ligament (cardinal ligament of Mackenrodt) is a thickening of the endopelvic fascia and extends laterally from the cervix to the sidewall of the pelvis.

D. The uterosacral ligament is a thickening of the endopelvic fascia and extends posteriorly from the cervix to the sacrum.

E. The pubocervical ligament is a thickening of the endopelvic fascia and extends anteriorly from the cervix to the pubic symphysis.

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