The ischial spine is the pointed projection from the posterior ischium between the greater and lesser sciatic notches. It serves as the attachment site for the sacrospinous ligament (converting the greater and lesser sciatic notches into foramina) and the coccygeus muscle. The pudendal nerve and internal pudendal artery cross over the ischial spine as they pass from the greater to the lesser sciatic foramen.
The ischial spines are the reference points for fetal station in labour — station 0 is when the fetal presenting part reaches the level of the ischial spines, with station expressed in centimetres above (negative) or below (positive) this reference. Pudendal nerve block is performed by directing a needle transvaginally to the sacrospinous ligament just posterior to the ischial spine. Sacrospinous fixation for vaginal vault prolapse places sutures through the sacrospinous ligament immediately lateral to the ischial spine.
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