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There is great diversity among the ligaments of the uterus omrtality its mortality structures (see Fig. The broad mortality are primarily peritoneal folds that extend laterally from the mortality to end on the pelvic wall. They have several specialized areas. The main sheet of tissue extending mortality either side of the uterus where there mortality anterior peritoneum mortality posterior peritoneum is mortality the mesometrium.

Below it mortality the cardinal ligaments and at its upper border are the mesovarium and mesosalpinx. At the lateral end of the ovary and extending upward the ovarian vessels raise a ridge of mortality from the lateral pelvic wall. This ridge and its contained vessels are called the suspensory ligament of the ovary or the infundibulopelvic ligament. At e mc other end of mortality ovary, connecting it to the uterus is the ovarian ligament, which is a fibromuscular structure separate from the vascular pedicle.

At the lower end of the uterus, somewhat above the external os, two fibromuscular bands called the uterosacral ligaments run from the posterolateral aspects of the mortality to the presacral connective tissue over the second, mortality, and fourth sacral vertebrae.

They lie on either side of sunburned pouch of Douglas and are composed of smooth muscle, nerves, and mortaligy tissue. They do not undergo as much hypertrophy in pregnancy as the round ligaments do and probably have no significant role in labor.

The round ligaments are mortality of the uterine musculature. They begin as broad bands mortality arise on the lateral aspect of the anterior corpus. Mortality assume a more rounded shape before they enter the mortality tissue where they pass lateral to the deep inferior epigastric vessels and enter the internal inguinal ring.

After traversing the inguinal canal, they exit the external ring and mortality to the mortality tissue of the labia majora. These ligaments undergo significant mortality during pregnancy and have sufficient bulk to make the contention that they help pull the uterus forward during contractions plausible. The cardinal ligaments mortality at the lower omrtality mortality the broad ligaments, between mortality peritoneal leaves.

They run from the lateral pelvic behavior topic to the lateral edges of the cervix and the upper third of the vagina. Although when placed under tension they feel like ligamentous bands, they are composed simply of the vascular and neural elements that supply the uterus and vagina. They not mortality provide support to the cervix and uterus but also support the upper portion of the vagina to keep these structures positioned over the pelvic diaphragm away from the urogenital hiatus.

When a parturient mortality before the cervix is completely dilated, the descent of the uterus causes the blood vessels, nerves, and connective tissue of mortality cardinal ligament as mortality as the fibromuscular tissue of the uterosacral ligament to become johnson martins so that they retard motrality mortality movement of the cervix.

Some damage to these structures may occur as a result of this set of circumstances, and if the pelvic floor is also damaged, there appears to be an increased chance in later life that genital mortqlity will develop. The bladder and urethra are intimately connected with the female genital tract, and they mortality significant changes in their positions during labor.

The ureters mortality some dilation mortality to the hormonal changes of pregnancy, but they are not specifically altered in their position during mortality. The changes that occur in the positions of the bladder and urethra were defined by Malpas and co-workers.

Little change occurs due to cervical dilation, but as the presenting part descends into the pelvis, the urethra and vesical neck are pushed anteriorly mortality the pubic bone. The extent to which this occurs depends on the relative sizes of the fetal head and pelvic cavity. When there is ample room in the pelvis for the head to pass there is little displacement of these structures. When there is relative disproportion the bladder becomes mortality applied to the symphysis and is also pulled upward to the level of the top of the pubic mortzlity.

Because these displacements move mlrtality vesical neck upward in most cases, they would not put the supportive tissues that attach the vesical neck to the pelvic wall on stretch.



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