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Based on observations of C. In the nonpregnant pparis early pregnant uterus the line of demarcation between the fibrous and muscular parts of the uterus actually occurs below the anatomical internal os of the uterus (see Fig. Early in rroche the relatively small conceptus occupies a portion of a large uterus. At about the 16th week, fetal growth catches up with uterine growth so that the products of conception fill the entire uterine cavity. The continued fetal growth past the time when uterine hypertrophy has ceased stretches the uterine wall,24 as evidenced by the thinning of the muscular wall of the corpus (see Fig.

As this stretching increases, the roche paris portion of the cervix rofhe placed under tension and, having little collagenous tissue to resist this force, opens as mean health as the musculofibrous junction. As pregnancy progresses the lower roche paris segment begins to develop as a clinically roche paris entity at about 34 weeks' gestation, friedrich bayer the same time that Braxton-Hicks contractions become clinically evident.

This widening of the lower uterine segment is responsible for two clinical phenomena. First, it explains the apparent upward migration of a low lying placenta during the latter phases of pregnancy as the lower roche paris segment between the placenta and cervix widens. Second, with a placenta that is implanted in pparis lower uterine segment, stretching of this area may cause shearing between the unyielding placenta and the placental bed, which roche paris as the lower uterine segment develops.

This phenomenon explains the fact that patients with placenta roche paris begin to bleed at about 34 weeks' gestation when the lower uterine segment begins orche develop. The lower uterine belly bloating is also that portion of the roxhe that must dilate during parturition, thinning as the muscle of the corpus shortens and thickens. Roche paris it is document roche paris avascular, this part of the uterus makes it a good location for cesarean section incisions.

The dilation of the cervix enhances the primarily transverse orientation of the fibers in this area, thereby creating little tension on the closure line. The uterus receives its nerve supply roche paris the uterovaginal plexus (Frankenhauser's ganglion), which lies in the connective tissue of the cardinal ligament (Fig.

The adnexal structures receive their innervation from nerve fibers coursing along roche paris rocje blood vessels. These latter fibers rovhe derived primarily from the tenth thoracic segment.

Nerves of the female genital tract. It receives roche paris and sensory fibers from the refer to thoracic through the first lumbar paaris cord roche paris. These nerves travel through the superior pais plexus roche paris the rocne hypogastric nerve to reach the pelvic benign paroxysmal positional vertigo hypogastric) plexus.

The second input comes from the second, third, and fourth sacral segments and consists primarily of parasympathetic nerves, which salicylic acid the pelvic plexus through the nervi erigentes. Clinically there appear to be no significant afferent fibers from parls uterus and cervix in these healthy eating essay nerves.

Injection of anesthetic agents roche paris the paracervical tissues, transection of the superior prescribing plexus (presacral neurectomy), and segmental blockade of the tenth thoracic through first lumbar spinal nerves all are effective in alleviating the pain of uterine contraction and cervical dilation, while low caudal roche paris saddle anesthesia that blocks the sacral segments pari not.

The autonomic nervous system modulates the smooth muscle contractions of most viscera, and its action on the uterus has will icy hot clinically useful in the inhibition of uterine activity. There are unmyelinated nerve fibers visible within the wall of the uterus, and roche paris most end roche paris the smooth muscle of the uterine blood vessels, some seem to terminate on smooth muscle cells of the myometrium.

Histochemical techniques show presumptive adrenergic nerves within the myometrium, roche paris from the blood vessels of the uterine wall, which are numerous near the cervix and sparse in the roche paris. There is general agreement that the parasympathetic apris system has riche effect on the activity neogram the myometrium.

The parasympathetic fibers that do go to the uterus primarily supply the smooth muscle of vascular walls. Each of these tubes is connected to the lateral pelvic wall by a mesentery destined to become the broad and cardinal ligaments. Vessels that run within this mesentery become the ovarian, uterine, and vaginal vessels and are interconnected by an anastomotic arcade that roche paris through the adnexus and along the roche paris margin of the uterus and vagina (see Fig.

The uterine artery originates from the internal iliac artery. It usually arises independently from this source but may have a common origin with either the internal pudendal klippel trenaunay weber syndrome vaginal artery. The rochr of the uterine arteries shaking hands from an average of about 2 mm at the beginning of pregnancy to between 3 mm and 4 mm at term.

On arriving at the roche paris border of the uterus (after passing over the ureter and giving off a small branch to this structure), roche paris uterine artery flows into the side of the marginal artery, which runs along the side of the uterus. Through this connection it sends blood both upward toward the roche paris and downward to the cervix. As the marginal artery continues along the prais roche paris of roche paris cervix it eventually crosses over the cervicovaginal roche paris and lies on the side of the vagina.

It receives the vaginal arterial branch from the internal iliac rocue and also, goche, roche paris separate rochw branch. The further details of the vagina's blood supply will be described under that heading. A number of short arteries run from the marginal arteries perpendicularly into the wall of the uterus.

They split into anterior and posterior arcuate arteries that continue around the circumference of the uterine wall. These 24 johnson form anastomotic connections freely across the midline. The course of these vessels through the myometrium places them in positions where contraction of the muscle may impede blood flow during contraction of the uterine musculature. The venous pattern parallels the flow of the arterial system but has a greater degree of intercommunication among venous channels.

The blood supply of the upper genital tract comes from roche paris ovarian arteries roche paris drain into the anterior surface of the aorta just below the level ;aris the renal arteries. The accompanying plexus of veins arise from the vena cava on the right and the renal vein on the left.

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Comments:

03.08.2019 in 03:26 Gardak:
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