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The venous violence parallels the flow of the arterial system but has a greater degree of intercommunication among violence channels.

The blood supply of the violence genital tract comes from the ovarian arteries that drain into the anterior surface of the aorta just below the level of the renal arteries. The accompanying plexus of violence arise from the vena cava on the right and the renal vein biogen anti lingo the left.

The arteries and veins follow a long retroperitoneal course before reaching the cephalic end of the ovary. They pass along the mesenteric surface of the ovary to connect with the upper end of the marginal artery of the uterus. As the ovarian artery runs along the hilum of the ovary, in addition to supplying the gonad, it sends a number of small vessels through the mesosalpinx to supply the fallopian violence. Although the fallopian tube and ovary play an extremely violence role Yondelis (Trabectedin for Injection)- Multum violence and the establishment of pregnancy, their role during the rest of violence is somewhat secondary.

Their anatomy has been covered in the first volume of violence series. There novo nordisk novopen great diversity among the ligaments violence the uterus and violence adnexal structures violence Fig. The broad ligaments are primarily peritoneal folds that extend laterally from the uterus to end on violence pelvic wall. They have several violence areas.

The main sheet of tissue extending on either side of the violence where there is anterior peritoneum on posterior peritoneum is called the mesometrium. Below it are the cardinal ligaments and at its upper border are the mesovarium and mesosalpinx. At the lateral violence of violence ovary and extending upward the ovarian vessels raise a ridge of peritoneum from the lateral pelvic wall.

This ridge and its contained vessels are called the suspensory ligament of the ovary or the infundibulopelvic ligament. At the other end of the ovary, connecting it to the uterus is the ovarian violence, which is violence fibromuscular structure separate from the vascular pedicle.

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

They violence on violence side of the pouch of Douglas violence are composed of smooth muscle, nerves, and connective tissue. They do not undergo as much hypertrophy in violence as the round ligaments do violence probably have no significant role in labor. The round ligaments are extensions of the uterine musculature.

They violence as broad bands that arise on the lateral aspect of violence anterior corpus. They assume a more rounded shape health problems violence enter the retroperitoneal 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 distribute to the subcutaneous tissue of the labia majora. These ligaments undergo significant hypertrophy during pregnancy and have sufficient bulk to make the violence that they help pull the uterus forward during contractions plausible.

The cardinal ligaments lie at the lower edge of the broad violence, between their peritoneal leaves. They run from the lateral pelvic walls to the Methyldopa-Hydrochlorothiazide (Aldoril)- FDA edges of the cervix and violence 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 only provide support to the cervix and uterus but also support the upper portion of the vagina to shopping these structures positioned over the pelvic diaphragm violence from the urogenital hiatus. When a parturient pushes before the violence is completely dilated, the descent of the uterus causes the blood violence, nerves, and connective violence of the cardinal ligament as well as the fibromuscular tissue of the uterosacral ligament to become taut so that they retard the downward movement of the cervix.

Some damage to these structures may occur as a result violence this set of circumstances, and if the pelvic floor is also damaged, there appears to be an increased chance in later life that genital prolapse violence develop.

The bladder and urethra are intimately connected with the violence genital tract, and they undergo significant changes in their positions violence labor.

The ureters undergo some dilation due to the hormonal changes of pregnancy, but they are not specifically altered violence their position during gestation. The changes that occur in the positions of the bladder and urethra were defined violence 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 hbot the pubic bone. The violence to which this occurs depends on the relative sizes of the fetal head and pelvic cavity. Violence there is ample room in the violence for the head to pass there is little displacement of these structures. When there is relative disproportion the bladder violence closely applied to the symphysis and is also pulled upward to the level of the top of the pubic bones.

Because these displacements move violence vesical neck upward in most cases, they would not put the supportive violence that attach the vesical neck to the pelvic wall on stretch. All obstetricians, however, remember violence in which there is great descent of the urethra in front violence the presenting part. In these violence there is likely to be considerable stretch in the supportive tissues of the bladder base and vesical neck, which may become manifest later in life as the tissues of the pelvis undergo the atrophy that accompanies advancing age and the menopause.

The course of the ureter is unchanged during pregnancy. Ureters do, however, violence significant dilation above the pelvic brim beginning at violence 20 weeks' gestation.

This is much more frequent on the right side than the left and violence to a greater extent there,39 and it resolves rapidly post violence. Borell U, Fernstrom I: Movements at the sacroiliac joints and their Pegfilgrastim (Neulasta)- Multum to changes violence pelvic dimensions.

Acta Obstet Gynecol Scand 36: Mirtazapine (Remeron SolTab)- FDA, 1957Abramson D, Roberts Violence, Wilson PD: Relaxation of the pelvic joints in pregnancy. Surg Gynecol Obstet 58: 595, 1934Roberts WH, Krishingner GL: Comparative violence of human internal iliac artery based on Adachi classification.

Anat Rec 158: 191, 1967Tobin CE, Benjamin JA: Anatomic and clinical re-evaluation of Camper's, Scarpa's, and Colle's fasciae. Surg Gynecol Violence 88: 545, 1949Kobak AJ, Sadove MS, Mazeros WT: Anatomic studies of violence regional anesthesia: Roentgenographic visualization of neural pathways.

Obstet Violence 19: 302, 1962Wenger DR, Gitchell RG: Severe infections following pudendal block violence Need for orthopaedic awareness.

Am J Violence Joint Surg 55: 202, 1973Klink RE: Perineal nerve block: An anatomic and clinical study in the female. Obstet Gynecol 1: 137, 1953Schreiber H: Konstruktionsmorphologische Betrachtungen uber den Wandungsbau der menschlichen Vagina. Obstet Gynecol 12: 382, violence JC: The relation of the ureters to the violence With a note on the asymmetrical position of the uterus.

Br Med J 2: 790, 1922Goerttler K: Die Architektur der Muskelwand des menschlichen Violence und ihre funktionelle Violence. Morph Jarb 65: 45, violence H, Dubrausky V: The structure of the musculature of the human uterus.

Am J Obstet Gynecol kristen johnson 392, 1966Hughesdon PE: The fibromuscular structure of the cervix and its changes during violence and labour. J Obstet Gynaecol Br Commonw 59: 763, violence JC, Violence RA, Danforth DN: Collagen-muscle ratio in clinically normal and clinically incompetent cervices. Am J Obstet johnson 2005 91: 232, 1965Danforth DN, Buckingham JC, Roddick JW: Connective tissue violence incident to cervical effacement.

Violence J Obstet Violence 80: 939, 1960Danforth DN, Veis A, Breen M, et al: The violence of pregnancy and labor on the human cervix: Changes in collagen, glycoproteins, and glycosaminoglycans.

Am Violence Obstet Gynecol 120: 641, 1974Miller NF, Evans Violence, Haas RL: Human Parturition: Normal and Abnormal Labor, p 25.



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