. Gynecology : . sues marking the junction of the INJURIES DUE TO CHILDBIRTH 493 involuntary muscle-fibers, the urogenital trigone, and the fascia covering thepubococcygeus. It is at this point that lacerations of the pelvic floor usuallyoccur, and the effect of such injuries is measured by the extent to which therelations of the various structures to each other are disturbed. Figures 200-203give a diagrammatic representation of the effect of such injuries. A lacerationin the median line through A that does not extend below the upper margin ofthe external sphincter involves some of the involun
. Gynecology : . sues marking the junction of the INJURIES DUE TO CHILDBIRTH 493 involuntary muscle-fibers, the urogenital trigone, and the fascia covering thepubococcygeus. It is at this point that lacerations of the pelvic floor usuallyoccur, and the effect of such injuries is measured by the extent to which therelations of the various structures to each other are disturbed. Figures 200-203give a diagrammatic representation of the effect of such injuries. A lacerationin the median line through A that does not extend below the upper margin ofthe external sphincter involves some of the involuntary muscle-fibers and causeslittle disturbance of function and is easily repaired at the time of injury. Injuryon one side allows the pubococcygeus on that side to sag away from the medianline by the detachment of the involuntary muscle-fibers. If the tear extendsthrough the skin, as it usually does, the relations of the pubococcygeus onthat side to the external sphincter are disturbed and the sphincter is drawn. Fig. 201.—Diageam Showing the Pubococcygeus Portion of the Levator Ani Muscles, the Urogenital Trigone, and the External Sphincter. B, B, junction of involuntary muscle-fibers, pubococcygeus, and urogenital trigone. toward the uninjured side. The deep transversus perinei and the urogenitaltrigone on the injured side retract, pulling the pubococcygeus fibers outward,such retraction increasing in force if the fascia of the levator ani and the trigoneare separated from each other. If the tissues on both sides are injured, the re-sulting disturbance of function of the pelvic diaphragm is more marked, theinvoluntary fibers are torn from the two halves of the pubococcygeus, and themuscles sag away from the median line (Fig. 203). The retraction of the trigoneoccurs on both sides and the external sphincter drops downward and backwardand is usually drawn toward the half of the pubococcygeus from which thereis the least separation of the involuntary fibers. The posterior vag
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Keywords: ., bookcentury1900, bookdec, booksubjectgynecology, booksubjectwomen
