Gynecological diagnosis and pathology . result of a balance of forces. It is subjectedto continuous downward pressure varying with respiration and muscularstrain. Counteracting this force we have the pelvic floor and the con-nective and muscular tissue (ligamentum colli) in the base of the broadligament, and what we might describe as four guy-ropes, namely, the tworound ligaments in front and the utero-sacral ligaments behind (fig. 8). The uterus is thus supported by the connective and muscular tissuearound the cervix and by the pelvic floor (the fascia and levatores ani);while its forward dir
Gynecological diagnosis and pathology . result of a balance of forces. It is subjectedto continuous downward pressure varying with respiration and muscularstrain. Counteracting this force we have the pelvic floor and the con-nective and muscular tissue (ligamentum colli) in the base of the broadligament, and what we might describe as four guy-ropes, namely, the tworound ligaments in front and the utero-sacral ligaments behind (fig. 8). The uterus is thus supported by the connective and muscular tissuearound the cervix and by the pelvic floor (the fascia and levatores ani);while its forward direction is -due to the action of the utero-sacralligaments, which keep the cervix backwards, and of the round ligaments,and especially intra-abdominal pressure, which keep the fundus directedforwards. Each of these factors calls for a short reference. While the import-ance of the pelvic floor as a means of support was pointed out manyyears ago by Berry Hart, the part played by the connective and muscular CHANGES IN POSITION OF UTERUS 4i. 42 GYNECOLOGICAL PATHOLOGY tissue (liganientum colli) at the base of the broad ligament in relation tothe uterine artery has only recently been emphasised. After the uterushas been freed in front and behind, in the operation of vaginal hyster-ectomy, it cannot be pulled down until this perivascular tissue has beendivided. The action of the utero-sacral ligaments_ is brought out by thefact that when these do not regain their tone in the puerperium there isa tendency to retroversion, also by the fact that the normal anteflexionis exaggerated when these ligaments are contracted by cicatrisation afterutero-sacral cellulitis. The part played by the round ligaments is ofless importance, but use is made of them in the operative treatmentof displacements. Intra-abdominal pressure is a factor in constantoperation. So long as the cervix is drawn back by the utero-sacralligaments and the fundus kept forward by the round ligaments, thispressure acts on the
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Keywords: ., bookcentury1900, bookdecade1910, booksubjectgynecology, bookyear1
