Gynecological diagnosis . Fig. 87.—Complete Prolapse orProcidentia. (After Euguier.) inward, and downward from 224 MALPOSITIONS OF THE UTERUS chronic distention of the urinary bladder, chronic fulness of therectum, sudden jar, etc. (see Retroversion, page 234). Whenonce the axis has been changed, the intra-abdominal pressure is ex-erted against the anterior face of the uterus and the broad liga-ments, and increased pressure accentuates the retroversion, and atthe same time pushes down the uterus, now in the same axis asthe vagina. Factors which make for greater downward pressure,such as a pers
Gynecological diagnosis . Fig. 87.—Complete Prolapse orProcidentia. (After Euguier.) inward, and downward from 224 MALPOSITIONS OF THE UTERUS chronic distention of the urinary bladder, chronic fulness of therectum, sudden jar, etc. (see Retroversion, page 234). Whenonce the axis has been changed, the intra-abdominal pressure is ex-erted against the anterior face of the uterus and the broad liga-ments, and increased pressure accentuates the retroversion, and atthe same time pushes down the uterus, now in the same axis asthe vagina. Factors which make for greater downward pressure,such as a persistent cough or violent straining because of chronic. Fig. 88.—Prolapse of the Vagina and Cervix, with Elongation of the Supra-vaginal Cervix. diarrhea, tend to cause descensus uteri. Constant straining is animportant factor in the causation of prolapse; therefore prolapseis found most frequently among women of the working women are apt to get up and begin work soon after con-finement when the uterus is large and heavy and retroverted. Inversion of the vagina may take place without actual descentof the uterus because of the elasticity of the vagina, and, prolapsemay be simulated by elongation of the lower uterine segment. DESCENT OR PROLAPSE 225 True hypertrophic elongation of the cervix, a lengthening of thecervix and the lower segment of the uterus, is by no means anuncommon condition. In such a case, should the utero-sacralligaments, which ordinarily limit the amount of the descent of theuterus, prove to be strong and not susceptible of stretching, thefundus uteri may remain nearly at its normal level while the exter-n
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