Identifier: gynaecologyforst00eden (find matches)
Title: Gynaecology for students and practitioners
Year: 1916 (1910s)
Authors: Eden, Thomas Watts, 1864-
Subjects: Gynecology Gynecology
Publisher: New York : Macmillan
Contributing Library: Francis A. Countway Library of Medicine
Digitizing Sponsor: Open Knowledge Commons

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ro-iliac joint, they carry with theman investment of strong fibrous tissue (see Fig. 297). These vessels withtheir sheaths form an important lateral attachment, which will opposedescent of the uterus. Further, at this level is to be found a well-formed band of fibrous tissue which has been named the transverseligament of the cervix (Paterson). It follows the line of the uterine 566 GYNECOLOGY vessels, but at a lower level, and is continuous with their fibrousinvestment ; it is continuous externally with the fibrous sheath ofthe iliac vessels, and with strong fibrous bands which enter the pelvisthrough the sciatic notch ; internally it is attached to the sides ofthe uterus, to the sides of the vaginal vault and to the sides ofthe urethra and bladder. It has been frequently pointed out thatin removing the uterus per vaginam the cervix cannot be pulled downmuch below its normal level until the structures at its sides havebeen divided, when it comes down easily outside the vulva. It is PV
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FLOOR. L. Levator PB CC B TL Fig. 297. Coronal Section through the Pelvicani; 0. Obturator internus ; PR. Pubic ramus ; TL. Triangular ligament ;B. Bulb of vagina ; CC. Crus clitoridis ; PV. Internal pudic vessels andnerve ; U. Uterine artery ; F. Veins of the parametrium (after Elliott Smith and Stopford). the division of the uterine vessels and the transverse ligaments whichliberates the cervix. It appears, therefore, that the uterus is maintained at its normallevel by the pelvic diaphragm, and by the supplementary transversefascial bands attached to the cervix and vaginal vault. The continualchanges in intra-abdominal pressure which result from respiration,changes of posture, coughing, sneezing, and general muscular effortare opposed by the contraction of the muscles of the pelvic diaphragm,which are therefore in constant functional activity. It is possiblethat abnormal increases in intra-abdominal pressure may lead tocompensatory hypertrophy of these muscles. On the other hand,inj

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