3.3 Anatomy of the pelvis Flashcards
(93 cards)
1
Q
what is the pelvic inlet formed by?
A
- arcuate line
- pecten pubis (pectineal line)
- ala of sacrum and promontory
2
Q
what is the pelvic outlet formed by?
A
- pubic symphysis
- ischiopubic rami
- sacrotuberous ligament
- sacrum and coccyx
3
Q
which parts of the pelvis are in the same vertical plane in anatomical position>
A
In anatomical position (erect posture), the right and left anterior superior iliac spines (ASIS) and the anterior aspect of pubic symphysis lie in the same vertical plane. The pubis and the ischium are aligned more towards the anterior and inferior region while the ilium and sacrum is aligned more posteriorly and superiorly.
4
Q
what does the true (obstretrical) conugate refers to?
A
minimum antero-posterior (AP) diameter of lesser pelvis extending from middle of sacral promontory to postero-superior margin of pubic symphysis (around 11cm). It is the first bony landmark the foetus will pass through.
5
Q
how is the diagonal conjugated measured?
A
palpating the sacral promontory with the tip of middle finger to the level of inferior margin of pubic symphysis
6
Q
what is the anterior inferior pelvic wall formed by?
A
- Formed by bodies and rami of pubic bones and the public symphysis.
- Behind the pubis lies the urinary bladder.
- Between the pubis and the urinary bladder lies a space called the retropubic space. The weight of a full bladder will be borne by the anterior inferior pelvic wall.
7
Q
what is the lateral pelvic walls formed by?
A
- Formed by right and left innominate (hip) bones
- The obturator membrane covers the obturator foramen, which lies below the superior ramus of the pubis, lateral to the inferior pubis and ischial pubic rami and above the ischial tuberosity.
- The obturator internus muscle covers most of the lateral wall of pelvic cavity
- The thickened portion of obturator fascia forms as tendinous arch (represented in red dotted line), provides attachment to pelvic diaphragm
8
Q
What is the posterior pelvic walls formed by?
A
- Sacrum and coccyx
- Sacroiliac ligament (at the SI joint)
- Sacrotuberous and sacrospinous ligaments (connects sacrum to the ischium)
- Piriformis muscle: Piriformis originates from pelvic surface of sacrum, passes through greater sciatic foramen and inserts at superior border of greater trochanter of femur
- Anteromedial to pyriformis lies the sacral plexus
- Nerve supply: nerve to piriformis (S1,S2)
9
Q
what is the pelvic floor formed by?
A
- Formed by funnel shaped pelvic diaphragm (fibromuscular structure)
- Consists of coccygeus and levator ani muscles (consist of pubococcygeus and iliococcygeus) and the fascia covering the superior and inferior aspects of the muscles
10
Q
Where does the levator ani attach to and its nerve supply ?
A
- Anteriorly to public bones
- Posteriorly to ischial spines
- Laterally to tendinous arch of obturator fascia
Nerve supply: Nerve to levator ani (S3,S4)
11
Q
what kind of joint is the sacroiliac joint and what are its movements?
A
- atypical synovial
- Minimal movement (slight anterior and posterior tilting of hip bones)
12
Q
what kind of joint is the pubic symphysis and what are its movements?
A
- secondary cartilaginous
- None (for shock absorption and allows delivery of baby)
13
Q
what kind of joint is the sacrococcygeal joint and what are its movements?
A
- secondary cartilaginous
- Flexion and extension of coccyx (passive movements during defecation and labour → further increases AP diameter of the pelvic outlet)
14
Q
when we sit down, which part of the hip bone do we sit on?
A
part of the hip bones which one sits on (transmits weight to the ground in the upright sitting position
15
Q
what is the promontory?
A
Anterior projecting edge of the body of S1 (important obstetrical landmark →
16
Q
what is the ala and what does it serve as an attachment for?
A
Large lateral projections (wings) on each side of the base of sacrum (articulation with the hip bones → sacroiliac joints):
• Attachment for: psoas major, iliacus muscle
17
Q
what is the sacraal foramina?
A
4 pairs of openings for the exit of the posterior and anterior (larger) rami of the pelvic spinal nerves
18
Q
what is the sacral canal?
A
Continuation of vertebral canal in the sacrum (contains cauda equina)
19
Q
What is the sacral hiatus?
A
Inverted U-shaped structure resulting from the absence of the laminae and spinous processes of S5 and (sometimes) S4
20
Q
obturator internus
- origin
- insertion
- innervation
- function
A
- obturator membrane
- lesser sciatic foramina –> greater trochanter of femur
- Nerve to obturator internus (L5 – S2)
- Abduction of lower limbs, Lateral rotation of hip
21
Q
Piriformis
- origin
- insertion
- innervation
- function
A
- Pelvic surfaces of S2 – S4; superior margin of greater sciatic notch and sacrotuberous ligament
- greater sciatic foramina –> greater trochanter of femur
- Nerve to piriformis (S1 – S2)
- Abduction of lower limbs, Lateral rotation of hip
22
Q
coccygenus
- origin
- insertion
- innervation
- function
A
- ischial spine
- inferior end of sacrum & coccyx
- S4- S5
- Support pelvic viscera & flexion of coccyx
23
Q
levator ani
- origin
- insertion
- innervation
- function
A
- Body of pubis, tendinous arch of obturator fascia, ischial spine
- Perineal body, coccyx, anococcygeal ligament, walls of prostate/vagina, rectum, anal canal
- Nerve to levator ani (S3 – S4), Inferior rectal nerve, Coccygeal plexus
- Support pelvic viscera &
resist increases in IAP (prevents vaginal and uterine prolapse)
24
Q
where do the fibers of the pubovaginalis run?
A
Fibres running along the sides of the vaginal opening (sphincter)
25
where do the fibers of the puborectalis run?
Fibres running along the sides of the rectum → maintains continence:
• Faecal: most important part in the anal sphincter complex
• Urinary: pre-rectal fibres loop around urethra and vagina
26
where do the fibers of the pubococcygenus run?
Fibres run from the ischiopubic ramus to the anococcygeal raphe
27
where do the fibers of the ileococcygenous run?
Fibres run from the ischium to the anococcygeal raphe (often thin and poorly developed → more aponeurotic than muscular)
28
ovarian artery
- origin
- course
- supply
- Abdominal aorta
- Descends in suspensory ligament of ovary
- Pelvic ureter, ovary, ampullary end of uterine tube
29
median sacral artery
- origin
- course
- supply
- Abdominal aorta
- Descends in midline over L4 to coccyx
- Inferior lumbar vertebrae, sacrum, coccyx
30
superior rectal artery
- origin
- course
- supply
- IMA
- Crosses left common iliac vessels
- superior part of rectum
31
obturator artery
- origin
- course
- supply
- anterior division of internal iliac arteries
- Runs anteroinferiorly on obturator fascia of lateral pelvic wall → obturator canal
- Pelvic muscles, ilium, lower limb
32
uterine artery
- origin
- course
- supply
- anterior division of internal iliac arteries
- Runs in base of broad ligament → crosses ureter superiorly to lateral uterine cervix
- Uterus, ligaments of uterus, medial parts of uterine tube and ovary, superior vagina
33
vaginal artery
- origin
- course
- supply
- anterior division of internal iliac arteries
- Divides into vaginal and inferior vesical branches
- Vaginal branch: lower vagina, vestibular bulb, rectum
- Inferior vesical branch: fundus of urinary bladder
34
internal pudendal artery
- origin
- course
- supply
- anterior division of internal iliac arteries
- Exits pelvis via greater sciatic foramen → enters perineum via lesser sciatic foramen → pudendal canal → UG triangle
- Main artery of the perineum: muscles and skin of anal and urogenital triangles, erectile bodies
35
middle rectal artery
- origin
- course
- supply
- anterior division of internal iliac arteries
- Descends in pelvis to inferior rectum
- Inferior part of rectum, vagina
36
inferior gluteal artery
- origin
- course
- supply
- anterior division of internal iliac arteries
- Exits pelvis via greater sciatic foramen
- Pelvic diaphragm, piriformis, quadratus femoris, lower limbs
37
The pelvis is mainly drained by the pelvic venous plexuses, which are formed by the interjoining veins surrounding the pelvic viscera (e.g. vesical, rectal, vaginal, uterine):
• Various plexuses unite and drain into the internal __________________ (mainly) and _______ and _________ (minor)
o Internal iliac veins form superior to the greater sciatic foramen and lie posteroinferior to the internal iliac arteries (roughly along arterial branches)
• Drain into the common iliac veins then the IVC (at the level of __________)
iliac veins ;
the inferior mesenteric vein and internal vertebral venous plexus ;
L4/L5
38
what is the lumbosacral trunk formed by and where does it join?
Formed by the union of L4 & L5 superior to the pelvic brim/inlet:
• Passes inferiorly on the anterior surface of the ala of sacrum to join the sacral plexus
39
what are the branches of the sacral plexus (S1- S4)?
Located on the posterolateral wall of the lesser pelvis and gives rise to the sciatic nerve and pudendal nerve:
• Sciatic nerve (L4 – S3):
• Pudendal nerve (S2 – S4):
40
what are the branches of the pudendal nerve?
*Branches of the pudendal nerve:
• Sensory to: external genitalia, peri-anal skin, perineum, clitoris/penis
• Motor to: external urethral sphincter, external anal sphincter, levator ani, skeletal muscles of perineum
• Inferior rectal nerves: peri-anal skin, external anal sphincter, anal canal
• Perineal nerve: posterior labial nerve, deep branch of transverse perineal muscles, external urethral sphincter, skin of perineum
• Dorsal nerve to clitoris (superficial, deep divisions)
41
what is the course of sciatic nerve?
greater sciatic foramen (inferior to the piriformis) → enter gluteal region → lower limbs
42
what is the course of the pudendal nerve?
greater sciatic foramen → hooks around ischial spine** and sacrospinous ligament → enter perineum via lesser sciatic foramen (main nerve of perineum)
43
other than the pudendal nerve, what other nerves provide sensory innervation to the external genitilia
ilio inguinal nerve , genital branch of
| genitofemoral nerve, posterior femoral cutaneous nerve
44
whabt is the perineal body?
fibromuscular structure along the midline between the anal orifice and the vestibule → attachment of several pelvic floor and perineal muscles
45
what structures do the urogenital triangle contain?
Vulva (external genitalia), ureter orifice, vaginal orifice
46
what structures do the anal triangle contain?
External anal sphincter (anal orifice), ischiorectal fossae
47
where does the fatty superficial layer of the superficial perineal fascia attaches?
continuous anteriorly and superiorly with fatty layer of subcutaneous tissue of anterior abdominal wall
48
where does the fatty deep membranous layer of the superficial perineal fascia attaches?
attaches to posterior margin of perineal membrane, perineal body, medial aspect of superior part of thigh
49
where does the deep perineal fascia attaches?
Attached to ischiopubic rami; fused to suspensory ligament of clitoris
50
what does the deep perineal fasciae surrounds?
Surrounds ischiocavernosus, bulbospongiosus, transverse perineal muscle
51
what does the superficial perineal pouch in females conttain?
clitoris & associated muscle (ischiocavernosus), bulbs of the vestibule & surrounding muscle (bulbospongiosus), superficial transverse perineal muscles, greater vestibular glands, nerves, vessels:
52
what is the clitoris made up of?
Erectile tissue (consisting of a root and a small cylindrical body composed of two crura, two corpora cavernosa, and glans clitoris) → organ of sexual arousal (highly sensitive and enlarges on tactile stimulation)
53
what is the mon pubis?
Rounded fatty eminence (mass of fatty subcutaneous tissue) anterior to the pubic symphysis and continuous with anterior abdominal wall → amount of fat increases at puberty and decreases after menopause
54
what is the labia majora?
Prominent folds of skin which indirectly protect the clitoris and urethral and vaginal orifices (join at the anterior and posterior commissures)
55
what is the labia minora?
Delicate folds of skin containing sebaceous glands (no hair follicles):
• Surround and close over the vestibule of vagina (where external urethral and vaginal orifices open)
56
what is the vestibule and what does it contain?
Space surrounded by the labia minora: • Urethral orifice, vaginal orifice, ducts of the greater and lesser vestibular glands open into the vestibule
• Vestibular bulbs: paired masses of elongated erectile tissue lying along the sides of the vaginal orifice (covered by bulbospongiosus)
• Greater vestibular (Bartholin’s) gland: secretes mucous secretions which lubricate the vagina (lie posterior to the bulb) → similar to the bulbourethral glands in males
57
what is the arterial supply of the female external genitilia?
external pudendal artery (from femoral artery), internal pudendal artery (from internal iliac artery)
58
what is the venous drainage of the female external genitilia?
internal pudendal veins (into internal iliac vein)
59
what is the lymphatic drainage of the female external genitilia?
superficial inguinal nodes (similar to in males)
60
what is the innervationof the female external genitilia?
pudendal nerve (S2 – S4; somatic)
61
what is the deep perineal pouch bounded by?
The deep perineal pouch is bounded by the perineal membrane (inferior), pelvic diaphragm (superior), and obturator fascia (lateral)
62
What does the deep perineal pouch contain?
* Contains the proximal part of the female urethra, deep transverse perineal muscles, dorsal clitoral neurovasculature, ischioanal fossae, external urethral sphincter
* Components of external urethral sphincter: sphincter urethrae, compressor urethrae, sphincter urethrovaginalis
63
bulbospongiosus muscle
- attachments
- innervation
- function
- Perineal body → splits and passes on each side of the lower vagina → pubic arch and clitoris
- Muscular (deep) branch of perineal nerve (branch of pudendal nerve)
- Supports and fixes perineal body, vaginal sphincter, erection of clitoris, compresses Bartholin’s gland
64
ischiocavernous muscle
- attachments
- innervation
- function
- Ischiopubic ramus and ischial tuberosity → embraces crus of clitoris → crus and perineal membrane
- Muscular (deep) branch of perineal nerve (branch of pudendal nerve)
- Maintains erection of clitoris (compresses outflow veins)
65
superficial transverse perineal muscle
- attachments
- innervation
- function
- Ischiopubic ramus and ischial tuberosity → perineal body
- Muscular (deep) branch of perineal nerve (branch of pudendal nerve)
- Supports and fixes perineal body to support viscera and resist increases in IAP
66
deep transverse perineal muscle
- attachments
- innervation
- function
- Ischiopubic ramus and ischial tuberosity → perineal body
- Muscular (deep) branch of perineal nerve
- Supports and fixes perineal body to support viscera and resist increases in IAP
67
external urethral sphincter
- attachments
- innervation
- function
- Surround urethra (sphincter urethrovaginalis also encloses vagina)
- Dorsal nerve of clitoris (terminal branch of pudendal nerve)
- Maintain urinary continence (sphincter urethrovaginalis also compresses vagina)
68
which part of the pelvic viscera does the peritneoum cover?
covers the front and sides of upper third of rectum, front of middle third of rectum → reflected onto upper posterior vaginal wall, cervix, body and fundus of uterus → superior surface of bladder → anterior abdominal wall
69
The uterus is a thick-walled, pear-shaped, hollow muscular organ where the embryo and foetus develop (muscular walls adapt to foetal growth → provide power for childbirth):
• Usually anteverted (tipped anterosuperiorly relative to the axis of the vagina) and anteflexed (bent anteriorly relative to the cervix)
• Mass lies over the superior surface of urinary bladder → position changes with the degree of fullness of the bladder and rectum and the stage of pregnancy
Parts of the cervix
- Fundus: Rounded part of the body lying superior to the uterine ostia
- Body: Superior 2/3; contains uterine cavity (lined by ______________ epithelium):
• Lies between the layers of _______________ and is freely movable
• Vesical surface (related to bladder) and intestinal surface
- Isthmus: 1cm-long constricted part of the uterus (separates body from cervix)
- Cervix: Cylindrical, relatively narrow inferior 1/3 (~2.5cm in non-pregnant women)
• Supravaginal part: between the ________________
• Vaginal part: rounded part protruding into the _______________ and surrounds the ______________ (in turn surrounded by the vaginal fornix – narrow recess)
• Possesses two angles: angle of anteversion (between ______________) and angle of anteflexion (between _______________)
• Internal and external os mark the ends of the cervical canal
o Ectocervix (part of the cervix at the external os) is lined by stratified squamous epithelium
simple columnar ;
the broad ligament;
isthmus and the vagina;
anterosuperior vaginal wall ;
external os of the uterus;
cervix and vagina;
cervix and uterus
70
What are the relations of the uterus?
- Anterior: Vesicouterine pouch, urinary bladder
- Posterior: Rectouterine pouch, rectum
- Lateral: Broad ligament (connected to lateral pelvic walls)
71
uterus
- arterial
- venous
- innervation
- lymphatics
- Arterial: Uterine arteries (from anterior division of internal iliac arteries)
- Venous: Uterine veins (drain into uterine venous plexus → internal iliac veins)
Innervation
- Parasympathetic: pelvic splanchnic nerves (S2 – S4)
- Sympathetic: uterovaginal plexus (from inferior hypogastric plexus)
Lymphatics: Drains via the round ligament of uterus → inguinal nodes → external and internal iliac nodes:
• Fundus: superficial inguinal LNs, para-aortic LNs
• Most of body: external iliac LNs
• Cervix: internal iliac LNs
72
what are the components o the broad ligament?
Mesovarium: Suspends the ovaries from the posterior layer (ovaries are not intraperitoneal/completely covered by peritoneum):
• Suspensory ligament of ovary lies lateral to the attachment of the mesovarium to the ovary → suspends ovaries from lateral walls
Mesosalpinx: Contains the Fallopian tubes
Mesometrium: Forms the mesentery of the uterus (most of the broad ligament)
73
what does the upper part of the broad ligament contain?
contains the Fallopian tubes, ligament of ovary (attaches ovary to the angle of the uterus), round ligament of uterus
74
what does the lower part of the broad ligament contain?
carries the uterine and ovarian vessels, pampiniform venous plexus (from ovaries), lymphatics and nerves o Related to ureters (uterine artery runs above the ureter)
75
The round ligament of uterus is a remnant of the ____________________ and attaches anteroinferiorly to the __________________:
• Develops from the relocation of the ovaries from its developmental position on the posterior abdominal wall to the pelvic cavity
• Course: _____________________
ovarian gubernaculum;
uterotubal junction (between uterus and Fallopian tube);
uterus → runs in front of the iliac vessels (along the lateral pelvic wall) → deep inguinal ring → inguinal canal → superficial inguinal ring → labia majora
76
what is the vagina related to?
Anterior: Base of bladder (separated by connective tissue), urethra
Posterior: Rectouterine pouch (of Douglas), rectum
77
The vaginal fornixes are gutters/recesses formed between the cervix and the vaginal wall:
• Only the ___________ is covered by peritoneum (related to the pouch of Douglas)
• Anterior and posterior fornixes are palpable during vaginal examination
• Lateral fornixes are present on the lateral aspects of the cervix
posterior fornix
78
vagina
- arterial
- venous
- innervation
- lymphatics
Arterial
- Superior third: uterine artery (from anterior division of IIA)
- Inferior two-thirds: vaginal artery (from middle rectal artery) and internal pudendal artery
Venous: Vaginal veins (drain into vaginal venous plexus → internal iliac veins)
Innervation
- Parasympathetic: pelvic splanchnic nerves (S2 – S4)
- Sympathetic: inferior hypogastric nerve
- Somatic: pudendal nerve (S2 – S4) → only in the lower 1/5
Lymphatics
- Upper and middle parts: internal and external iliac LNs
- Lower part & fornixes: superficial inguinal LNs
79
what are the parts of the fallopian tubes?
Infundibulum: Terminal lateral portion of the Fallopian tube (trumpet-shaped) which opens into the peritoneal cavity via the abdominal ostium:
• Fimbriae: finger-like projections spreading over the medial surface of the ovary (one large ovarian fimbria attached to the superior pole of the ovary)
Ampulla: Widest and longest part of the tube (usual site of fertilisation)
Isthmus: Thick-walled part of the tube entering the uterine horn
• Uterine part: short intramural segment passing through the wall of the uterus and opens via the uterine ostium into the cavity
80
faloopian tubes
- arterial
- venous
- innervation
- lymphatics
Arterial: Uterine and ovarian arteries (from anterior division of IIA)
Venous: Uterine and ovarian veins (into IIV)
Innervation: Uterine and ovarian plexuses (from inferior hypogastric plexus)
Lymphatics: Para-aortic LNs
81
```
The Fallopian (uterine) tubes extend from the ________________ to the _____________, suspended within the mesosalpinx of the broad ligament:
• Runs _________ to the ovary and terminates lateral to it
```
upper lateral part of uterus (cornua/horns);
lateral pelvic wall
superior;
82
ovaries
- arterial
- venous
- lymphatics
Arterial: Ovarian artery (from abdominal aorta) → also supplies part of Fallopian tube
• Course: suspensory ligament of ovary → broad ligament → ovary
Venous: Pampiniform venous plexus (in broad ligament) → ovarian veins (drain into the IVC on the right and left renal vein on the left)
Lymphatics: Para-aortic LNs (due to development of ovaries in the lumbar region)
83
what are the passive supports of the uterus?
- Position of the uterus: Normal anteflexion and anteversion of the uterus causes it to rest on top of the bladder (pressed against the bladder)
- Pelvic diaphragm: Tone during sitting and standing and active contraction during periods of increased IAP
84
what are the active supports of the uterus?
Broad ligament: Attaches the lateral body of the uterus to the lateral pelvic walls
Round ligament of uterus: Extend from the uterotubal junctions to the lateral pelvic walls (attaches to the labia majora)
Cardinal (transverse cervical/Mackenrodt’s) ligaments: Main support; extend from the supravaginal cervix and lateral parts of the fornix of vagina to the lateral pelvic walls
Uterosacral ligaments: Pass superiorly and slightly posteriorly from the sides of the cervix to the middle of the sacrum (palpable during rectal examination) → runs on the floor of the pararectal fossae
Pubocervical ligaments: Extend from the sides of the cervix to the pubic symphysis
85
what does anversion mean?
e long axis of cervix (red line) is normally bent forward on the long axis of vagina (blue line) forming an angle of 90.
86
what does anteflexion mean?
Anteflexion: the long axis of the body of uterus (green line) is bent forward at the level of isthmus (internal os) on the long axis of cervix forming an angle of 170.
87
what are the boundaries of the uterine cavity?
The uterine cavity extends from the external os to the wall of the fundus and continues inferiorly as the cervical canal
88
what are the walls of the uterus made out of?
Wall of uterus
• Perimetrium – the serous outer coat formed by peritoneum
• Myometrium – the middle smooth muscle coat, with main branches of the blood vessels and nerves
• Endometrium – inner mucous coat (lining epithelium of the uterus, changes in the epithelium and structure of uterus during menstrual cycle.
89
what are the boundaries of the female perineum?
Boundaries of the female perineum (similar to the pelvic outlet)
• Anterior: Pubic symphysis
• Anterolateral: ischopubic rami
• Lateral: ischial tuberosity
• Posterolateral: sacrotuberous ligament
• Posterior: coccyx
90
Pelvic splanchnic nerves form the parasympathetic innervation to pelvic organs
• Arises from _______________
• Carries preganglionic par, descending and sigmoid colonasympathetic motor fibers and viscerosensory fibers from pelvic organs
• The nerve join to form the _________________ that carry the vesical, uterovaginal and rectal plexus
• Some of the fibers ascend into the abdominal cavity and gives the parasympathetic innervation to left colic flexure
S2,S3 and S4 nerve;
inferior hypogastric plexus (mixed)
91
The lymphatics from the cervix and the vagina pass through the ________________ and from there, towards the lumbar group/ sacral group of lymph nodes to the lumbar group of lymph nodes.
From the body of uterus, ovaries and the uterine tube (particular infundibular part of uterine tube) it goes into the straight to ____________. Meanwhile, the median most part of uterine tube goes to the _______________ and finally goes towards the lumbar lymph nodes.
Lymphatic drainage from the vulva goes towards the ______________ and from there, the lymph is drained into the lumbar group of lymph nodes. The glans clitoris and labia minora goes into the _________________ and from there the lumbar group of lymph nodes. Urethra goes from the internal iliac group of lymph nodes to the lumbar group of lymph nodes.
internal or external iliac groups of lymph nodes ;
lumbar part of the lymph nodes;
superficial inguinal lymph nodes;
superficial inguinal group of lymph nodes;
deep inguinal group of lymph nodes
92
Injury during childbirth
- During childbirth, the pelvic floor supports the fetal head while the cervix of the uterus is dilating to permit delivery of the fetus.
- The perineum, levator ani, and ligaments of the pelvic fascia may be injured during childbirth .
- The ________________, the main and most medial parts of the levator ani, are the muscles torn most often.
- These parts of the muscle are important because they encircle and support the urethra, vagina, and anal canal.
- Weakening of the levator ani and pelvic fascia (e.g., tearing of the paracolpium) from stretching or tearing during childbirth, may decrease support for the vagina, bladder, uterus, or rectum, or alter the position of the neck of the bladder and the urethra.
- These changes may cause __________________e, characterized by dribbling of urine when intra-abdominal pressure is raised during coughing and lifting, for instance, or lead to the prolapse of one or more pelvic organs.
pubococcygeus and puborectalis;
urinary stress incontinenc
93
Tubal pregnancy is the most common type of ectopic gestation (embryonic implantation and initiation of gestational development outside of the body of the uterus). If not diagnosed early, ectopic tubal pregnancies may result in __________________ during the first 8 weeks of gestation. Tubal rupture and hemorrhage constitute a threat to the mother's life and result in death of the embryo.
rupture of the uterine tube and severe hemorrhage into the abdominopelvic cavity
