Friday, 24 June 2016

Uterus in the Child-Uterus after Menopause-Uterus in Pregnancy-Role of the Uterus in Labor-Prolapse of the Uterus-Hysterectomy and Damage to the Ureter-Varicosed Veins and Hemorrhoids in Pregnancy-

Uterus in the Child
The fundus and body of the uterus remain small until puberty, when they enlarge greatly in response to the estrogens secreted by the ovaries.

Uterus after Menopause
After menopause because the ovaries no longer produce estrogens and progesterone, the uterus atrophies and becomes smaller and less vascular. These changes occur.

Uterus in Pregnancy
During pregnancy, the uterus becomes greatly enlarged as a result of the increasing production of estrogens and progesterone, first by the corpus luteum of the ovary and later by the placenta. At first, it remains as a pelvic organ, but by the third month the fundus rises out of the pelvis, and by the ninth month it has reached the xiphoid process. The increase in size is largely a result of hypertrophy of the smooth muscle fibers of the myometrium, although some hyperplasia takes place.

 
Role of the Uterus in Labor
Labor, or parturition, is the series of processes by which the baby, the fetal membranes, and the placenta are expelled from the genital tract of the mother. Normally, this process takes place at the end of the 10th lunar month, at which time the pregnancy is said to be at term. The cause of the onset of labor is not definitely known. By the end of pregnancy, the contractility of the uterus has been fully developed in response to estrogen, and it is particularly sensitive to the actions of oxytocin at this time. It is possible that the onset of labor is triggered by the sudden withdrawal of progesterone. Once the presenting part (usually the fetal head) starts to stretch the cervix, it is thought that a nervous reflex mechanism is initiated and increases the force of the contractions of the uterine body. The uterine muscular activity is largely independent of the extrinsic innervation. In women in labor, spinal anesthesia does not interfere with the normal uterine contractions. Severe emotional disturbance, however, can cause premature parturition


Prolapse of the Uterus
The great importance of the tone of the levatores ani muscles in supporting the uterus. The importance of the transverse cervical, pubocervical, and sacrocervical ligaments in positioning the cervix within the pelvic cavity. Damage to these structures during childbirth or general poor body muscular tone may result in downward displacement of the uterus called uterine prolapse. It most commonly reveals itself after menopause, when the visceral pelvic fascia tends to atrophy along with the pelvic organs. In advanced cases, the cervix descends the length of the vagina and may protrude through the orifice.
Because of the attachment of the cervix to the vaginal vault, it follows that prolapse of the uterus is always accompanied by some prolapse of the vagina.

Hysterectomy and Damage to the Ureter
During the surgical procedure of hysterectomy, great care must be exercised to not damage the ureters. When the surgeon is looking for the uterine artery on each side at the base of the broad ligament, it is essential that he or she first identifies the ureter before clamping and tying off the artery. The uterine artery passes forward from the internal iliac artery and crosses the ureter at right angles to reach the cervix at the level of the internal os.


Varicosed Veins and Hemorrhoids in Pregnancy
Varicosed veins and hemorrhoids are common conditions in pregnancy. The following factors probably contribute to their cause: pressure of the gravid uterus on the inferior vena cava and the inferior mesenteric vein, impairing venous return, and increased progesterone levels in the blood, leading to relaxation of the smooth muscle in the walls of the veins and venous dilatation.














































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