By Tim Chard MD, FRCOG, Richard Lilford MB, BCh, MRCOG, MRCP, PhD (auth.)
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It is 12 cm long and passes through the broad ligament to the lateral wall of the pelvis where it crosses the psoas and external iliac vessels. It hooks round the inferior epigastic arteries to the deep inguinal ring, passes through the inguinal canal and fans out into the labium majus. It is composed mainly of fibrous tissue with some smooth muscle at the uterine end and some striated muscle at the labial end. Ligaments Formed from Pelvic Fascia The connective tissue covering the levator ani is condensed into musculofibrous bands in three areas: (a) the transverse cervical ligament (cardinal ligament) arising from the arcuate line on the side wall of the pelvis; (b) the pubocervical ligaments arising from fascia over the pubic bone and passing around the bladder neck; and (c) the uterosacral ligaments (posterior part of the cardinal ligaments) arising from the sacral'promootory.
Continence During rest, continence is maintained by the external sphincter and maximal urethral pressures are normally recorded from this level of the urethra. The 44 Anatomy external sphincter is composed of short 'slow-twitch' fibres which have no muscle spindles. It is therefore ideally suited to maintaining prolonged tonic contraction. During sudden increases in abdominal pressure (coughing, sneezing) additional mechanisms ensure that urethral pressure remains higher than intravesical pressure: 1.
The dermis, skeleton, connective tissue, muscles, vascular and urogenital systems arise from mesoderm. The cavity that later divides the somatic and visceral sheets of intra-embryonic mesoderm is the coelom. Pericardial Cav ity Card iogenic Plate Mesoderm Notochord Buccopharyngeal Membrane Allantois in Body Stalk Fig. 18. Schematic longitudinal section of a presomite embryo. : : . ' ~ :~ ,. '. , ct:~:r;~~> ,~ . ,'. ~~~~-r-~ , Cardiac Tube .. ' " ...... Notochord (lateral to this mesoderm is found) Yolk Sac Cavity Fig.
Basic Sciences for Obstetrics and Gynaecology by Tim Chard MD, FRCOG, Richard Lilford MB, BCh, MRCOG, MRCP, PhD (auth.)