648 



UTERUS AND ITS APPENDAGES. 



cavity; and, pressing upon the bladder and 

 rectum, occasions sometimes an irritable con- 

 dition of these parts. But usually at the end 

 of the third month, the fundus may be felt 

 emerging from the pelvic cavity ; and in the 

 course of the fourth month, it is always easily 

 distinguishable in the lower part of the hypo- 

 gastric region, having then risen to the height 

 of about three fingers-breadth above the pelvic 

 brim. In the fifth month, the hypogastric 

 region is completely filled ; the abdomen then 

 acquiring a considerable rotundity in this situ- 

 ation. By the termination of the sixth month, 

 the umbilical region also is filled, and the 

 fundus uteri may be felt on a level with, or a 

 little above, the navel. In the course of the 

 remaining three months, the uterus rises gra- 

 dually, until its fundus reaches the level of the 

 ensifonn cartilage. And this is very nearly 

 the limit of its ascent, though it occasionally, 

 and chiefly in first pregnancies, rises slightly 

 above that point. In women who have a 

 roomy pelvis, and in those cases where the 

 natural form of the uterus is not altered by 

 over-distension nor mal- position of the foetus, 

 there usually takes place, a few days or shortly 

 before labour, a certain descent of the uterus, 

 which has the effect of partially emptying the 



epigastric region, and relieving it from the 

 pressure which it had sustained, especially 

 during the last month. 



The direction which the uterus takes in 

 rising from the pelvis into the abdominal ca- 

 vity, is determined by various circumstances ; 

 and it is interesting to observe in what way 

 the addition of so large a body as the fully 

 developed uterus to the already occupied ab- 

 domen, is provided for, without any of the 

 viscera suffering injurious pressure, and with- 

 out that impediment to the circulating and 

 respiratory systems, which, in the absence of 

 such a provision, must inevitably take place. 



The oblique direction of the uterus, up- 

 wards and forwards, is determined, firstly, by 

 the corresponding obliquity of the pelvis, the 

 plane of whose brim forms with the horizon 

 an angle of 60. But as the fundus gradually, 

 after three months, emerges from the pelvic 

 cavity, the oblique direction of the uterus is 

 maintained by the symphysis pubis in front, 

 and the sacral promontory behind. Between 

 these, the superior portion of the uterus con- 

 tinues to ascend, supported next by the abdo- 

 minal walls anteriorly, and the spine poste- 

 riorly. The intestines, being bound down by 

 the mesentery, cannot be displaced, and will 



Fig. 447. 



Position of the uterus at the end of pregnancy. (After Maygrier.) 



