THE FEMALE PELVIS - 391 



condition is termed anteflexion. The position of the uterus 

 varies somewhat with the condition of the bladder, but the 

 organ is prevented from becoming retroflexed and retroverted 

 by two ligaments on each side. 



The round ligament is a fibro - muscular band, which is 

 attached to the uterus just below the uterine tube. It passes 

 laterally in the broad ligament, and projects slightly from its 

 anterior layer. On leaving the broad ligament, the round 

 ligament of the uterus enters the abdominal inguinal ring, 

 traverses the inguinal canal, and emerges from the subcutaneous 

 inguinal ring to be attached to the skin and subcutaneous tissue 

 of the labium majus (p. 396). Its relations at the abdominal 

 inguinal ring and in the canal are precisely the same as those 

 already described for the spermatic cord (p. 253). 



The operation of shortening the round ligaments is sometimes 

 carried out in cases of retroflexion, but abdominal hysteropexy, 

 which consists in suturing the fundus to the anterior abdominal 

 wall, is more frequently performed. 



The utero-sacral ligaments are fibro-muscular bands, which 

 extend from the posterior surface of the uterus just above the 

 cervix to the posterior wall of the pelvis lateral to the rectum. 

 They are extra-peritoneal, but produce peritoneal ridges, which 

 are known as the utero-sacral folds. These ligaments may 

 become shortened, following inflammatory conditions of the 

 perimetrium, and drag the lower part of the uterus backwards, 

 giving rise to acute ante-flexion. 



In a retroflexed uterus, the cervix assumes a more vertical 

 position, and the external orifice of the uterus may be directed 

 straight down the vagina. In this position, the flexion at the 

 isthmus may be sufficiently pronounced to cause difficulty in 

 the evacuation of the menstrual discharge. 



The pregnant uterus ascends from the pelvis into the 

 abdomen as it enlarges in size, but the retroverted gravid uterus 

 is prevented from doing so by the sacral promontory. The 

 enlargement of the viscus, therefore, causes increased intra- 

 pelvic pressure, and the urethra is pressed against the symphysis 

 pubis, causing first retention of urine, and later, the overflow 

 from a distended bladder. If the position of the uterus is 

 corrected, the pregnancy will follow a normal course. 



The Uterine (Fallopian) Tube is attached to the uppermost 

 part of the lateral border of the uterus, and extends laterally 

 in the free upper margin of the broad ligament towards the 



