CHANGES IN THE APPENDAGES OF THE GENITAL APPARATUS.
The broad and round ligaments, the ovaries and the tubes, also un dergo organic and functional changes.
1st. Broad Ligaments.—The uterus steadily tends to separate their two peritoneal folds as it enlarges. Carried upward by the uterus, they become hypertrophied along with the serous covering of the organ and exhibit hyperplasia.
At the same time they become vertical.
2d. Round Ligaments.—With the uterus they undergo hypertrophy, and form two largo cords which, from the great development of the pos terior uterine wall, are no longer inserted into the lateral wall, but at the union of the posterior four-fifths and the anterior one-fifth of its lateral surfaces.
3d. Ovaries.—They rise in the abdominal cavity with the broad liga ments, and, becoming vertical, almost touch the uterus. Ovulation ceases, while the Graafian vesicle, whence came the ovum, which was the starting point of gestation, undergoes phenomena of cicatrization called the corpus luteum of pregnancy.
The ovaries increase in size.
4th. Tubes.—The Fallopian tubes undergo hypertrophy with the uterus. Their muscular tissue increases and their epithelium loses its cilite, becom ing nucleated. Robin describes a yellowish white fluid in the tubes com posed of a viscid liquid holding in suspension nuclei of epithelium, and fatty granulations without leucocytes.
5th. Mammary the structural changes that we have described in the anatomical portion of this work, the mammary glands suffer external changes during gestation, which are, as we will see, of prime importance in the diagnosis of the first pregnancy. These are: a. Swelling and enlargement manifest themselves in the first few weeks; and, generally, there is experienced, at the same time, a feeling of tingling and painful tension in them. The veins enlarge, and, if the mammary swelling is considerable, we will find ecchymoses or wheals such as are found on the abdomen, thighs and buttocks. Towards term, colos trum appears; this can easily be pressed out by squeezing the nipple, which is now large, dark, sensitive and erectile.
b. The areola undergoes important changes. Its color changes: very dark, almost black, in brunettes; moderately dark in blonde women; it is slightly, if at all, changed in women with red hair. The areola en larges and bulges, at times looking like a watch-glass upon the breasts.
Ten to twelve tubercles, tubercles of Montgomery, appear on this areola; a fluid identical with colostrum can be squeezed from them. To-day they are thought to be little rudimentary mammary glands. Around the primary, or true, areola, there forms, especially in brunettes, a second, wider, more indistinct areola, which starts from the primary, and finally merges into the skin of the gland. It has a somewhat mottled look, due
to a number of little white spots, bounded by brown lines; hence the name mottled or spotted areola. At the middle of every white spot is a little black dot, which is but a little hair, as can be verified though a mag nifying glass.
6th. Abdominal Wall.—The growing uterus distends the walls; vertically this extension may be 2.7 inches, and extensive changes occur in the musenlo-aponeurotic layer in consequence.
The umbilicus, sunken for the first two months of pregnancy from falling of the gravid uterus, gradually disappears as gestation progresses. Its fundus approaches its sides, and at the seventh month it is on a level with the rest of the skin. Henceforth, it becomes more and more projecting.
The umbilical ring dilates so that, at times, the finger may be intro duced in it.
The skin is fissured, looks chafed and is covered with wheals, especially in the sub-umbilical and inguinal regions. These wheals, reddish or bluish, are striated during pregnancy, and do not disappear at delivery, but become white, like old scars, and thus can be distinguished from those arising during another pregnancy. Caused by great distension of the skin, and the ecchymoses produced in the derma, they may appear in a non-pregnant individual, where there has been rapid and great distension of the skin.
Pigment is deposited in a line, the dark, or brown line, which runs from the pubes to the umbilicus, which it surrounds, and a little beyond this point, in most women. It is constant in brunettes, but not well marked in blondes; it may be wanting in red-haired women. In some very dark women the whole abdomen, and the upper part of the thighs, are a more or less deep brown from deposit of pigment.
In the musculo-aponeurotic layer the greatest distension is at the lines alba; this may become 3.9 to 4.2 inches long, and the two recti muscles may be separated by a considerable space. If, when the woman is in bed, she be made to throw back her head and chest a little, there is a more or less marked projection between the recti muscles, which has received the name of eventration; the borders of each rectus muscle may then be felt, and an exact idea obtained of the muscular relaxation. When this is exaggerated a girdle is necessary. When eventration is marked, the uterus, no longer supported by the abdominal wall, pushes before it the lines. alba producing the pendulous belly (venire en be.sace).
Pigmentation may also occur on the face; it is then called the mask.