Detailed muscular structure and neural control anatomy of the levator ani muscle. A study based on female human fetuses (original) (raw)

American journal of obstetrics and gynecology, 2017

Abstract

Injury to the levator ani muscle or pelvic nerves during pregnancy and vaginal delivery are responsible for pelvic floor dysfunction. To demonstrate the presence of smooth muscular cell areas within the levator ani muscle and describe their localization and innervation. Five female human fetuses were studied after approval from the French Biomedicine Agency. Specimens were serially sectioned and stained by Masson's trichrome and immunostained for striated and smooth muscle, as well as for somatic, adrenergic, cholinergic, and nitriergic nerve fibers. Slides were digitized for 3D reconstruction. One fetus was reserved for electronic microscopy. We explored the structure and innervation of the levator ani muscle. Smooth muscular cell beams were connected externally to the anococcygeal raphe and the levator ani muscle and with the longitudinal anal muscle sphincter. The caudalmost part of the pubovaginal muscle was found to bulge between the rectum and the vagina. This bulging was ...

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