Physiology of the uterus At Feb 12, 2024 · Endometriosis is a condition in which patients experience the growth of endometrial tissue outside of the uterus. Controversy exists about the direction of the flow in the anastomoses and thus the origin of the arterial supply to the tube and tubal part of the uterus. The cervix opens anteriorly into the uterine body. The cervix produces mucus secretions that become thin and stringy Study with Quizlet and memorize flashcards containing terms like 1. Sep 17, 2020 · The uterus is the primary female reproductive organ. Study with Quizlet and memorize flashcards containing terms like Hypothalamus Pituitary glands Ovaries Uterus, Hypothalamus -> Pituitary gland -> Ovary -> Uterus, Hormones and more. The function of the uterine cervix during pregnancy is described at the end of the article. The portion of the uterus superior to the opening of the uterine tubes is called the fundus. Aug 13, 2020 · Uterine peristalsis of the non-pregnant uterus is actively involved in very early reproductive processes, such as rapid and sustained directed sperm transport and high fundal implantation, as well Jul 27, 2022 · Its average size is approximately 5 cm wide by 7 cm long (approximately 2 in by 3 in) when a female is not pregnant. The principal elements of uterine physiology are the endometrium and myometrium. clevelandclinic. May 16, 2023 · The cervix is a fibromuscular organ linking the uterus to the vagina. About 6 to 7 days later, the differentiating blastocyst implants into the uterine decidua. The myometrium consists of smooth muscle fibers and is the middle and thickest layer of the uterine wall. The blood supply to the uterus originates mainly from the uterine artery. The uterus is described as a hollow, muscular, pear-shaped organ. The blastocyst divides into trophoblast and embryoblast. Aug 15, 2022 · The uterus is only about three inches long and two inches wide, but during pregnancy it changes rapidly and dramatically. There are three separate stages, characterised by specific physiological changes in the uterus which eventually result in expulsion of the foetus. Progesterone is also secreted by the ovarian corpus luteum during the first ten weeks of pregnancy, followed by the placenta in the later phase of pregnancy. The progress in obstetrics in recent years has demonstrated that many complications which occur during pregnancy and labor can be reduced to a minimum by proper prenatal supervision. 18 Myometrial Architecture Uterine musculature is arranged in three indefinite layers—external, internal and middle stratum. FSH and LH stimulate the ovary to secrete the sex steroids, oestrogen (E) and progesterone (P), which feed back on the hypothalamus and pituitary to Nov 28, 2022 · Uterus: Your uterus is a hollow, pear-shaped organ that holds a fetus during pregnancy. The upper two-thirds of the uterus is termed the corpus, or body of the uterus. Calcium activates myosin light chain kinase which induces uterine contraction. The vaginal canal is positioned between the urethra and bladder anteriorly, and the rectum posteriorly. He tabulates more than 2,500 references. Jul 1, 2020 · The physiological functions of the uterine endometrium (uterine lining) are preparation for implantation, maintenance of pregnancy if implantation occurs, and menstruation in the absence of pregnancy. The walls contain a high proportion of glycogen during this period. Get a printable copy (PDF file) of the complete article (198K), or click on a page image below to browse page by page. Jul 24, 2023 · The physiology of the vagina changes drastically over the lifetime of a woman as a response to changes in hormones. The phases of the ovarian cycle include the follicular phase, ovulation, and the luteal phase. The endometrial cycle consists of the proliferative phase, the secretory phase, and the menstrual phase. Anatomically, internal to external: uterine cavity, internal While this topic is given great prominence, it cannot be said to be over-emphasized, and an excellent balance is maintained throughout the book between all aspects of uterine physiology. Jan 31, 2020 · This is a multi-layered, hollow, Y-shaped organ. The uterus grows throughout pregnancy to accommodate the fetus. Several ligaments support the uterus, attaching it to the pelvic wall and other pelvic organs including the bladder and rectum. It is situated within the pelvis and measures approximately 8 cm in length, 4 cm in width and 5 cm in depth in the normal, non-pregnant state. The uterine body is the site where semen should be deposited during artificial insemination. Jul 24, 2023 · After fertilization of the sperm and ovum, four cell division leads to a morula (16 cells). It is the functional layer, adjacent to the uterine cavity, that thickens in response to estrogen and then is sloughed during menstruation. The uterus is a muscular, hollow organ in the female pelvis that is approximately 5 cm wide, 8 cm long, and 4 cm thick with a volume of 80 to 200 mL. All medical providers must be aware of these alterations present in pregnancy to be Dec 19, 2023 · Conserved in female reproduction across all mammalian species is the estrous cycle and its regulation by the hypothalamic-pituitary-gonadal (HPG) axis, a collective of intersected hormonal events that are crucial for ensuring uterine fertility. The body of the uterus of the cow is short, while the uterine horns are relatively long and well developed. Menstruation is a steroid-regulated event, and there are alternatives for a progesterone-primed The round ligament attaches to the uterus near the uterine tubes, and extends to the labia majora. The effects of metabolic inhibition on uterine metabolism and intracellular pH in the rat. (pp 829-830), 2. Strug MR, Su RW, Kim TH, et al. Breastfeeding This article reviews the normal anatomy of the female pelvis and focuses on uterine physiology, presenting the kinematics of the uterus that can be identified on ultra-fast MR imaging. The fertilized embryo moves from the oviduct into the uterine horn, where fetal and maternal membrane development begins. Aug 13, 2020 · Uterine peristalsis of the non-pregnant uterus is actively involved in very early reproductive processes, such as rapid and sustained directed sperm transport and high fundal implantation, as well It has three sections. The uterus, also known as the womb, is a hollow muscular organ that is part of the genitourinary system. Describe the endometrium, the myometrium, and the serosa. Blair Bell 1 and Cragin 2 have stated that an effort should be made to determine its cause and treatment before the onset of labor. It also discusses the many facets of the junctional zone on MR imaging. three-month period), the fundus (upper margin of the body of the uterus) may be palpated (felt) through the abdomen above the pubic bone (symphysis pubis). Nov 18, 2024 · The uterus has four major regions: the fundus is the broad curved upper area in which the fallopian tubes connect to the uterus; the body, the main part of the uterus, starts directly below the level of the fallopian tubes and continues downward until the uterine walls and cavity begin to narrow; the isthmus is the lower, narrow neck region Full text. The isthmus is the narrow medial end of each uterine tube that is connected to the uterus. Immediately following the delivery, the uterus and the placental site contract rapidly to prevent further blood loss. € þÈԬ ÐásÞÿûþôÿÿû¼>þ Î ®´™Ql /³ . it is 2. Uterus: Vessels of the uterus and its appendages, rear view. 5 cm deep in its widest part. Jul 24, 2023 · The vagina is an elastic muscular tube of 7 to 10 cm in length that extends from the vulva (female external genitalia) to the cervix of the uterus where it ends in an anterior and posterior fornix. Uterine secretions called “uterine milk” provide nutrition for the dividing ovum. Anatomical Types of Uteri. Apr 17, 2022 · The Blood Supply • The blood supply is derived from the uterine and ovarian arteries that extend from the internal iliac arteries and the aorta. If fragments of the placenta remain in the uterus, they can cause postpartum hemorrhage. For non-pregnant women, it is approximately 60g in weight. Chapters are devoted to innervation of the uterus, its blood and lymph supply, its metabolism and its growth. A physiologically normal uterus typically lies in a position of anteversion (tilts forward at the cervix) and anteflexion (tilts forward at the isthmus). Jul 22, 2015 · The anatomy of the uterus consists of the following 3 tissue layers (see the following image): The inner layer, called the endometrium, is the most active layer and responds to cyclic ovarian hormone changes; the endometrium is highly specialized and is essential to menstrual and reproductive function The middle layer, or myometrium, makes u Feb 8, 2024 · This acts on receptors in the uterus which causes an increase in intracellular calcium ions. Jul 30, 2022 · The uterine tubes (also called fallopian tubes or oviducts) serve as the conduit of the oocyte from the ovary to the uterus. Feb 8, 2022 · Abnormal uterine bleeding affects many individuals who menstruate and can have a detrimental impact on physical and mental health. Jul 29, 2016 · Physiology of the Uterus and Cervix Eric J. 7. IHK› òhëí›!ì‰Qb$–$’°lÿ½©fç@Ò1tpwµ+ $‡ KW. Sometimes, the development in utero may be incomplete; this is called a Mullerian anomaly and can lead to many variants, ranging from a uterine septum to uterine didelphys (double Sep 30, 2024 · An individual may have a hysterectomy (uterus removed) but still keep their ovaries and fallopian tubes. Dec 6, 2022 · The uterus is a hollow, pear-shaped organ responsible for various functions, such as gestation (pregnancy), menstruation, and labor and delivery. Jul 25, 2023 · The primary function of the uterus is reproductive. During this time, the mother’s body goes through immense changes involving all organ systems to sustain the growing fetus. uterus: muscular hollow organ in which a fertilized egg develops into a fetus. • The increased demands of pregnancy necessitate a rich supply of blood to the uterus. The wall of the uterus is made up of a complexly interdigitated network of Dec 9, 2024 · The narrow inferior region of the uterus, known as the cervix, connects the uterus to the vagina below it and acts as a sphincter muscle to control the flow of material into and out of the uterus. The size of the uterus usually reaches its peak at about 36 weeks’ gestation (see Figure 7. Sep 10, 2020 · Found. Uterine contractions continue for several hours after birth to return the uterus to its pre-pregnancy size in a process called involution, which also allows the mother’s abdominal organs to return to their pre-pregnancy locations. Wray S. Anatomy of the uterus Parts and position. Collagen is reorganized and consolidated early in gestation with proliferation and hyperplasia of the cellular component. The conversion of progesterone generation from the corpus luteum to the May 22, 2001 · This article reviews the normal anatomy of the female pelvis and focuses on uterine physiology, presenting the kinematics of the uterus that can be identified on ultra-fast MR imaging. 6. environment. Fundus: the domed area at the top of the uterus, between the junctions with the two fallopian tubes. This article shall consider the different stages of labour, and Jan 1, 2004 · In its most basic form, the uterus is a muscle comprised of cells, and when contraction of the uterine walls occurs there is an instantaneous generation of an electrical signal in the mV scale Jun 1, 2022 · The uterus is a pear-like structure made up of the fundus, body and cervix (Figure 1). Dr. In these situations, an egg could be fertilized and grow—usually in the fallopian tube. The cervix of a parous woman is considerably larger than that of a nulliparous woman, and the cervix of a woman of the uterine body are approximately equal; after puberty, the ratio of the body to the cervix is between 2:1 and 3:1. The uterus has an estimated length of 5 to 7 cm and width of 5 cm. Your uterus is divided into two parts: the cervix and the corpus. Uterine electromyography could be used to better define management in a variety of conditions associated with human labor. uterine tubes: (also, fallopian tubes or oviducts) ducts that facilitate transport of an ovulated oocyte to the uterus. Mar 20, 2024 · The uterine walls contain 3 distinct layers: the endometrium, myometrium, and the serosa. The potential benefits of the prop … Sep 27, 2024 · The Ovarian and Endometrial Cycles. The uterus is divided into three regions: fundus, corpus, and cervix. The production of ovarian hormones is under direct The cervix is a fibromuscular organ that links the uterine cavity to the vagina. 6 days ago · The uterus has four major anatomical divisions, shown in Figure 3. org Mar 20, 2024 · The uterine walls contain 3 distinct layers: the endometrium, myometrium, and the serosa. Endometrial cavity: the triangular space between the walls of the uterus. This short article describes the normal anatomy of the uterus and will focus on definitions, structure, location, supporting ligaments, blood supply and innervation. With pregnancy progression, the uterus leaves the pelvis and ascends to the abdominal cavity; The abdominal content displaced in response to the increased size of the uterus which is five times more than normal; This increase in the size of uterus is associated with an increase of blood supply to the uterus and uterine muscle activity, May 13, 2022 · During the second and third trimesters, the pre-pregnancy uterus—about the size of a fist—grows dramatically to contain the fetus, causing a number of anatomical changes in the mother (Figure \(\PageIndex{1}\)). The Uterus is the reproductive organ with the most species variations. Finally, the uterosacral ligament stabilizes the uterus posteriorly by its connection from the cervix to the pelvic wall. Uterine (endometrial) Cycle ¡ The secretory changes prepare the endometrium (stored nutrients) for implantation of the fertilized ovum . The body (or corpus) of the uterus is the wider region of the uterus superior to the cervix. At this point, the foetus becomes known as a neonate. RBPJ mediates uterine repair in the mouse and is reduced in women with recurrent Mar 12, 2020 · The uterus is a female secondary sex organ located within the pelvis. The ectopic endometrial tissue responds to hormonal stimulation and undergoes cyclic growth and shedding. Locate and identify the structures. 1. The uterus has four major anatomical divisions, shown in Figure 3. Menstrua … Feb 24, 2023 · The round ligament attaches to the uterus near the uterine tubes, and extends to the labia majora. The uterus is situated posterior to the bladder, anterior to the rectum, and consists of Dec 19, 2023 · Conserved in female reproduction across all mammalian species is the estrous cycle and its regulation by the hypothalamic-pituitary-gonadal (HPG) axis, a collective of intersected hormonal events that are crucial for ensuring uterine fertility. From the uterine body on, the reproductive tract separates. Sep 8, 2017 · Examples of physical deformations of the uterus may include having a uterus with two inner cavities or vaginas (affecting roughly one in 350 women), having only one fallopian tube that will connect to the uterus, or having a heart shaped uterus instead of a pear-shaped one that is evolutionarily optimized to bear a child. It is located at the lower pelvis, which is posterior to the bladder and anterior to the rectum. This rapid uterine contraction can lead to abdominal pain or cramps after childbirth. Reynolds is a Mar 13, 2024 · The uterus acts as a site for menstruation as well as protection and support for the growing fetus. The trophoblastic cells on the surface of the implanted ovum begin to digest the endometrium & absorb of the uterus is initiated by estradiol and completed by progesterone. Conclusion: While two-photon microscopy has become a widely used technology for intravital imaging, new advances in the development of staging and experimental protocols can still push the limits of this The window of endometrial receptivity is restricted to days 16-22 of a 28-day normal menstrual cycle, 5-10 days after the luteinizing hormone (LH) surge (Navot et al. Discuss the special, age-related patient management considerations EMTs should provide for both younger and older female patients who are experiencing gynecologic To understand the physiology of normal labour and its abnormality, it is necessary to study the uterine musculature in pregnancy and its mode of control. Physiology of the hypothalamic-pituitary-ovarian axis. The author index alone occupies 18 pages. Hypoxia likely plays a pivotal role in endometrial repair pro-cesses. Redirecting to /core/books/abs/diagnostic-and-operative-hysteroscopy/anatomy-and-physiology-of-the-uterus/0F8998FB510064122930F71D48AE511A Nov 14, 2022 · Involution, a part of postpartum physiology, refers to the process of reproductive organs returning to their prepregnant state. The base of the Y is called the uterine body, while the two branches are called the horns. Studies in animals and humans indicate that uterine performance can be successfully monitored during pregnancy using uterine electromyography. The round ligament attaches to the uterus near the uterine tubes, and extends to the labia majora. It can present with: Excessively painful menstrual cramps; Heavy bleeding during menses; Pain on intercourse (dyspareunia) Infertility The American Physiological Society publishes research articles in various physiological disciplines, contributing to biomedical advancements. Gonadotropin releasing hormone (GnRH) stimulates pituitary secretion of luteinizing hormone (LH) and follicle stimulating hormone (FSH). This article reviews the normal anatomy of the female pelvis and focuses on uterine physiology, presenting the kinematics of the uterus that can be identified on ultra-fast MR imaging. Study with Quizlet and memorize flashcards containing terms like functions of the uterus, Functions of the uterus part 2, Hormone production and more. Jul 30, 2023 · The uterus is a muscular, hollow organ in the female pelvis that is approximately 5 cm wide, 8 cm long, and 4 cm thick with a volume of 80 to 200 mL. The uterus accepts the ovum after fertilization, holds and provides nutrients and oxygen for the fetus and during birth, and it contracts to cause delivery. Due to anatomical barriers such as the pelvis, the uterus is pushed partially into the abdomen due to its expansion during pregnancy. Ê÷þÿÅ_ì »f¼ X @ð‚` zû Discovering the Holy Grail in postpartum uterine involution. Duplex Uteri Some of the observed DC clusters were located near the lumen of the uterus or small blood vessels, each situated on the antimesometrium side. Mar 1, 2021 · If the ovum is fertilized, it begins embryological development; if not, it simply degenerates. Following birth, oxytocin maintains uterine contractions and reduces the risk of postpartum bleeding. Your corpus is the larger part of your uterus that expands during pregnancy. Describe the anatomy and physiology of the female reproductive system; include the developmental changes that occur during puberty and menopause. Nov 7, 2022 · The Uterus is the organ of pregnancy as this is where implantation and development of the feotus occurs. The uterus is divided into the cervix, isthmus and corpus. An extrauterine pregnancy (outside of the uterus) is known as an ectopic pregnancy and is a medical emergency that requires treatment. THE publication of a book entirely devoted to the behaviour of the uterus is an index of the remarkable advances that the last few years have seen in knowledge of reproductive physiology. , 1991). At 12 weeks’ gestation (near the end of the first trimester, i. The uterine cavity refers to the fundus of the uterus and the body of the uterus. e. The fundus is the superior part of the uterus above the superolateral angles where the fallopian tubes enter bilaterally. It is composed of three layers: endometrium, myometrium, and perimetrium. 1). The physiology of uterine motility in experimental animals as well as in the human being is thoroughly considered. A physiologically normal uterus typically lies in a position of anteversion (tilts forward at the cervix) and anteflexion (tilts forward at the isthmu … See full list on my. It ends through either spontaneous or elective abortion or delivery. This hollow, pear-shaped organ is located in the lower pelvic cavity between the urinary bladder and rectum. The cervix is approximately 4 cm in length and 3 cm in diameter. Abnormal uterine bleeding (AUB; including symptom of HMB) is common and debilitating. On a coronal cut section, its cavity has an inverted triangle shape. It is characterized by its important role in the female reproductive system. The uterus (from Latin uterus, pl. The endometrium thus plays a pivotal role in reproduction and continuation of our species. Oct 30, 2023 · One can begin to see clear signs of the uterine body at a gestational age of 9 weeks. It is a gynecological disorder dependent on hormones observed most commonly in reproductively active women [2,4-5]. Definition. The uterus is pear-shaped and positioned in the center of the pelvic cavity (behind the bladder and anterior to the rectum) and consists of four parts: the fundus, body, isthmus, and cervix. The serosa is the outermost lining of the uterus. Bieber The uterus, and specifically the endometrium, is a dynamic and ever-changing organ throughout much of a woman's life. [1] Histologically, it is the presence of endometrial-like tissue or glands outside the uterine cavity [1-5]. phase until menstruation ensues. The top rim of the uterus is called the fundus and is a landmark for many doctors to track the progress of a pregnancy. … The bibliography of 1,190 references arranged alphabetically should be a great aid to any one working in this field. Nonetheless, knowledge of the direct mediators that synchronously shape the uterine microenvironment for successive yet distinct events, such as the May 16, 2023 · Pregnancy is a state of having implanted products of conception located either in the uterus or elsewhere in the body. The fundamental physiologic processes that occur from menarche to menopause must be well understood by physicians to allow appropriate diagnosis and treatment of underlying The edition appears ten years after the first one. Mar 17, 2024 · Labour (also known as parturition) is the physiological process by which a foetus is expelled from the uterus to the outside world. These variations occur in both the anatomical types of uterus as well as the uterine horn appearance and endometrial linings. Birth 2011;38(1):80. The lower one-third of the uterus comprises the cervix, with the upper boundary of the cervix being the internal os. Although there have been recent advances in knowledge regarding uterine contractions, there remains a huge gap in understanding the related physiology at the cellular and molecular Apr 29, 2024 · Uterus. Discuss the physiology of the uterus. Oct 30, 2023 · The uterus is the main organ of the female reproductive system. Ultra-fast MR imaging seems to be a powerfu … It has three sections. Nov 14, 2022 · Involution, a part of postpartum physiology, refers to the process of reproductive organs returning to their prepregnant state. The uterus then continues into the non- receptive period for the remaining cycle as the late luteal . The menstrual cycle comprises 2 distinct cycles—one within the ovary and another within the endometrium. Figure \(\PageIndex{1}\): Size of Uterus throughout Pregnancy. : uteri or uteruses) or womb (/ w uː m /) is the organ in the reproductive system of most female mammals, including humans, that accommodates the embryonic and fetal development of one or more fertilized eggs until birth. However, the uterine and ovarian arteries form anastomoses bilaterally. Around the fourth day after fertilization, the morula enters the uterus as a blastocyst. 4: Body: the major portion, which is the upper two-thirds of the uterus. Blood loss from the uterus may be of normal quantity (NMB); however, a quarter of women of reproductive age experience heavy menstrual bleeding (HMB). The middle section of the uterus is called the body of uterus (or corpus). “Uterine inertia” is an outstanding problem which still confronts us. Though relatively quiescent in pre-pubertal and post-menopausal years, the uterus possesses a variety of functions during a woman’s reproductive years. This Review discusses endometrial physiology and the causes May 1, 2023 · Progesterone is an endogenous steroid hormone that is commonly produced by the adrenal cortex as well as the gonads, which consist of the ovaries and the testes. The wall of the uterus is made up of three layers. it is the shedding of the lining of the uterus which include blood, some endometrial tissue, white blood cells and mucus menstrual cycle the rhythmic preparation of the uterus to receive a fertilized egg and the discharge of the uterine lining usually at monthly intervals when no fertilized egg enters the uterus (prepares the uterus for pregnancy). Full text. Get a printable copy (PDF file) of the complete article (233K), or click on a page image below to browse page by page. In the nulliparous adult, the uterus is approximately 7–8 cm long and 4–5 cm wide at the widest part (Fig. The human uterine cervix undergoes extensive changes during pregnancy. Although it is described as being cylindrical in shape, the anterior and posterior walls are more often ordinarily apposed. At birth, the vagina is heavily estrogenized from maternal hormones, and this causes the vagina to be acidic with a predominance of lactobacilli. • New, larger blood vessels develop to accommodate the need of the growing uterus. Estradiol causes contraction of the uterus near the time of estrus and ovulation, which aids in sperm transport. Your ovaries produce Jan 11, 2018 · The lining of the uterus (endometrium) is made up of two layers defined less by structure than by function: the basal layer (the deepest third of the endometrium) and a functional layer. Progesterone has a quieting effect on the uterus so that there are no contractions which might disturb pregnancy. The endometrium lines the uterine cavity; its thickness and structure vary with hormonal stimulation. The uterus is suspended within the body cavity by two tough, sheet-like structures called the broad ligaments. It has three sections. vagina: tunnel-like organ that provides access to the uterus for the insertion of semen and from the uterus for the birth of a baby Sep 10, 2020 · The uterus is the primary female reproductive organ. The cervix lies anterior to the bowel and posterior to the bladder. The endometrium (also known as the mucosal layer or membrane) is the innermost layer of the uterus. The endometrium and the muscular wall of the uterus develop from the mesenchyne of the genital cord. As term approaches, multiple factors work together in complex interactions that cause collagen dispersion a … Nov 12, 2024 · Hypoxia likely plays a pivotal role in endometrial repair pro-cesses. Physicians who never read the first edition missed learning a great deal about the physiology of the uterus. Nonetheless, knowledge of the direct mediators that synchronously shape the uterine microenvironment for successive yet distinct events, such as the The physiological functions of the uterine endometrium (uterine lining) are preparation for implantation, maintenance of pregnancy if implantation occurs, and menstruation in the absence of pregnancy. The fertilized ovum becomes an embryo, attaches to a wall of the uterus, creates a placenta, and develops into a fetus (gestates) until childbirth. About an inch long, the body of the uterus serves as a connection between the two uterine horns and the cervix. In the present edition, Reynolds has reviewed practically the entire literature dealing with this subject. The cervix is the narrow inferior portion of the uterus that projects into the vagina. Ovaries: Ovaries are small, oval-shaped glands that are located on either side of your uterus. Sep 19, 2022 · Since uterine contractions are always present in a thriving uterus, they are differentiated based on frequency, amplitude, duration, and direction of propagation. Each of the two uterine tubes is close to, but not directly connected to, the ovary and divided into sections. The uterus receives the fertilized ovum and it becomes implanted in the uterine wall, which provides nourishment and protection for the developing fetus. Contractions release further oxytocin, forming a positive feedback loop. The uterus is situated posterior to the bladder, anterior to the rectum, and consists of Jul 30, 2023 · The uterus is a muscular, hollow organ in the female pelvis that is approximately 5 cm wide, 8 cm long, and 4 cm thick with a volume of 80 to 200 mL. 2). Sagging of these ligaments with age, parity or trauma can cause a downward tilting of the uterus. The Journal of Physiology 1990;423:411–23. 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