Uterus - Wikipedia
the ovaries and the ligaments of the uterus. if large enough the uterine mass can cause. Anatomical Relations These organs are supplied by the ovarian and uterine arteries, which are also contained within the It consists of a fold of peritoneum, thus some sources consider it to be part of the broad ligament. ); Peritoneal relations (figs. and ) The female genital organs comprise the ovaries, uterine tubes, uterus, vagina, and external genitalia (fig. 35 -1).
It is the usual site of fertilization, and it conveys the early embryo to the uterine cavity. The uterine tubes develop as outgrowths of the peritoneal cavity; they maintain this continuity and thereby allow communication between the peritoneal cavity and the exterior of the body.
The Greek word salpinx, meaning "tube," is used in such compounds as mesosalpinx. Each uterine tube is situated in the superior, free border and between the layers of the broad ligament.
The uterine tube is subdivided into four parts, from lateral to medial: The infundibulum, which is closely related to the ovary, contains the abdominal opening of the uterine tube, by which the tube is in communication with the peritoneal cavity. Oocytes pass from the ovary through the abdominal opening and along the uterine tube. The fimbriae are irregular fringes that project from the margin of the infundibulum, and one ovarian fimbria may be longer than the others.
The ampulla, the longest and widest part, continues gradually into the isthmus. The uterine part, which lies in the wall of the uterus, contains the uterine opening of the uterine tube. Patency of the uterine tubes can be demonstrated radiographically hysterosalpingography by the injection of a radio-opaque medium into the uterus fig.
The uterine cavity receives the openings of the uterine tubes, and the uterine cavity and vagina the "birth canal" allow the exit of the fetus at birth fig. The Greek words hystera and metra are used in such compounds as hysterectomy and endometrium.
The uterus has three layers: The nulliparous uterus resembles an inverted pear and consists of two main parts: The body is twice as long as the cervix, whereas the converse is true in the newborn. The body includes the fundus, which is the portion that lies superior and anterior to the openings of the uterine tubes.
The body is usually tilted anteriorly onto the bladder anteflexion, see fig. Superior and posterior, the body is separated from the rectum by the recto-uterine pouch see fig. Right and left margins are anchored to the broad ligaments. The region between the body and cervix is referred to as the isthmus: As the bladder fills, the uterus tends to become retroverted.
The cervix may be considered in two parts: The cavity of the uterine body, which is somewhat triangular in coronal perspective see fig. The canal of the cervix communicates with the vagina by the external os, which is bounded by anterior and posterior lips.
The entire uterine cavity can be demonstrated radiographically by hysterosalpingography see fig. The uterus can be palpated bimanually fig. Dilatation of the cervical canal and curettage scraping of the uterine lining are performed for diagnostic or therapeutic purposes. The uterus is supported by being anchored to the vagina and by its peritoneal and fascial attachments to nearby structures.
The peritoneum is reflected from the bladder uterovesical pouch to the isthmus uteri and then over the fundus and onto the posterior aspect of the cervix recto-uterine pouch and vagina see figs.
The peritoneum that covers the uterus continues laterally as a double fold known as the broad ligament figs. The ligament extends to the lateral wall of the pelvis and serves as a mesentery for the uterine tube, which lies between its two layers.
This part is the mesosalpinx, whereas the part adjacent to the uterus is called the mesometrium. The posterior layer of the broad ligament forms the mesovarium. In addition to the uterine tube, the broad ligament contains connective tissue the parametriumthe uterine and ovarian vessels, the round and ovarian ligaments, and some embryonic remnants e.
The round ligament is a fibrous band attached to the uterus immediately inferior to the entrance of the uterine tube. It extends laterally and anteriorly, hooks around the inferior epigastric artery, traverses the inguinal canal, and terminates in the labium majus.
The round ligament is accompanied in the fetus, and occasionally in the adult, by a process of peritoneum, the processus vaginalis. The visceral pelvic fascia on the lateal aspect of the cervix is thickened as the lateral or transverse cervical or cardinal ligament and as the uterosacral ligament on the posterior aspect see fig.
The uterine arteries fig.
Each artery ascends between the layers of the broad ligament, near the lateral margin of the body, and supplies branches to both anterior and posterior surfaces. The uterine venous plexus is connected with the superior rectal vein, thereby forming a portalsystemic anastomosis.
The fundus and upper part of the body drain into the lumbar aortic nodes, the lower part of the body into the external iliac nodes, and the cervix into the external and internal iliac and the sacral nodes. The cavity of the vagina communicates with that of the uterus, and it opens into the vestibule below.
The vagina extends inferiorly and anteriorly, parallel to the plane of the pelvic inlet. The anterior and posterior walls of the vagina are about 7.
They are highly distensible and are in contact inferior to the cervix. The recess between the vagina and the vaginal part of the cervix consists of a continuous anterior, lateral, and posterior fornix.
The posterior fornix, which is the deepest, is related to the recto-uterine pouch. The opening of the vagina into the vestibule may be partially closed by a fold called the hymen see fig.
The ovaries, fallopian tubes and peritoneum - Understanding - Macmillan Cancer Support
The vagina is related anteriorly to the cervix, ureters, and bladder and is fused with the urethra. Posteriorly, the vagina is related to the recto-uterine pouch, the rectum, and the perineal body.
The lateral fornix of the vagina is related to the ureter and uterine artery.
The pubococcygeal muscles act as a sphincter for the vagina. The vagina is supplied by branches including uterine and vaginal of the internal iliac artery. The vagina and cervix can be inspected through a speculum in the vagina.
Digital examination per vaginum may be combined with palpation through the anterior abdominal wall by the other hand bimanual examination. The following structures are palpable per vaginam: Anteriorly-urethra, vaginal part of cervix, distended bladder, and body of uterus bimanually 2. Laterally-ureters and displaced or enlarged ovaries and uterine tubes bimanually 3. Posteriorly-rectum, any mass in the rectouterine pouch, and sometimes sacral promontory 4.
Vaginal Papanicolaou smears taken from the cervix are used in histodiagnosis. Questions Where is the ovary situated? The long axis is vertical see fig. The term superficial epithelium is preferable to germinal epithelium because the primordial germ cells are now believed to arise extragonadally.
Three pairs of ligaments help to maintain the position of the uterus within the pelvis. These include the cardinal ligaments, the pubocervical ligaments, and the uterosacral ligaments.
These 3 sets of ligaments run along the base of the broad ligament and serve as primary supports. The pubocervical ligaments are a pair of fibrous bands that attach the anterior portion of the cervix to the posterior pubic symphysis. The uterosacral ligaments are another pair of fibrous bands that attach the posterior cervix to the anterior surface of the sacrum.
The broad ligament and the round ligaments of the uterus serve as a secondary support for the uterus within the pelvis.
Ligaments of the Female Reproductive Tract
The fusion of these ducts leads to the development of the female pelvic organs. The round ligaments are remnants of the gubernaculum, which forms during development. In males, the gubernaculum guides the testes through the inguinal canal into the scrotum.
In females, the remnants are called the round ligaments of the uterus. They connect to the anterior horns of the uterus and travel anteriorly in the pelvis to the deep inguinal rings where they move through the inguinal canal and attach to the labia majora. The round ligaments help to keep the uterus in an anteverted position, flexed forward over the bladder.
The uterus is anteverted in the majority of women. However, the angle and position of the uterus are highly variable. During pregnancy as the uterus expands and moves out of the pelvis, the round ligaments can be stretched which causes discomfort in some women. Blood Supply and Lymphatics The broad ligament contains the blood vessels to the ovaries, fallopian tubes, and uterus. The ovarian arteries branch from the abdominal aorta and run through the suspensory ligaments of the ovaries, also known as the infundibulopelvic ligaments.
The suspensory ligaments attach each ovary to the pelvic sidewall. The ovarian ligaments, which connect each ovary to the lateral side of the uterus, do not contain any blood vessels.
These are also known as the utero-ovarian ligaments or the proper ovarian ligaments. The uterine arteries branch from the internal iliac arteries and travel to the uterus via the cardinal ligaments, or lateral transverse cervical ligaments, which run along the base of the broad ligament. Surgical Considerations Defects in the broad ligament can lead to herniation of bowel, uterine tubes, or ovaries.
Most defects of the broad ligament are unilateral and may be partial or complete. When the defect is partial, there is a risk of internal bowel herniation, usually the ileum and rarely the colon.