Uterus and its relations
Definition
- hollow muscular organ
- one of the internal organs of female reproductive system
Situation and Position
- in the pelvic cavity
- between urinary bladder and rectum
- anteverted
- anteflexed
- at right angles to the vagina
- anterior surface rests on the urinary bladder
Structure
flattened anteroposteriorly
pear shaped
the different parts are : -
1. fundus - dome shaped part
2. body - main part. Narrowest inferiorly at the internal os where it continues with cervix
3. cervix - protrudes through the anterior wall of the vagina, opening into it at the external os.
Wall of the uterus three layers
I. perimetrium
Consists of peritoneum - anteriorly peritoneal covering forms a fold vesicouterine pouch
- posteriorly forms rectouterine pouch
- laterally forms broad ligament
II. Myometrium
thickest layer - smooth muscle fibres - contains a little areolar tissue, blood vessels and nerves
III. Endometrium - columnar epithelium - mucous secreting glands - thickness varies during the monthly menstrual cycle - the upper 2/3 of the cervical mucous membrane;
- the lower 1/3 squamous epithelium continuous with that of the vagina
Blood supply, lymph drainage and nerve supply
- uterine arteries - branches of internal iliac arteries
- venous drainage into internal iliac veins
- lymph drains into aortic lymph nodes and groups of nodes associated with the iliac blood vessels.
- Nerve supply sympathetic from the lumbar outflow - parasympathetic from sacral outflow
Supports of uterus
1. broad ligaments
2. round ligaments
3. uterosacral ligaments
4. transverse cervical ligaments (cardinal ligaments)
5. pubocervical fascia.
Relations of the uterus
Anteriorly : the base of the bladder
Posteriorly : the rectum, anal canal with Pouch of Douglas in between them and the utrus
vagina
Laterally : the uterine tubes and ovaries
Broad ligament
lateral ligaments (of Mackenrodt) at the base of the broad ligaments surrounding
the uterine vessels
Superiorly : loops of intestine
Inferiorly : the vagina
Applied Anatomy
Normal position anteversion and anteflexion - abnormal position : retroversion
Posteriorly rectum is situated : During D & C of the pregnant uterus the curette may perforate into the rectum
Superiorly the pertoneal cavity with intestines - the curette may enter peritoneal cavity and damage the intestines
Prolapse of the uterus : the supporting ligaments may elongate due to aging or damage of parturition and the uterus may descend into the vagina and may even come out of the body
