Shape, Site, etc

Dimensions Parts

Relations

UTERUS OVARY pear-shaped hollow muscular organ, lying within the each located within a depression; pelvic cavity, between the rectum & urinary bladder the ovarian fossa, on lateral pelvic wall, *normal position : AVF (anteflexion, anteversion) at the level of ASIS - anteflexion : forward angle btween long axis of body of uterus & that of cervix = an obtuse angle (170) *boundaries of ovarian fossa - anteversion : forward angle between long axis of ant obliterated umbilical artery vagina & that of cervix = right angle (90) (medial umbilical ligament) post ureter, internal iliac artery ** uterus maybe be retroflexed or retroverted but lat obturator nerve considered normal if it is mobile and asymptomatic sup superior iliac vessels - retroversion = angle between vagina & cervix > 90 - retroflexion = angle btwn cervix & body > 170 1 x 2 x 3 inches (nullipara) 1 x 2 x 3 cm (nullipara) * 2 surfaces Fundus :upper rounded free part above the level of Lateral related to peritoneum of the openings of fallopian tube lateral pelvic wall & : has 2 surfaces (anterior & posterior) Body obturator nerves&vessels : constricts lower down at a constriction (isthmus) to become the cervix Medial is covered by the Cornua : junction between the fundus & the body fimbriated end of the : lies in the lateral angle of uterus uterine tube Cervix : lower narrow part that protrudes into the * 2 borders upper vaginal end Anterior attached to the mesovarium relations of BODY of uterus Posterior is free anterior separated from urinary bladder by the *2 ends (vesical) utero-vesicular pouch Tubal attached to the fimbria & surface suspensory ligament of posterior separated from the rectum by rectoovary (intestinal) uterine (Doughlas) pouch Uterine attached to the lateral surface *coils of sigmoid colon & terminal angle of uterus by ileum present inside the pouch ovarian ligament below & lateral - attachment of broad ligament behind FT - uterine artery *peritoneal relation : - uterine tube joins uterus at cornua ovary is completely covered by - round ligament (attached below & in peritoneum except the anterior front of lateral angle of uterus) border (attached to the mesovarium) -ovarian ligament (attached below & behind the lateral angle of uterus)

UTERINE (FALLOPIAN) TUBE - musculo-membranous tube showing great motility - lies in the upper free edges of the broad ligament - extends from cornua of uterus to peritoneal cavity close to the ovary

VAGINA - cylindrical musculomembranous tube - descends anterior-posteriorly from the cervix to the vaginal vestibule - walls of vagina are in contact with each others -anterior wall is 3 inches - posterior wall is 4 inches & is in contact with external os - vaginal recess around cervix is called fornix 7cm 10cm length relation of the surfaces ant cervix, urethra and urinary bladder post Douglas pouch upper
1/4 middle 2/4 lower 1/4

each is 10cm long Intramural part Isthmus in the wall of the uterus

the narrowest part Ampulla the widest longest part, It is a site for fertilization Infundi- - funnel-shaped bulum lateral end of FT - has 20- 30 finger like processes (fimbriae) *[ovulation] fimbriae trap non-fertilized ovum & sweep it

rectum perineal body ureter levator ani, pelvic fascia grater vestibular gland cervical canal opens into vaginal vestibule

lat
upper 1/3 middle 1/3 lower 1/3

sup inf

Ligaments

Arterial supply

to front of the sacrum junction of back of cervix & vagina pubic body cervix & lateral lateral wall fornix of vagina of pelvis uterine end of cornua of ovary uterus Round ligament cornua of uterus labia majora Broad ligament lateral margin of side wall of uterus pelvis *round ligaments of ovary & uterus represent upper & lower part of gubernaculums ligament respectively Uterine artery (from anterior division of internal iliac artery) - supplies uterus, medial part of uterine tube, upper vagina & ureter

ligament Utero-Sacral ligament Pubo-Cervical ligament Transverse cervical ligament Ovarian ligament

extend from cervix

ligament Suspensory ligament *contains ovarian vessels & nerves Ovarian ligament Mesovarium

connects upper end of ovary

to lateral pelvic wall

uterine end of ovary anterior border of ovary

cornua

* 4 vaginal fornices 2 lateral closely related to fornices the ureter & uterine artery anterior shallow fornix posterior deepest one, fornix known as seminal pool

upper layer of broad ligament medial part : Uterine artery (from Internal Iliac artery) lateral part : Ovarian artery (from abdominal aorta) anterior division of IIA 1. Vaginal artery 2. Uterine artery 3. Middle rectal artery 4. Internal pudendal artery *they form ant & post azygos arteries to supply vaginal wall Vaginal venous plexus drains into vaginal veins into internal iliac vein

1. Ovarian arteries (runs through the suspensory ligament then through mesovarium to reach the ovary) 2. Uterine arteries (anastomoses with ovarian artery)

Venous drainage

Uterine venous plexus drains into internal iliac vein

Pampiniform venous plexus ovarian vein Right ovarian vein drains into IVC Left ovarian verin drains into left renal vein 1. Para-aortic LN at the level of L2 (along ovarian vessels) 2. Superficial inguinal LNs (along round ligament) 3. Opposite ovary

- Ovarian veins - Uterine veins

Lymph drainage

Para-aortic lymph nodes upper part internal & external iliac LNs internal iliac LNs superficial inguinal LNs

fundus, upper part of body cornuae lower part of body cervix

para-aortic LNs superficial inguinal LN external iliac LN internal & external iliac, sacral LN

middle part lower part

uterus Peritoneal covering the uterus 1. Peritoneal is reflected from the lower part of anterior abdominal wall to cover upper surface of urinary bladder. 2. then reflected in the front of uterus at the isthmus, to form utero-vesicular pouch 3. then covers the anterior surface of body of uterus, fundus of the uterus, posterior surface of the body and cervix of uterus, and upper of posterior wall of vagina 4. then reflects in front of middle 1/3 of rectum, to form recto-uterine (Doughlas) pouch Laterally, forms folds that extend from the uterus to the side walls of pelvis known as broad ligaments, containing uterine tubes in their upper free borders. Inferiorly, 2 peritoneal layers are separated by CT (at the attached border of broad ligaments/root) -ureter runs below the root from backwards forwards on its way to UB. -uterine vessels run between the 2 layers above ureter, near the cervix above the lateral fornix, then it ascends along the side of uterus Broad ligament: a double- layered fold of peritoneum, extended from the lateral margin of the uterus to the side wall of the pelvis -2 surfaces : : anterior inferior surface: attached to the side wall of pelvis : posterior superior surface : ovary is attached to this surface by a short peritoneal fold called, the mesovarium - 3 borders : free superior anterior border :containg uterine tube : lower posterior border (root) : attached to the floor of pelvis : medial border : enclosing the uterus Parts of the broad ligament: i) Mesometrium: between pelvic floor, ligament of ovary and body of uterus. ii) Mesosalpinx: between uterine tube ,mesovarian and ligament of ovary. iii) Suspensory ligament of ovary Contents of the broad ligament : (1) Uterine tube, in the upper border. (2) Ligament of ovary. (3) Upper part of round ligament of uterus. (4) Uterine artery, along the lateral border of uterus. (5) Termination of ovarian vessels. (6) Epoophron, and paraoophron , above and medial to attachment of mesovarium respectively. (7) Extraperitoneal fatty tissue

Factors keeping the uterus in position (uterine support): Levator ani. Ligaments of the uterus. Perineal body. Surrounding organs. Urogenital diaphragm * External os normally lies at the level of the ischial spine.