L1,2 Flashcards
What is the uterus?
The uterus is a hollow, thick-walled, pear-shaped, muscular organ in which the fetus develops.
Where is the uterus located?
The uterus is located in the pelvic cavity, between the urinary bladder anteriorly and the rectum posteriorly.
What is the shape of the uterus?
The uterus is pear-shaped, with its apex directed inferiorly and its base directed superiorly.
What are the dimensions of the uterus?
The uterus is approximately 3 inches long, 2 inches wide, and 1 inch thick.
What are the parts of the uterus?
• Fundus
• Body
• Cervix
What is the normal position of the uterus?
-The longitudinal axis of the uterus forms a right angle (90°) with the axis of the vagina, called the angle of anteversion.
-At the level of the internal os, the body is slightly bent forward on the cervix, forming the angle of anteflexion, which is nearly 170°.
-Normally, the uterus is anteverted anteflexed (AVF) with an empty bladder.
What is the abnormal position of the uterus?
• Retroverted retroflexed (RVF): The axes of the uterus and vagina are on the same line, which may cause prolapse of the uterus, especially in old-age multiparous women. This position can also cause difficulties in getting pregnant.
• Retroverted anteflexed
• Excessive anteflexion
What is the fundus of the uterus?
• The fundus is the part superior to the openings of the uterine tubes.
• It is convex all around and completely covered by peritoneum.
• It is related to the coils of the ileum and sigmoid colon.
What is the body of the uterus?
• The body of the uterus is 2 inches long and 2 inches wide.
• It has anterior and posterior surfaces and 2 lateral borders.
• Anterior surface: Covered by the peritoneum down to the level of the isthmus (internal os), related to the urinary bladder, with the uterovesical pouch in between.
• Posterior surface: Covered by peritoneum down to the cervix and posterior fornix of the vagina, related to the sigmoid colon and the coil of the terminal ileum.
• Lateral borders: At the upper ends, the uterine tubes enter the uterus. The round ligament of the uterus attaches antero-inferiorly, and the ligament of the ovary attaches postero-inferiorly. Along the lateral border, the uterine vessels course between the two layers of the broad ligament.
What is the cervix of the uterus?
• The cervix is one inch long and one inch in diameter, with a fusiform-shaped lumen.
• It is more fixed due to the strong ligaments attached to it.
• It projects through the anterior vaginal wall, dividing it into supravaginal and vaginal parts.
• It communicates with the body through the internal os and with the vagina through the external os.
-Supravaginal part:
• It is covered by peritoneum posteriorly down to the upper part of the posterior vaginal wall
• Aneriorly it is related to the urinary bladder.
• Posteriorly it is related to the rectum with Douglas pouch in between.
• Laterally it is related to the uterine artery which crosses the ureter.
-Vaginal part projects into the upper part of the anterior wall of the vagina dividing it into 4 fornices (2 lateral, one anterior and one posterior).
What is the supravaginal part of the cervix?
• The supravaginal part of the cervix is covered by peritoneum posteriorly, down to the upper part of the posterior vaginal wall.
• Anteriorly, it is related to the urinary bladder.
• Posteriorly, it is related to the rectum, with Douglas pouch in between.
• Laterally, it is related to the uterine artery, which crosses the ureter.
What is the vaginal part of the cervix?
• The vaginal part of the cervix projects into the upper part of the anterior wall of the vagina.
• It divides the vagina into four fornices:
• Two lateral fornices
• One anterior fornix
• One posterior fornix
What is the distance from the external os to the fundus of the uterine cavity?
The uterine cavity is 6 cm from the external os to the fundus.
How is the cavity of the body of the uterus described in a sagittal section?
In a sagittal section, the cavity of the body is a transverse slit.
How is the cavity of the body of the uterus described in a coronal section?
In a coronal section, the cavity of the body is triangular, with its base between the openings (horns of the uterus) of the uterine tubes and its apex at the internal os leading to the cervical canal.
What is the shape of the cervical canal?
How does the cervical canal communicate with the uterine cavity and the vagina?
-The cervical canal is fusiform.
-The cervical canal communicates with the uterine cavity by the internal os and with the vagina by the external os.
What connects the uterus to the walls of the true pelvis and surrounding organs?
The uterus is connected to the walls of the true pelvis and surrounding organs by numerous ligaments.
How are the ligaments of the uterus classified?
The ligaments of the uterus are classified into two types: peritoneal ligaments and fibromuscular ligaments.
What are the peritoneal ligaments of the uterus?
The peritoneal ligaments of the uterus include the broad ligaments.
What are the fibromuscular ligaments of the uterus?
The fibromuscular ligaments of the uterus include:
• Transverse cervical ligaments
• Uterosacral ligaments
• Pubocervical ligaments
• Round ligaments of the uterus
What are peritoneal ligaments? What are the broad ligaments?
Peritoneal ligaments are two peritoneal folds extending from the side of the uterus to the lateral pelvic wall. The broad ligament is a peritoneal fold with two layers and four borders.
How do the layers and borders of the broad ligament behave?
The two layers are continuous anteriorly to form the free (anterior) border and diverge posteriorly to attach to the pelvic floor, forming the attached (posterior) border.
How is the superior layer of the broad ligament connected to the ovary?
The superior layer is connected to the ovary by mesovarium and is pierced by the infundibulum of the uterine tube.
The broad ligament border?
Anterior (free) border, Posterior (attached) border, Medial border, Lateral border
What does the medial 4/5 of the anterior (free) border of the broad ligament contain?
It contains the uterine tube.
What does the lateral 1/5 of the anterior (free) border of the broad ligament form?
It forms the suspensory ligament of the ovary.
What is the significance of the posterior (attached) border of the broad ligament?
• It rests on the pelvic floor and is attached to it.
Where is the medial border of the broad ligament attached?
• It is attached to the side of the uterus.
Where is the lateral border of the broad ligament attached?
• It is attached to the lateral pelvic wall where the two layers of the ligament are continuous with the parietal peritoneum.
What is the mesovarium?
• It is an evagination from the superior layer of the broad ligament to the anterior border of the ovary.
• It transmits the ovarian vessels, lymphatics, and nerves to and from the ovary.
What is the suspensory ligament of the ovary (infundibulopelvic part)?
• It is the lateral part of the broad ligament.
• It extends from the infundibulum of the tube and the upper end of the ovary to the lateral pelvic wall.
• It transmits ovarian blood vessels, lymphatics, and nerves.
What is the mesosalpinx (mesentery of the tube)?
• It is the part of the broad ligament between the uterine tube, mesovarium, ovary, and ligament of the ovary.
• It contains the anastomosis between the uterine and ovarian arteries.
What is the mesometrium (mesentery of the uterus)?
• It extends from the side of the uterus to the lateral wall of the pelvis below the ovary and its ligament and above the pelvic floor.
• It contains the uterine vessels along the lateral border of the uterus.
What is the first structure found in the broad ligament?
The uterine tube.
What ligaments are found in the broad ligament?
• Round ligament of the uterus.
• Ligament of the ovary.
What arteries are present in the broad ligament?
• Uterine vessels close to the side of the uterus.
• Ovarian vessels in the suspensory ligament and mesovarium.
What nerve plexuses are found in the broad ligament?
• Uterovaginal plexus alongside the uterine artery.
• Ovarian plexus around the ovarian artery.
What embryonic remnants are found in the broad ligament?
• Epoophoron and Gartner’s duct.
• Paroophoron.
What other structures are found in the broad ligament?
• Lymphatic vessels.
• Extraperitoneal connective tissue.
What are the transverse cervical (Mackenrodt’s, lateral cervical, or cardinal) ligaments, and where do they extend?
The transverse cervical ligaments extend from either side of the cervix and upper vagina to the lateral pelvic wall.
What is the main function of the transverse cervical ligaments?
They are the main ligaments that support the uterus.
Where do the uterosacral ligaments extend, and what is their function?
• Extension: They extend from the cervix across the sides of the rectum to the middle of the sacrum.
• Function: They pull the cervix backward to counter the forward pull of the round ligament of the uterus, maintaining the uterus in the anteverted and flexed (AVF) position.
What are the pubocervical (pubo-vesico-cervical) ligaments, and where do they extend?
The pubocervical ligaments extend from the cervix across the urinary bladder to the pubis.
Where are the round ligaments of the uterus located, and what is their pathway?
• Location: The round ligaments are fibromuscular bands attached to the anterior surface of the uterus below and in front of the uterotubal junctions.
• Pathway: They are present within the broad ligament, pass forward and laterally, enter the deep inguinal rings, traverse the inguinal canals, and merge with the areolar tissue of the labia majora.
What are the ligaments of the ovaries, and where do they extend?
The ovarian ligaments are fibromuscular bands that extend from the posterior surface of the uterus below and behind the uterotubal junctions to the uterine ends of the ovaries.
Supporting factors of the uterus?
The uterus is maintained in position by various factors. The most important of these are:
1. Ligamentous factor (many ligaments but especially the transverse cervical and utero-sacral).
2. Muscular factor (muscles of pelvic and urogenital diaphragms).
3. Perineal body.
4. Surrounding viscera.
What is the arterial supply of the uterus?
The uterine artery, a branch of the internal iliac artery, supplies the uterus.
What branches does the uterine artery give off?
It gives cervical and vaginal branches, ascends along the side of the uterus giving uterine branches, and later divides into tubal and ovarian branches within the broad ligament.
How is the uterus drained venously?
Where does the uterine venous plexus drain?
The uterine veins enter the broad ligaments with the arteries and form a uterine venous plexus on each side of the cervix.
Veins from the uterine plexus drain into the internal iliac vein.
Where does lymph from the cervix drain?
Where does lymph from the body of the uterus drain?
To the external, internal iliac, and sacral lymph nodes.
To the external iliac lymph nodes.
Where does lymph from the uterotubal junction drain?
Where does lymph from the fundus drain?
Along the round ligament of the uterus to the superficial inguinal lymph nodes.
To the para-aortic lymph nodes.
What provides the autonomic nerve supply to the uterus?
Which spinal cord segments contribute to the parasympathetic innervation of the uterus?
The uterovaginal autonomic plexus derived from the inferior hypogastric plexus.
S2-S4 spinal cord segments through the pelvic splanchnic nerves.
From where does the sympathetic innervation of the uterus originate?
The inferior thoracic and superior lumbar spinal cord segments via lumbar splanchnic nerves.
How do visceral afferent fibers conduct pain impulses from the fundus and body of the uterus?
How do visceral afferent fibers conduct pain impulses from the cervix?
They follow the sympathetic innervation to the inferior thoracic and superior lumbar spinal ganglia.
They follow the parasympathetic fibers through the uterovaginal and inferior hypogastric plexuses and pelvic splanchnic nerves to S2-S4.
What are some dispositions of the uterus other than anteversion and anteflexion?
Was retroversion of the uterus once considered a predisposing factor in uterine prolapse or pregnancy complications?
Excessive anteflexion, anteflexion with retroversion, and retroflexion with retroversion.
Yes, but it has been proven unjustified.
What are the uterine (Fallopian) tubes?
They are a pair of ducts that transmit the ovum from the ovary to the uterus.
What is the position of the uterine tubes?
The uterine tubes lie in the medial 4/5 of the anterior free border of the broad ligament.
What is the length of the uterine tubes?
The uterine tubes are about 10 cm long.
What are the two ends of the uterine tube, and where do they open?
• Lateral (peritoneal) end: Opens into the peritoneal cavity by piercing the upper layer of the broad ligament (abdominal ostium).
• Medial (uterine) end: Opens into the superior angle of the uterine cavity at the junction of the fundus with the body (uterine ostium).
What are the parts of the uterine tube, and what are their characteristics?
- Intramural (uterine):
• Length: 1 cm (shortest and narrowest part).
• Traverses the uterine wall and opens into the superior angle of the uterine cavity via uterine ostium.- Isthmus:
• Length: 2 cm (short and narrow).
• Thick-walled and straight. - Ampulla:
• Length: 5 cm (longest and widest part, 4 mm diameter).
• Thin-walled and tortuous.
• Site of fertilization. - Infundibulum:
• Length: 2 cm (funnel-shaped lateral part).
• Opens into the peritoneal cavity via the abdominal ostium.
• Margin has irregular finger-like processes called fimbriae, which are closely related to the ovary.
• A large fimbria is attached to the tubal end of the ovary called ovarian fimbria.
- Isthmus:
How is the uterine tube supplied with blood?
What is the nerve supply of the uterine tube?
• Medial 2/3: Supplied by uterine blood vessels.
• Lateral 1/3: Supplied by ovarian blood vessels.
——-
• Medial 2/3: Supplied by the uterine nerve plexus.
• Lateral 1/3: Supplied by the ovarian nerve plexus.
How is the lymphatic drainage of the uterine tube distributed?
• Most tubal lymphatics ascend with those of the fundus of the uterus and ovary to the lateral aortic and pre-aortic lymph nodes.
• Lymphatics from the isthmus and utero-tubal junction accompany the round ligament of the uterus to the superficial inguinal lymph nodes.
What is the clinical significance of the uterine tubes?
includes:
1. Patency of Uterine Tubes
• Assessed by:
a. Hysterosalpingography
b. Endoscopy
2. Female Sterilization
• Methods:
a. Tubal sterilization
b. Hysteroscopic sterilization
