Uterus Basic structure

 Pear-shaped organ
 Approximately 8 cm long and 5 cm wide Supported by the pelvic diaphragm
Composed of.
 Body (corpus) -upper two thirds
 Fundus-rounded upper part superior to the entrances of the uterine tubes
 Isthmus-narrower area just above the cervix
 Cervix (neck) -cylindrical inferior part that projects into the superior vagina
 Uterine cavity is small (6 cm in length) and slit-like Uterine horns are
superolateral regions where the uterine (Fallopian tubes) enter

Uterine wall has three layers

 Perimetrium-outer layer of peritoneum with underlying connective tissue

The uterus has two surfaces:

 anteroinferior and posterosuperior

A portion of the cervix, body, and fundus of the uterus is covered with peritoneum

Cervix

Thick-walled canal, 2.5 cm long, connecting the body of the uterus with the vagina
Communicates superiorly via internal os with uterus Communicates with vagina
inferiorly via external os Approximately half of the cervix lies above the vagina
(supravaginal) and is covered posteriorly with the peritoneum of the rectouterine
pouch

The bladder is separated from the anterior surface of the supravaginal part of the
cervix by connective tissue The lower half of the cervix (vaginal part) protrudes into
the vagina and can be examined clinically

Relationships of the uterus

Anterior Posterior Vesicouterine pouch, superior surface of bladder Rectouterine

Vascular supply of uterus (including cervix) Arterial Uterine arteries (branches of

Vaginal arteries (branches of uterine arteries with anastomoses with internal

Venous drainage: via uterine venous plexus to internal iliac veins

Lymphatics drain to External iliac nodes Internal iliac and sacral nodes

Superficial inguinal nodes (along round ligament) Innervation From the uterovaginal
plexus, a subdivision of the inferior hypogastric (pelvic) plexus

Sympathetic, parasympathetic, and visceral afferents to and from the uterus pass
through this plexus Sympathetic innervation from lower lumbar spinal cord segments
via lumbar splanchnic nerves and intermediate plexuses Parasympathetic
innervation from pelvic splanchnic nerves (S2,3,4 spinal cord levels) via pelvic
plexus Aferent fibers with pain information from body and fundus ascend through
plexuses to lumbar splanchnic nerves to reach upper lumber/lower thoracic spinal
cord segments Aferent fibers with pain information from cervix and a l information
except for pain from body and fundus fo low parasympathetic fibers back to central
nervous system Vagina Basic structure Muscular tube, 8 to 10 cm long Superior end
surrounds the cervix: upper two thirds lie within pelvic cavity Slopes downward and
forward through the pelvic diaphragm Opens inferiorly into vestibule between labia
minora Lining has multiple transverse folds-rugae Recessed area of vagina around
the cervix is caled the vaginal fornix; composed of shalow anterior, deep posterior,
and lateral fornices Posterior fornix directly related to rectouterine pouch
Relationships of the vagina Superior External os cervix Inferior Vestibule between
labia minora Anterior Posterior wa l bladder Posterior Lateral Rectouterine pouch
Ampula of rectum Levator ani muscles Blood supply Uterine arteries supplies
superior part Vaginal arteries supply middle part Lower part supplied by middle rectal
and internal pudendal arteries Venous drainage Vaginal venous plexus to uterine
venous plexus to internal iliac veins Innervation Upper three fourths same as uterus
Lower one fourth is somatic via the pudendal nerve Visceral and sympathetic fibers
reach the lower one fourth via the pudendal nerve; no parasympathetics Variations in
Position of the Uterus When the bladder is empty, body of the uterus bent anteriorly
on the cervix: anteflexion Axis of cervix also bent forward relative to axis of vagina:
anteversion Thus the body of uterus lies on superior surface bladder Ful bladder
reduces these angles Reversal of these angles is caled retroversion and retroflexion
Ligaments Associated with the Uterus Broad ligament Double layer of peritoneum
that sweeps up and over the uterus, ovaries, and the uterine tubes Thus has an
anterior and a posterior lamina Extends from the sides of the uterus to the lateral
pelvic wa ls 287 / 425 Part that suspends the ovary from the posterior lamina is the
mesovarium Part of broad ligament above the level of the ovary and mesovarium
that sweeps over the uterine tubes is the mesosalpinx Part of broad ligament below
the mesovarium or the mesentery of the uterus Uterine arteries and veins run
medially from the internal iliac arteries to the uterus at its base Encloses the plexus
of uterine veins Ligament of the ovary Extends from the medial pole of ovary to the
lateral wall of the uterus, just beneath the entrance of the uterine tube, on each side
Remnant of proximal part of embryonic gubernaculums page 182 page 183 Round
ligament of the uterus Extends from the lateral wall of the uterus, just beneath the
entrance of the uterine tube, to the lateral pelvic wall on each side Crosses external
iliac vessel to enter deep inguinal ring Passes through inguinal canal to labium majus
Remnant of distal part of embryonic gubernaculums Suspensory ligament of the
ovary An extension of the broad ligament superiorly on the posterolateral pelvic wall
Covers the ovarian vessels, associated nerves, and lymphatics Uterine (Fallopian)
Tubes Basic anatomy Approximately 10 cm long, extending laterally from the uterine
horns to the peritoneal cavity near the ovaries Run in free upper border of broad
ligament (mesosalpinx) Provide a channel for ova from ovary to uterine cavity and
site for fertilization Divided into four parts for descriptive and functional purposes
Infundibulum Horn-shaped distal end Opens into peritoneal cavity Has finger-like
processes (fimbriae) at distal end that spread over surface of ovary Ampulla Widest
and longest part Where fertilization usually occurs Connects infundibulum and
isthmus Isthmus Thick-walled Enters uterine horn Uterine part: passes through the
wall of the uterus Blood supply Arterial (anastomoses) Uterine arteries Ovarian
arteries Venous drainage Uterine venous plexus Ovarian veins Lymphatics To
lumbar lymph nodes Innervation Ovarian and uterine plexuses = subdivisions of
pelvic plexus page 183 page 184 Ovaries Basic structure Ovoid in shape
Approximately 4 cm long and 2 cm wide Lie in the ovarian fossa on lateral pelvic wall
between external and internal iliac vessels Attached to the broad ligament by
mesovarium, which transmits ovarian vessels Connected to lateral wall by
suspensory ligaments of the ovary, containing ovarian vessels, nerves, and
lymphatics Arterial supply Ovarian artery 288 / 425 Branch of abdominal aorta
Terminates in ovarian and tubal branches Venous drainage Pampiniform plexus
combines to form single ovarian vein On right this drains into the inferior vena cava
On the left drains into the left renal vein Lymphatics Folow ovarian vessels to lumbar
lymph nodes Innervation Sympathetic and aferent fibers reach the ovary via the
ovarian vessels Parasympathetic fibers from pelvic splanchnic nerves (S2,3,4 spinal
cord levels) reach ovary via same route