Supports of Uterus

1. SUPPORTS OF UTERUS
Sagnik
Saha

2. Introduction
 Uterus is inverted pear shaped, highly
mobile ,thick walled ,muscular organ in
the female body.
 It is situated obliquely in the lesser
pelvis between urinary bladder
anteriorly and the rectum & sigmoid
colon posteriorly.

3. Importance of Support
 The Supporter of the Uterus is
needed to kept it in it’s actual
position & prevented from sagging
down .
 The uterus is supported and
prevented from prolapse(downward
Displacement) by a number of
structures providing support to it.

4. Supports
Primary support
Muscular/
active
Pelvic diaphragm
Perineal body
Urogenital
diaphragm
Visceral
Urinary bladder
vagina
Uterine axis
Fibro-muscular
Mackenrodt’s
Ligament
Pubocervical
ligaments
Uterosacral
ligaments
Round ligaments
Secondary support
Peritoneal folds
Broad Ligaments
Utero –vesical fold
Recto-uterine fold
Pelvic cellular
tissue

5. PRIMARY SUPPORT
1. Muscular / Active Support

6. A. Pelvic Diaphragm
 It is a gutter shaped musculo-fascial
partition between the pelvic cavity &
perinium .
 Pubococcygeus part of levetor ani plays
the most significant supportive role of
uterus.
 Pubococcygeus has 4 components:
Pubococccygeus proper, Puborectalis,
puboanalis and pubovaginalis/
pubovesicalis
 Pubovaginalis narrows the hiatus
urogenitalis & constricts the vagina from
side to side & prevents the discent of
Uterus.

7. Lateral view
Superior
View

8. B. Perineal Body
 It is a pyramidal fibromuscular node intervening
between the anal canal & urogenital apparaters.
 It is known as gynaecological perineum which receives
the attachment of following muscle : longitudinal muscle
coat of anal canal ,sphincter ani exturnus, superficial
transverse perini (2) , deep transverse perini (2)
Bulbospongious, pubococcygeus part of levetor ani
 The perineal body acts as an anchor for the pelvic
diaphragm & maintains the integrity of the pelvic floor.
 If it is torn during delivery & not properly repaired the
,urogenital hiatus becomes enlarged, the vagina dilates
& uterus descent.

10. C. Urogenital Diaphragm
 It is a
musculofascial
partition
between the
pelvic cavity &
the anterior
part of pelvic
outlet.
 It helps in
closure of
urogenital
hiatus from
bellow &
constricts the
vagina.

11. 2. Visceral Support
Urinary
Bladder
Vagina
Uterine Axis

12. Uterine Axis
 Angle of Anteversion
 It is forward angle
formed by long axis of
vagina & that of cervix at
the level of external os
measuring approx. 90°
provided Urinary Bladder
and rectum are empty.
 Angle of Anteflexion
 It is forward angle
formed by long axis of
uterus & that of cervix at
the level of internal os
measuring approx. 125°
-170° provided Urinary
Bladder and rectum are
empty

13. 3. Fibromuscular support
 Mackenrodt’s Ligaments : These are fan shaped fibro-
muscular band derived from condensation of parametric
tissue .They form a hammock that keep the cervix in
position & prevent downward displacement of uterus. It
is also known as lateral /transverse cervical ligament/
cardinal ligament.
 Pubocervical ligaments : these are a pair of thin fibrous
band which extend from cervix to the posterior surface
of pubis.
 Uterosacral ligaments : Each ligaments extends from
cervix to the 3rd sacral vertebra .They pull the cervix
backwards & help in maintenance of anteversion &
anteflexion position of uterus.

15. Round Ligaments of Uterus
 It is a remnant of
distal part of
gubernaculum of
ovary .
 Attached
proximally to the
cornu of uterus
and distally to the
labia majora.
 It pull the fundus
forwards &
maintains the
Anteversion &
anteflexion.

16. SECONDARY SUPPORT
1. Peritoneal folds /
Ligaments

17. Broad Ligaments
 Each Ligament is Broad , quadrilateral fold of
peritoneum that extends from lateral borders
of Uterus to the lateral pelvic wall.

18. Peritoneal Folds

19.  Utero vesical fold : It is formed by
reflection of peritoneum that extends
from anterior border of the body of
uterus to the upper surface of urinary
bladder.
 Rectovaginal / Rectouterine fold : It
is formed by peritoneal reflection from
posterior fornix of vagina to the
rectum. It forms the floor of pouch of
Doglus .

20. 2. Pelvic cellular Tissue/
Loose packing meterial
 The parametric tissue made up of fibro-
areolar & fibro-muscular tissue fills up
the dead space between pelvic
peritoneum & pelvic floor & act as a
packing structure .
 Ovarian hormones control the growth of
parametric tissue