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Gross Anatomy of Uterus

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Hello friends..you can use these notes for your convenience as they are taken from many other standard books.. Thank you.

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Gross Anatomy of Uterus

  1. 1. Gross Anatomy of Uterus DR. VIBHASH KUMAR VAIDYA DEPARTMENT OF ANATOMY
  2. 2. Introduction  Synonym: Latin uterus; Greek hystera: womb  The uterus is a childbearing organ in females.  It provides a suitable site and environment for implantation of a fertilized ovum and development of the embryo.  The uterus is a thick-walled, muscular organ with narrow lumen.  Situated in the pelvis between the urinary bladder and the rectum.  Superiorly, on each side, it communicates with the uterine tube and inferiorly with the vagina. Dr.Vibhash
  3. 3. Shape and Size  It is pear-shaped, being flattened anteroposteriorly. Measurements:  Length: 3 inches (7.5 cm).  Breadth (at fundus): 2 inches (5 cm).  Thickness: 1 inch (2.5 cm).  Weight: 30–40 g. Dr.Vibhash
  4. 4. SUBDIVISIONS/PARTS OF THE UTERUS  The uterus is divided into two main parts:  (a) the large upper pear-shaped part—the body.  (b) a small lower cylindrical part—the cervix.  The body forms upper 2/3rd of uterus and cervix forms the lower 1/3rd of the uterus.  The junction between the body and cervix is marked by a circular constriction called isthmus.  The uterine tubes are attached to the upper part of the body.  The point of fusion between the uterine tube and body is called cornu of the uterus. Dr.Vibhash
  5. 5. Body  Above the imaginary horizontal plane passing through the openings of the uterine tubes, expanded dome-like end of the body is called fundus.  The fundus is convex on all sides and covered by the peritoneum.  The body extends from the fundus to the isthmus and contains the uterine cavity.  It is flattened anteroposteriorly and presents anterior and posterior surfaces, and right and left lateral borders. Anterior surface: It is flat and directed downward and forward.  It is covered by the peritoneum up to the isthmus, where it is reflected on to the upper surface of the urinary bladder forming the uterovesical pouch. Posterior surface: It is convex and directed upward and backward.  It is covered by the peritoneum which extends downward up to the posterior fornix of the vagina, where it is reflected on the anterior aspect of rectum forming rectouterine pouch (or pouch of Douglas). Dr.Vibhash
  6. 6. 1 = anterior abdominal wall; 2 = back of the pubis; 3 = superior surface of the bladder; 4 = uterovesical pouch; 5 = posterior surface of the uterus and posterior fornix; 6 = rectouterine pouch (of Douglas); 7 = rectum. Dr.Vibhash
  7. 7. Right and left lateral border: Each lateral border is rounded and related to the uterine artery.  It is nonperitoneal for it provides attachment to the broad ligament of uterus.  The uterine tube enters the uterus at the upper end of this border.  Here the round ligament of the uterus is attached anteroinferior to the tube and the ligament of the ovary is attached posteroinferior to the tube. Dr.Vibhash
  8. 8. Cervix  It is the lower cylindrical part.  Its lower part projects into the upper part of the vagina through its anterior wall.  Thus, the cervix is divided into two parts:  (a) upper supravaginal part.  (b) lower vaginal part. Dr.Vibhash
  9. 9. Normal Position And Axes Of The Uterus  Normally the uterus lies in position of anteversion and anteflexion. Anteversion: The long axis of the cervix is normally bent forward on the long axis of vagina forming an angle of about 90°.  This position is called the position of anteversion. Anteflexion: The long axis of the body of uterus is bent forward at the level of isthmus (internal os) on the long axis of cervix forming an angle of 170°.  This position of the uterus is known as anteflexion. Dr.Vibhash
  10. 10. Relations Of The Uterus Anteriorly  The body of uterus is related to the uterovesical pouch and the superior surface of urinary bladder.  The supravaginal portion of cervix is related to the posterior surface of urinary bladder.  The vaginal portion of cervix is related to the anterior fornix of the vagina. Posteriorly  The body of uterus is related to the rectouterine pouch with coils of ileum and sigmoid colon in it.  The supravaginal portion of cervix is related to the rectouterine pouch with coils of ileum and sigmoid colon in it.  The vaginal portion of cervix is related to posterior fornix. Laterally  The body of uterus is related to the broad ligament and uterine artery and vein.  The supravaginal portion of cervix is related to the ureter and uterine artery.  The vaginal portion of cervix is related to the lateral fornices of the vagina. Dr.Vibhash
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  12. 12. Cavity Of The Uterus  The cavity of uterus is small in comparison to its size due to its thick muscular wall.  It is divided into two parts: cavity of the body and cavity of the cervix. Cavity of the Body (Uterine Cavity Proper):  It is a triangular in coronal section.  The apex of this cavity is continuous below with the cervical canal through internal os.  The implantation commonly occurs in the upper part of its posterior wall.  It is slit in sagittal section, because the uterus is compressed anteroposteriorly and its anterior and posterior walls are almost in contact. Dr.Vibhash
  13. 13. Cavity Of The Uterus…. Cavity of the Cervix (Cervical Canal):  It is a spindle-shaped canal, being broader in the middle and narrow at the ends.  It communicates anterosuperiorly with the cavity of body of uterus through internal os and inferiorly with the cavity of vagina through external os (ostium uteri).  In nulliparous women (women who have not given birth to a baby) the external os is small and circular,  whereas in multiparous women (women who have given birth to two or more babies) the external os is large and transverse, and presents anterior and posterior lips. Dr.Vibhash
  14. 14. Ligaments  The ligaments of the uterus are classified into two types: false and true.  The false ligaments are peritoneal folds whereas the true ligaments are fibromuscular bands.  The false ligaments do not provide support to the uterus while true ligaments provide support to the uterus. Dr.Vibhash
  15. 15. Arterial Supply  The uterus is supplied mainly by two uterine arteries and partly by two ovarian arteries.  The uterine artery is a branch of anterior division of internal iliac artery.  It crosses the ureter from above lateral to the cervix above the lateral to the fornix of the vagina.  Then it ascends along the side of the uterus. At the superolateral angle of uterus it turns laterally, runs along the uterine tube, and terminates by anastomosing with the ovarian artery. Dr.Vibhash
  16. 16. Venous Drainage  The veins of the uterus correspond to arteries.  They form venous plexus along the lateral borders of the uterus,  which drains into internal iliac veins through uterine and vaginal veins. Dr.Vibhash
  17. 17. Lymphatic Drainage  The lymphatic drainage of the uterus is clinically important because uterine cancer spreads through lymphatics. 1. From fundus and upper part of the body: most of the lymphatics drain into pre- and para- aortic lymph nodes along the ovarian vessels. However, a few lymphatic vessels from the lateral angles of the uterus drain into superficial inguinal lymph nodes along the round ligaments of the uterus. 2. From the lower part of the body: the lymph vessels drain into external iliac nodes via broad ligament. 3. From cervix: on each side the lymph vessels drain in three directions: a) Laterally, the lymph vessels drain into external iliac and obturator nodes by passing parametric tissue, few of these vessels are intercepted by paracervical nodes. b) Posterolaterally, the lymph vessels drain into internal iliac nodes by passing along the uterine vessels. c) Posteriorly, the lymph vessels drain into sacral nodes by passing along the uterosacral Dr.Vibhash
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  19. 19. Nerve Supply  The uterus is richly innervated by both sympathetic and parasympathetic fibres.  1. The sympathetic fibres are derived from T12–L2 spinal segments. The sympathetic fibres cause uterine contraction and vasoconstriction.  2. The parasympathetic fibres are derived from S2–S4 spinal segments. The parasympathetic fibres inhibit the uterine muscles and cause vasodilatation. Dr.Vibhash
  20. 20. Supports Of The Uterus  The uterus is kept in position and prevented from sagging down by a number of structures providing support to it.  The supports of the uterus are subdivided into two types: chief or primary supports and accessory or secondary supports. Dr.Vibhash
  21. 21. Primary Supports:- 1. Muscular (a) Pelvic diaphragm. (b) Perineal body. (c) Urogenital diaphragm. 2. Visceral (a) Urinary bladder. (b) Vagina. (c) Uterine axis. 3. Fibromuscular (a) Transverse cervical ligaments (of Mackenrodt). (b) Pubocervical ligaments. (c) Uterosacral ligaments. (d) Round ligaments of the uterus. Dr.Vibhash
  22. 22.  Secondary Supports: 1. Broad ligaments . 2. Uterovesical fold of peritoneum. 3. Rectovaginal fold of peritoneum. Dr.Vibhash
  23. 23. Clinical Correlation Cervical carcinoma: It is the most common cancer in females (11%).  The second commonest cancer in females is breast cancer (about 8%).  It is rare before 20 years of age and reaches its peak between the ages 45 and 55 years. 80% cervical cancers are squamous cell carcinoma and are related to sexual activity. Early sexual exposure and promiscuity are prominent factors.  It spreads directly to adjacent structures and metastasizes via lymphatics to pelvic lymph nodes and then to the preaortic and para- aortic lymph nodes. Caesarean section: It is the surgical procedure for delivering the baby by cutting open the abdomen and uterus in cases where vaginal delivery is not possible. Dr.Vibhash
  24. 24. Clinical Correlation..  Prolapse of the Uterus  The great importance of the tone of the levatores ani muscles in supporting the uterus has already been emphasized.  The importance of the transverse cervical, pubocervical, and sacrocervical ligaments in positioning the cervix within the pelvic cavity has been considered.  Damage to these structures during childbirth or general poor body muscular tone may result in downward displacement of the uterus called uterine prolapse Dr.Vibhash
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