Internal female genital organs. Uterus

1. THE UTERUS
The Uterus
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DR. RAM VEER SHARMA
DR. RAM VEER SHARMA
M.D. Ayu. (PT&SR)
I.P.G.T.&R. Jamnagar
MMM Govt. Ayu. College UDAIPUR
Mob. 9414757932
Email. ramveersharma1960@gmail.com

2. THE UTERUS
Definition :-
The uterus or womb is an internal genital organ for ,
• Menstruation,
• Sperm transportation,
• Sperm capacitation,
The Uterus
• Sperm capacitation,
• Embryo embedding, and-
• Child birth in woman .
 Shape:- Hollow and Pyriform.
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3. Situation:- fiÙkiDok”k;kseZ/;s xHkZ”k¸;k ;= xHkZ fr’BfrAA
 It is lies at about center of the pelvic cavity, in between
• Front - Urinary bladder.
• Behind - Rectum.
The Uterus
• Behind - Rectum.
• The external os lies at the level of ischial spine.
• Top of the uterus (funds) lies below the plane of the pelvis
inlet.
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4. Size:- In nulliparous,
• Length - 3"= 7.5 Cm.
• Breath - 2" = 5.0 Cm
• Each wall- 1.24 Cm. Thick
• Thickness- 1"= 2.5 Cm.
• Weight- 45 to 80 Gm.
The Uterus
• Weight- 45 to 80 Gm.
 Volume of cavity-10 ml to 5000 ml during pregnancy.
• Loeqf’Bizek.k foLrkj%A
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5. Parts - (3)
A) Corpus or body of uterus= Upper 2/3= about 5Cm.
The Uterus
B) Isthmus = Junction of corpus with cervix= 0.5 Cm.
C) Cervix = Lower 1/3 = about 2.5 Cm.
 Supra vaginal- upper ½ = 1.2 Cm.
 Vaginal or portio vaginalis- lower ½= 1.2 Cm.
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6. Parts - (3)
D) Cavity:- In sagital section – Narrow, and slit.
Triangular at cornual end
Length- external os to fundus = 6.5Cm.
Cervical canal = 1" = 2.5 Cm.
The Uterus
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7. Development of the uterus
The Uterus
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8. Position :-
 The fundus is directed to symphysis pubis,
The Uterus
 And the cervix looks downwards and backwards.
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9.  Anteverted- ( Bent to front)
 Angle between uterus and vaginal axis - 90º.
The Uterus
 Anteflexed ( Bent at own axis)
 Angle between uterine cornu and cervix - 125 -140º.
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10. (a) Corpus Uteri
Relations -
 Anterior - Superior surface of bladder & utero vesicle pouch
 Posterior - Pelvic colon
The Uterus
 Posterior - Pelvic colon
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11. Corpus Uteri
 Lateral-
 Broad ligament,
 Round ligament,
 Ovarian ligament
 Fallopian tubes and ureters.
The Uterus
 Fallopian tubes and ureters.
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12. Corpus Uteri
Structure
 It is a hollow, Sera muscular structure.
 Lined with mucous membrane without any sub mucous layer.
The wall is consist of 3 layers,
The Uterus
1) Serous layer (Perimetrium)
 It covered the funds and anterior surface of the body.
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13. 2) Muscular Layer (Myometrium)
 It is formed by – bundles of smooth muscle fibers,
 Separated by fibers tissue through which runs the Blood
vessels, Nerves end, and Lymphatic's.
 This muscular layer is arranged in three layers , which is well
developed during pregnancy.
The Uterus
developed during pregnancy.
Layer Outer Middle Inner
Fibre arrangement Longitudinal Cross Circular
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14. A) Outer ( Longitudinal) Layer:- It is thin layer.
 It running Hood like from before over the funds to backwards
and stop short at the internal os label.
 It does not cover the sides of the uterus where blood vessels are
entered.
• It covers the uterine cornu on each side of uterus to be
The Uterus
• It covers the uterine cornu on each side of uterus to be
continued on fallopian tubes and round ligament.
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15. B) Middle ( Vascular) Layer:-
 It forms the main bulk of the wall.
 The muscle fibbers are – deposited as figure of 8, around the
vessels and thus acts as physiological ligatures to the
myometrial vessels during contractions.
The Uterus
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16. C) Inner (Circular) Surface:-
 It is present at all levels but chiefly developed at tubal astia and
the internal os. And it act as valve of uterus.
The Uterus
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17. 3) Mucous Layer (Endometrium) :-
 The endometrium is directly opposed to the muscles coat with
out sub mucous coat.
 The thickness of this layer in various phases is 1 to 6mm.
Structure of epithelial lining :-
a) Surface epithelium :-
The Uterus
a) Surface epithelium :-
 Consist of a single layer of low columnar cell, resting on a
basement membrane. It is ciliated.
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18. 3) Mucous Layer (Endometrium) :-
 Glandular:- The glands are the ingrowths of the surface
epithelium and are simple tubular type lined, but no ciliated.
• Electronic microscopically:- epithelium shows two type of
epithelial cells, are
(i) Secretary cells with microvilli.
The Uterus
(i) Secretary cells with microvilli.
(ii) 5 to 15% intervening ciliated cells.
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19. b) Stroma :- are supporting tissue, arranged in three layers.
 Satellite :- these are connective tissue cells with branching
fibrils.
 Stroma cells are embryonic mesenchymal cells and assume
various shapes and size. Elliptical, round or fuci form.
The Uterus
It undergoes changes under hormonic stimulation.
Lymphatic's and polymorphonuclear lymphocytes are also
present.
Blood and lymph vessels are also present with nerve ending.
 Secretion:- Is scanty, watery , and alkaline fluid, it baths the
endometrial surface. DR. RAM VEER SHARMA

20. The Cervix
 The cervix is the lowest part of the uterus = 1“ -2.5 Cm.
 It is extended from the histological internal os and end at
external os which opens in to the vagina.
Shape:- Almost cylindrical,
The Uterus
Status Shape of cervix Shape of the external os
Nulliparous Conical looking Circular
Parous Cylindrical having bilateral Slit
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21. Relations
Anterior:- Supra vaginal-
 Bladder,
• Utero vesicle pauch,
• Anterior vaginal fornix.
The Uterus
• Anterior vaginal fornix.
Posterior :-
• Pouch of Douglas
• Posterior vaginal fornix
• Utero sacral ligament
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22. Relations:-
Lateral:-
• Lateral vaginal fornix
• Broad ligament
• Perimetrium
• Cardinal ligament
The Uterus
• Cardinal ligament
• Uterine vessels
• Ureter
• Para cervical lymphatic's.
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23. Structure- 3 Layers.
a) Serious layer:- It covers only posterior surface of supra vaginal
cervix.
b) Muscular layer:- Fibrous and elastic tissues,
Mixed with 10-15% involuntary muscles, and
Arranged spirally, the sides of portio vaginalis is thinner.
The Uterus
Arranged spirally, the sides of portio vaginalis is thinner.
c) Mucous layer:-
 Endo cervix :-Internal os to external os.
 Single layer of tall mucified , secretory, columnar cells with
basal nuclei and with surface micro villi, intervening a few
ciliated epithelial cells.
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24. • Portio vaginalis :-
 Is covered with Squamous epithelium like that of vagina.
 It covers external os to Cervico vaginal junction.
d) Transitional epithelial zone:- At the external os-
 The epithelial lining abruptly change from columnar to
The Uterus
 The epithelial lining abruptly change from columnar to
squamous epithelium.
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25. Limit of transitional zone -
 The lining may exist 1 to 10mm.
 The level of squamo columnar junction varies at different
period of life.
During estrogenic stimulation as in –
• Postnatal period,
The Uterus
• Postnatal period,
• Puberty,
• Pregnancy,
• The endo cervical epithelium may extend up to
portiovaginalis.
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26. Secretion
 The secretion is –
• Reaction - Alkaline –Ph.7.8, mucous, like unboiled white egg.
• Volume:- 20 to 60 Mg. / day.
• And it increase during M.C. period up to - 700Mg. / day.
 Composition - The mucouse is rich in-
The Uterus
 Composition - The mucouse is rich in-
• Fructose,
• Glycoprotein and
• Mucopolisachrides,
• Nacl.
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27. The physical and chemical properties of cervical secretion
change with (Hormonal influence) menstrual cycle, and with
pregnancy.
(i) Under estrogenic stimulation- Glycoprotein network is
arranged parallel to each other, thus facilitating to sperm
The Uterus
ascent.
(ii) The progesterone - Produces interlacing bridges thereby
preventing sperm penetration.
• A part forms the mucous plug which functionally closes
cervical canal and has got bacteriolytic property.
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28. Changes
 At ovulation:- Secretion becomes copious,
 More elastic
 Less viscous
 Less cellular.
The Uterus
 Less cellular.
• After ovulation :- The changes are reversed.
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29. Ferning of Cervical Mucouse
 Ferning of cervical mucous is an ovulatory characteristic sign ,
which becomes absent following ovulation.
The Uterus
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30. Cause of Ferning
• Nacl interacts with mucin in cervical mucous to cause Ferning
pattern of cervical mucous during ovulation.
Ferning of mucus is -
a. Started at - 4 to 6 day of cycle.
The Uterus
b. Becomes maximum at - 24 to 48 Hrs before ovulation.
c. Reduction started after - 24 to 72 Hrs of ovulation.
d. Completely absent 22 day of cycle.
• If Iern test is + Ve after 22 days – Indicate to Anovulation.
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31.  Ph. Of cervical mucus :- * In proliferative phase - 6.8.
* Secretory phase - 6.1.
* Normally mean - 6.8.
Chemical Contains :-
 Water- 85 to 90 %,
The Uterus
 Water- 85 to 90 %,
 Mucoid or mucine – 25 % amino acid, and 17 % galactose.
Salic acid, Albumin, Globulin, Lipoprotein, Immunoglobulin,
Cholesterol, Nacl, Potassium and Prostaglandins.
DR. RAM VEER SHARMA

32. Changes in Body and Cervix with Age and Parity
a. In intrauterine life - The proportion between body and cervix
1 : 5 or 6.
b. At birth - Organ is about = 2.5 Cm. = 1 : 3.
c. After puberty ( corpus grows quicker) organ is about - 7.5Cm.
The Uterus
d. The parous uterus is about 25% longer in size than adult
nulliparous uterus.
e. After menopause- atrophies, length is reduced, walls are
thinner and more fibrous. The Portio vaginalis atrophies and
may disappear.
DR. RAM VEER SHARMA

33. Functions of the Cervix
• Internal os act as uterine sphincter, remaining close during
pregnancy, and only opens during labour.
• Freely secretes mucous during coitus, this lubricates as well as
neutralizes acid reaction of vagina, whereby the sperms
survive longer.
The Uterus
survive longer.
• Offers a barrier against ascending infection except during
menstruation, abortion, or labour.
• During pregnancy , the cervical secretion is very viscid and
act as a non permeable canal through which neither sperm nor
bacteria can pass.
DR. RAM VEER SHARMA

34. Functions of the Cervix
• Reception of sperm, penetration at ovulation time.
• Sperm reservoir,
• Protect to sperm from vaginal acidity.
• Energy providing to sperm (nutrition – Fructose contents)
• Filtrating to defective sperms.
The Uterus
• Filtrating to defective sperms.
• Possibly helps in sperm capacitation.
DR. RAM VEER SHARMA

35.  Blood Supply - Two Main Sources
1) Uterine Artery:-
 Internal iliac artery (Anterior division) Uterine artery
enter near uterine cornu.
Branches:-
a. Fundal branch:- which gets distributed to fundus,
The Uterus
a. Fundal branch:- which gets distributed to fundus,
b. Tubal branch :- through mesosalphinx to fallopian tube.
c. The ovarian anastomosus with terminal branch of ovarian
artery.
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36. 1) Uterine Artery:-
Course of Artery - It runs Downwards & Forwards - along
with lateral pelvic wall.
 Almost in the same direction as the Ureter, until is reach at the
Base of the broad ligament.
 Than, at the level of internal os,
The Uterus
 Than, at the level of internal os,
 It turn medially and cross the Ureter anteriorly from above and
at right angle to it. 1.5 to 2 Cm. lateral.
DR. RAM VEER SHARMA

37. 1) Uterine Artery:-
Course of Artery -
 On reaching the side of the uterus:-
 It runs downwards and take a spiral course, along the lateral
uterine wall between the layer of broad ligament.
 It ultimately anastomoses and end on with the tubal branch of
The Uterus
 It ultimately anastomoses and end on with the tubal branch of
ovarian artery in Mesosalpinx.
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38. .
The Uterus
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39. Branches:- On the pelvic floor:-
a. Uterine artery,
b. Descending Cervicovaginal branch, (From just before the
uterine artery comes in relation to the uterus) Supply to
Portiovaginalis and upper part of vagina.
(i) Circular (Arcuate) artery:-
The Uterus
(i) Circular (Arcuate) artery:-
• To the cervix which anastomosus of anterior with posterior.
• The body :- Segmental arcuate artery :- Anterior and posterior
are given the blood to outer third of myometrium and
Anastomosus with each other.
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40. The Uterus
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41. (ii) Basal endometrial artery :-
 Are supply to the basal portion of endometrium.
 The remains uninfluenced by hormones and left unaffected
during menstruation.
The Uterus
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42. (2) Ovarian Artery
It arises one on each side,
 Site:- From the anterior surface of aorta a little below the
origin of the renal artery.
 Course:- It enters the pelvic cavity through infundibulo pelvic
ligament and the hilum of the ovary.
The Uterus
ligament and the hilum of the ovary.
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43. (2) Ovarian Artery
Branches :-
a. Ovarian artery :- Supply to ovary through hilum.
b. Tubal branch :- Are given vertically in the mesosalphinx , the
lateral part of the fallopian tube.
c. Uterine branch :- It also supply the upper part of the corpus
The Uterus
c. Uterine branch :- It also supply the upper part of the corpus
uteri.
d. Utero tubal branch.
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44. (2) Ovarian Artery
Branches :-
e. Round ligament branch.
f. Uterine anastomosus :- the artery is terminates near the
uterine cornu, and anastomosus with the ovarian branch of the
uterine branch.
The Uterus
uterine branch.
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45. Intrinsic Blood Supply
 From the Arcuate artery A few peripheral branches Supply
to the Myometrium.
 The Radial branches :- Are given perpendicularly inwards-
which course spirally through the myometrium and coverage
The Uterus
which course spirally through the myometrium and coverage
towards the endometrium.
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46. Intrinsic Blood Supply
 At the myoendometrial junction -
 The radial artery terminate in to two sets of vessels.
(a)Basal endometrial artery to basal layer of endometrium.
(b)Spiral endometrial artery supply to Superficial portion of
The Uterus
(b)Spiral endometrial artery supply to Superficial portion of
the endometrium and finally end in extensive capillary plexus.
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47. Intrinsic Blood Supply
c. Arterio venosus:- Anastomosus between the terminal
branches of spiral arteries and venous lakes.
 The spiral arteries undergo changes by hormonic stimuli,
becomes effected during menstruation, and are said to be the
The Uterus
becomes effected during menstruation, and are said to be the
Arteries of menstrual bleeding.

48. Intrinsic Blood Supply
The Uterus
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49. Veins :- Drainage -
(A) Arcuate vein (from Endometrium, Myometrium)
drains in to Uterine vein
drains Internal iliac
Tendency to form plexuses.
i. The plexuses anastomos freely with each other.
The Uterus
i. The plexuses anastomos freely with each other.
ii. The veins may not follow the course of the arteries.
iii. They have no valves.
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50. (B) Ovarian vein:-
 Pampiniform Plexus:- (Which are lies in between the layers
of broad ligament near the mesovarium beyond the infundibulo
pelvic ligament)
Drains
 In two ovarian veins on each side.
The Uterus
 In two ovarian veins on each side.
Drains (Which ascend up along the course of the
corresponding artery )
 The veins go higher up, becomes one and ultimately drains,
i. One on the left - in to left renal vein.
ii. Other on right - in to inferior vana cava.
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51. Lymphatics -
(A)Intrinsic lymph drainage:-Endometrial plexus (Two plexus )
a. Basal layer of endometrium from the basal layer
b. Sub serous layer. Run through the myometrium
to reach in close relation to blood vessels.
The Uterus
(B) Extrinsic lymph drainage :- From
Funds -Adjoining part of the corpus drains ovarian
lymphatic's drains Para aortic lymphatic's.
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52. Lymphatics -
Cornu :-
 From tubal attachment drains lymphatic trunk in round
ligament Drains
Superior inguinal group.
 Lower part of corpus drains in cervical lymphatic's
The Uterus
 Lower part of corpus drains in cervical lymphatic's
Drains
External iliac group.
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53. Cervix :- Perimetrium group ( in constant,)
 Internal iliac group
 Lumber group Para aortic sup.
 Obturator group all drain in to
External iliac group ( anterior & medial)
Common iliac group.
The Uterus
Common iliac group.
 Sacral group
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54. Nerves :-
 The uterus has a nerves supply from the (principally)
Sympathetic and Parasympathetic nerve system.
 Although it has the power of rhythmic contraction
independently by extrinsic nerve supply.
(A)Sympathetic:-
The Uterus
(A)Sympathetic:-
 Motor nerve - from – T12 – L5 (D5 –D6)
 Sensory nerve - from – T10 – L1.
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55. Nerves :-
 Para sacral plexus - (at bifurcation of aorta and 5th lumber
vertebrae)
• Inferior hypo gastric plexus—in the Perimetrium.
• Pelvic plexus – by –parasacral ganglia
 Sympathetic nerve fibers terminate between, muscle fibers
The Uterus
 Sympathetic nerve fibers terminate between, muscle fibers
and also run along the arteries to the endometrium.
• Although sympathetic appear to be sensory and motor to the
uterus, But the motor function is les understood as uterine ,
nerve play a little part in the contractibility of the uterus.
DR. RAM VEER SHARMA

56. • The sympathetic are vasoconstrictors.
• The sympathetic nerve function of the uterus is hormone
dependent.
• Pain of uterine origin has got a somatic distribution to the
lower abdomen, supplied by T10 - L1.
(B) Para Sympathetic :-
The Uterus
(B) Para Sympathetic :-
• Both motor and sensory nerves are derived from - S2-S3-S4
Segment. Through pelvic plexus to --- the cervix and lower
uterus.
• The motor function is minimal.
DR. RAM VEER SHARMA

57. The cervix:-
• Pain sensation from cervix is referred to mid sacral region of
back at S2-S3-S4 region.
Uterine corpus and cervix are relatively insensitive to handling,
incising, and burning by cauterization.
The Uterus
incising, and burning by cauterization.
How ever pain can feel , arises on stretching the cervix by
dilators, and distending the uterus by gas or any other device.
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58. Innervation of female genital organs
The Uterus
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59. Supports of Uterus
(i)Uterine ligaments, (ii) The vagina, (iii) The pelvic floor, (iv)
The pelvic cellular tissue.
• Ligaments:- (4) Are arranged around the cervix and vaginal
vault like that of a cort wheel.
(1) Cardinal or Mackenrodts Ligament
The Uterus
(1) Cardinal or Mackenrodts Ligament
• One on each side.
• It extending from – supra vaginal cervix, lateral vaginal vault
and wall (above) the lavator ani muscle.
• And terminated in the lateral pelvic fascia.
DR. RAM VEER SHARMA

60. Supports of Uterus
• Functions:- The ligament forms the chief support of the uterus
and / sling the uterus and vagina up and normal position.
(2) Uterosacral Ligament
• Are paired ligaments.
• Running from the posterior surface of the isthmus- backwards
The Uterus
• Running from the posterior surface of the isthmus- backwards
and slightly outwards on each side of the rectum.
• And are inserted to the sacrum at the level of junction of 2nd-
3rd sacral vertebrae.
• Function:- They helps to keep the uterus in Anteverted
position by bracing back the cervix towards the sacrum.
DR. RAM VEER SHARMA

61. (3) Pubocervical Ligament :- (Sub vesicle fascia)
• These are paired ligaments.
• Runs anteriorly –from the cervix and , anterior vaginal vault,
pass along the base of bladder and are,
• Inserted in to the back of the pubis.
The Uterus
• Functions:-
• It gives a base to the bladder, and helps to ante flexed position.
DR. RAM VEER SHARMA

62. (4) Round Ligament :- Pairs ligaments, right and left.
• These are cord like - about -10 Cm.log.
• Structure is of fibro muscular.
• Attached – on each side at uterine cornu, below and in front of
the tubes attachment.
The Uterus
• Pass laterally and forward underneath the anterior layer of the
broad ligament to the internal inguinal ring- it transverse the
inguinal canal and – it insert in labium majus.
• Functions:- They seem to keep the uterus in the position of
Anteversion.
DR. RAM VEER SHARMA

63. (5) Broad Ligament :- Are
• Double fold of peritoneum,
• Functions :- Stretching from the side of the uterus to the
lateral pelvic wall.
• Slight action in support and steadying the uterus.
The Uterus
DR. RAM VEER SHARMA

64. The Uterus
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65. The Uterus
6/23/2022 DR. RAM VEER SHARMA