This document provides an overview of pelvic anatomy including the pelvis, pelvic organs, uterus, cervix, adnexa, broad ligament, vagina, retroperitoneal structures, blood vessels, lymphatics, and congenital malformations. It describes the size, shape, position and layers of the uterus and cervix. It details the structures of the ovaries, fallopian tubes, broad ligament and their blood supply. It outlines the course and tributaries of the internal iliac artery. It maps the lymphatic drainage pathways of the uterus, cervix, fallopian tubes and ovaries.

1. BASIC AND APPLIED ANATOMY
Dr ankita

2. Pelvis
Retroperitoneal
space
Ureter
Blood vessels
Lymphatics
Pelvic organs
Uterus
Adnexa

3. Uterus
Pyriform muscular organ between bladder and
rectum.
Normal uterine size: 7×5 cm at fundus
Gravid uterus:
Hen’s egg 6 wks
Cricket ball 8 wks
Fetal head 12 wks

4. Uterus
Corpus
o Fundus
o Body
Isthmus
Cervix
.

5. Position and Angulation
• Angle of anteversion- 90˚
• Angle of anteflexion- 125˚

6. Congenital malformations

7. Cervix
Phase Body: cervix ratio
At birth Cervix very long
Prepuberty 1:2
Nulliparous 2:1
Parous 3:1
Menopausal 1:1
Ectocervix: squamous
Endocervix:columnar
Original squamocolumnar junction
New squamocolumnar junction
Transformation Zone
Changes with phases of life!
MOST COMMON SITE FOR ORIGIN OF CARCINOMA!!
PAP SMEAR

8. Adnexa
Ovary
Fallopian tube

9. Ovary
2.5-5 cm ×1.5 to 3 cm ×0.7 to 1.5 cm
(reproductive life)
Normal volume: < 10 cc
Upper limit in premenopausal women: 20 ml
Upper limit in postmenopausal women: 10 ml

10. • Cortex
• Medulla
Variety of ovarian
tumors

11. • 7 to 12 cm
• Tubal ligation
Fallopian tube
Ampulla-70 % ectopic
pregnancies
Expandable
Isthmus-
Easily
ruptured

12. Broad ligament
• ROUND
LIGAMENT
• FALLOPIAN
TUBE
• OVARIAN
LIGAMENT

13. • Infundibulopelvic
ligament
• Ovarian vessels
• Ureter

14. Ovarian fossa
• Superiorly: external
iliac artery and vein
• anteriorly : broad
ligament of the uterus
• posteriorly: ureter,
internal iliac
artery and vein
• inferiorly: obturator
nerve, artery and vein

15. True broad ligament
fibroid
Pseudo broad ligament
fibroid
Arises de novo in the
broad ligament
Arises from uterus,
Grows in between two
leaves of broad ligament
Ureter can lie anywhere Ureter is lateral & below
Lacks pseudocapsule Pseudocapsule present
High risk of ureteric
injury!!

16. Supports of Uterus
Upper
Round ligament
Broad ligament
Middle
Transverse ligament
Pubocervical
Uterosacral
Lower
Urogenital diaphragm
Levator ani,
Perineal body

17. Vagina

18. Anterior cul-de-sac
• Vesicouterine
pouch
• Caesarean
section &
abdominal
hysterectomy

19. • Vaginal
hysterectomy
• Culdocentesis
• colpotomy
Posterior Cul-de-sac/
rectouterine pouch

20. Retroperitoneal structures of the
lower abdomen

21. Ureters
25 to 30 cm
Abdominal ureter: 12 – 15 cms
Pelvic brim
Pelvic ureter: 12 - 15 cm

23. Ureter dorsal to the infundibulopelvic
ligament near or at the pelvic brim
Identification of the
ureter is imperative
prior to performing
an oophorectomy

24. At the pelvic brim, ureter crosses from lateral to
medial, as well as anterior to the bifurcation of
the common iliac arteries.

25. Ureter passes under uterine arteries
(“water under the bridge”)
Skeletonization of
uterine arteries

26. Ureter enters into paracervical
tissues- Tunnel of wertheim

27. Common sites of ureteral injuries

28. Blood supply of ureter

29. Blood vessels

31. Internal iliac
artery
Vaginal(inferior vesical)
Anterior
division
Parietal
branches
•Obturator
•Internal
pudendal
•Inferior
gluteal
Visceral
branches
•Uterine
•Superior
vesical
•Vaginal
(inferior
vesical)
•Middle
rectal

32. Internal iliac artery:
Posterior division
• Iliolumbar
• Lateral sacral
• Superior gluteal

33. Blood supply of genital tract

34. Blood supply of uterus
Important to know during ligation of
blood vessels……The rich collaterals!!

35. Course of uterine artery

36. Uterine artery ligation

37. Ovarian artery ligation

38. Internal iliac artery ligation

39. Lymphatics
Follow the pelvic vessels
3 main group of lymph nodes:
• Paraaortic
• Pelvic
• Inguinal

40. Ppar
Paraaortic lymph nodes

41. Pelvic lymph nodes

42. • Common iliac
• External iliac
• Internal iliac
• Obturator
• Medial sacral
• Pararectal

43. Lymphatic drainage of the cervix
• Internal iliac
• External iliac
• Obturator
• Sacral

44. Lymphatic drainage of uterus & vagina
Uterus
Fundus : Paraaortic
Cornu :superficial inguinal
Body :external iliac
Adjacent to cervix
: cervical lymphatics
Vagina
Upper2/3rd:cervical lymphatics
Lower 1/3rd:superficial inguinal

45. Lymphatic drainage of fallopian
tube & ovary
• Ovarian vessels-
paraaortic LNs
• Broad ligament-
pelvic LNs
• Round ligament-
inguinal LNs

46. Lumbar LN
common iliac LN
External iliac LN Internal iliac LN
Deep inguinal LN Obturator LN Sacral LN
Superficial inguinal LN