This presentation is self explanatory to be beneficial for the undergraduate and postgraduate nursing students for understanding anatomy of uterus.

1. ANATOMY & PHYSIOLOGY OF
UTERUS
Priya Shyamraj
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2. Principle organs of the female
reproductive system
• Ovaries
• Uterine tubes
• Uterus
• Vagina
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3. Internal Structures (cont.)
Fig. 4.4 Internal female sexual anatomy: front view of the internal organs. Parts of the
ovaries, uterus, and vagina are shown cut away.
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4. DEVELOPMENT OF UTERUS
• Bilateral mullerian ducts
• Development of uterus & fallopian tubes
• Lower segment fuse to form uterus
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5. Simplex uterus – the entire uterus is fused
into single organ
Bicornuate Uterus : the upper part of the
uterus remain separate, but the lower parts
are fused into a single structure
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6. The Uterus
• A hollow organ about the size and shape of a pear.
• It serves two important functions: it is the organ of
menstruation and during pregnancy it receives the
fertilized ovum, retains and nourishes it until it
expels the fetus during labor.
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7. POSITION OF THE UTERUS
• Inside the pelvis
• Dorsal to the urinary bladder
• Ventral to the rectum
• Uterus usually inclines to the right (
dextrorotation)
• Cervix directs towards the left ( levorotation)
and comes in close relation with the left
ureter.
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8. AXES OF THE UTERUS
• Anteversion & anteflexion
• Anteversion is a forward angle between the
axis of the cervix and that of the vagina
measuring about 90 degrees, provided the
urinary bladder and rectum are empty.
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9. ANTEFLEXION
• anteflexion is a forward angle between the
body and cervix at the isthumus measuring
about 125 degrees, provided the bladder and
rectum are empty.
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10. RELATIONS
• Anterior : the uterovesical pouch & bladder
• Posterior : the rectouterine pouch of Douglas
and the rectum
• Lateral : the broad ligaments, the uterine
tubes and the ovaries
• Superior : the intestines
• Inferior : the vagina
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11. Internal Structures (cont.)
Fig. 4.4 Internal female sexual anatomy: (a) cross-sectional side view of female
internal structures.
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12. • Major anatomical landmarks
– Body
– Isthmus
– Cervix
– Cervical os (internal orifice)
– Uterine cavity
– Cervical canal
– Internal os (internal orifice)
Uterus
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13. The Uterus
The uterus measures about
8cm long
5cm wide at the fundus
walls are bout 1.25cm thick
Weight 50 – 80 gm
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14. Main parts of uterus
• Body or corpus
• Isthumus
• Cervix
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15. Body or corpus
• The body is further divided into
• Fundus is the part which lies above the
opening of the uterine tubes.
• Body proper is triangular and lies between the
openings of the tubes and the isthumus
• Cornua of the uterus : the superolateral angles
of the body of the uterus project outwards
from the junction of the fundus and body
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16. ISTHUMUS
• Constricted part measuring about 0.5cm
• Situated between the body and the cervix.
• Limited above the anatomical internal os and
below by the histological internal os.
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17. CERVIX
• Cylindrical in shape
• Measures about 2.5 cm
• Extends from the internal os which opens into
the vagina after perforating its anterior wall.
• The part lies above the vagina is called supra
vaginal and the part which lies within the
vagina is called vaginal part.
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18. • Endometrium
• Myometrium
• Para metrium
• Perimetrium
Uterine wall consists of three layers:
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19. The Endometrium
• The endometrium is the inner layer or
mucosa.
• A fertilized egg burrows into the endometrium
(implantation) and resides there for the rest of
its development.
• Consists of functional endometrium and basal
endo metrium.
• Damage to the basal endometrium results in
adhesion formation and fibrosis.
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20. The Myometrium
• The myometrium is the smooth muscle
component of the wall.
• These smooth muscle fibers are arranged. In
longitudinal, circular, and spiral patterns,
and are interlaced with connective tissues.
• During the monthly female cycles and during
pregnancy, these layers undergo extensive
changes.
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21. PARMETRIUM
• The loose connective tissue around the uterus
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22. The Perimetrium
• The perimetrium is a strong, serous
membrane, peritoneum that coats the
entire uterine corpus except the lower
one fourth and anterior surface where
the bladder is attached.
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23. Figure 28.19a
Figure 28.19 The Uterine Wall
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24. The Blood Supply
• The blood supply is derived from the uterine and
ovarian arteries that extend from the internal iliac
arteries and the aorta.
• The increased demands of pregnancy necessitate a
rich supply of blood to the uterus.
• New, larger blood vessels develop to accommodate
the need of the growing uterus.
• The venous circulation is accomplished via the
internal iliac and common iliac vein.
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25. • The uterine artery is the branch of the internal
iliac artery and enters at the level of the
cervix.
• Divided into
– Arcuate artery
– Radial artery
– Basal artery
– Spiral artery
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26. Figure 28.18c
Figure 28.18 The Uterus
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27. Figure 28.19b
Figure 28.19 The Uterine Wall
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29. • The uterus is primarily supported by
• Pelvic diaphragm
• Perineal body
• Urogenital diaphragm
• Secondarily supported by ligaments
Support and stabilization
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30. Figure 28.14a, b
The Ovaries and Their Relationships to
the Uterine Tube and Uterus
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31. TRANSVERSE CERVICAL LIGAMENTS
• Cardinal ligaments
• Extends from the sides of the cervix to the
side walls of the pelvis.
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32. Uterosacral ligaments
• Extends from the cervix to the sacrum
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33. Pubocervical ligaments
• Pass forward from cervix under the bladder to
the pubic bones.
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34. Broad ligaments
• Formed from the folds of peritoneum, which
are draped over the uterine tubes. They hang
down like a curtain and spread from the sides
of the uterus to the side wall of the pelvis.
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35. Round ligaments
• Arise from the cornua of the uterus in front
and from below the insertion of each fallopian
tube, and pass between the folds of the broad
ligament through the inguinal canal and are
inserted into each labia majora.
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36. Ovarian ligaments
• Begin at the cornua of the uterus but behind
the tubes and pass down between the folds of
the broad ligament to the ovaries.
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37. Figure 28.18a, b
The Uterus
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40. LYMPHATIC DRAINAGE
• Lymph from the uterine body drains to the
internal iliac glands and from the cervix to
several other pelvic lymph glands
• This provides an effective defense against
uterine infection.
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41. NERVE SUPPLY
• Autonomic nervous system, the sympathetic
and parasympathetic system via pelvic plexus.
• The nerves are derived from the hypogastric
and ovarian plexus and from the third and
fourth sacral nerves.
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42. PHYSIOLOGY OF UTERUS
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43. Facts about the menstrual cycle
• Menstruation is the periodic discharge of
blood, mucus, and epithelial cells from the
uterus.
• It usually occurs at monthly intervals
throughout the reproductive period, except
during pregnancy and lactation, when it is
usually suppressed.
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44. Facts
• The menstrual cycle is controlled by the cyclic
activity of follicle stimulating hormone (FSH)
and LH from the anterior pituitary and
progesterone and estrogen from the ovaries.
• In other words, FSH acts upon the ovary to
stimulate the maturation of a follicle, and
during this development, the follicular cells
secrete increasing amounts of estrogen.
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45. Menstrual cycle: control by hormones
• hypothalamus releases GnRH that stimulates pituitary
• pituitary produces:
– Follicle-stimulating hormone (FSH):
• Estrogen production in ovaries
• Ovum maturation in follicles inside ovaries
– Luteinizing hormone (LH):
• Stimulates release of mature ovum
• Stimulates development of corpus luteum, the progesterone-secreting
part of the follicle that remains after egg is released.
• Negative feedback mechanism
– Each hormone is secreted until the organ it acts upon is
stimulated--then that organ secretes a hormone that reduces
secretion of the first hormone.
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46. Menstrual cycle: 3 phases
1) Menstrual phase: menstruation
- Menstrual flow=endometrial tissue, blood, and mucus
2) Proliferative phase: follicles mature, release ovum
-  FSH: ovum (egg) matures inside follicle
- Egg produces estrogen: causes endometrium to thicken a little
-  LH: causes ovulation (release of mature egg from follicle)
3) Secretory phase: corpus luteum develops
- Corpus luteum develops from follicle & secretes progesterone
-  progesterone: endometrium thickens & engorges w/blood &
nutrients in preparation for implantation of a fertilized egg
- If there is no implantation, corpus luteum degenerates, and estrogen
& progesterone levels fall --> triggers menstruation.
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47. Proliferative phase:
Changes to ovaries and uterus
• Follicle matures and releases ovum
• Uterine lining begins to thicken
Fig 4.6a
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48. Fig 4.6b
Secretory phase:
Changes to ovaries and uterus
• Development of corpus luteum from follicle
(corpus luteum degenerates if there’s no implantation of a
fertilized egg in the uterus)
• Uterine lining continues to thicken
Uterine lining
continues to thicken
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49. Fig 4.6c
Menstrual phase:
Changes to ovaries and uterus
• Uterine endometrium is shed as menstrual flow
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50. Hormonal interaction of the female cycle are as
follows:
• Days 1-5. This is known as the menses phase.
• A lack of signal from a fertilized egg influences
the drop in estrogen and progesterone
production.
• A drop in progesterone results in the
sloughing off of the thick endometrial lining
which is the menstrual flow.
• This occurs for 3 to 5 days.
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51. Day 6-14
• This is known as the proliferative phase.
• A drop in progesterone and estrogen
stimulates the release of FSH from the
anterior pituitary.
• FSH stimulates the maturation of an ovum
with graafian follicle.
• Near the end of this phase, the release of LH
increases causing a sudden burst like release
of the ovum, which is known as ovulation.
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52. Day 15-28
• This is known as the secretory phase.
• High levels of LH cause the empty graafian
follicle to develop into the corpus luteum.
• The corpus luteum releases progesterone,
which increases the endometrial blood supply.
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53. Changes during
menstrual cycle
Gonadotropins (FSH, LH)
Changes in the ovary
Levels of estrogen &
progesterone
Changes in the
endometrium
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54. • Endometrial glands secrete nutrients into the uterine
cavity, helping to prepare the lining for the arrival of
the fertilized egg.
• If the egg is fertilized, the embryo produces human
chorionic gonadotropin (HCG).
• The human chorionic gonadotropin signals the
corpus luteum to continue to supply progesterone to
maintain the uterine lining.
• Continuous levels of progesterone prevent the
release of FSH and ovulation ceases
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55. • The length of the menstrual cycle is highly variable. It
may be as short as 21 days or as long as 39 days.
• Only one interval is fairly constant in all females, the
time from ovulation to the beginning of menses,
which is almost always 14-15 days.
• The menstrual cycle usually ends when or before a
woman reaches her fifties. This is known as
menopause
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56. Ovulation
• The release of an egg cell from a mature ovarian
follicle.
• Is stimulated by hormones from the anterior pituitary
gland, which apparently causes the mature follicle to
swell rapidly and eventually rupture.
• The follicular fluid, accompanied by the egg cell, oozes
outward from the surface of the ovary and enters the
peritoneal cavity.
• After it is expelled from the ovary, the egg cell and one
or two layers of follicular cells surrounding it are
usually propelled to the opening of a nearby uterine
tube.
• If the cell is not fertilized by union of a sperm cell
within a relatively short time, it will degenerate.
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57. Menopause
• Is the cessation of menstruation.
• This usually occurs in women between the ages of 45
and 50.
• Some women may reach menopause before the age
of 45 and some after the age of 50.
• Ovulation may occur sporadically or may cease
abruptly.
• Periods may end suddenly, may become scanty or
irregular, or may be intermittently heavy before
ceasing altogether.
• Markedly diminished ovarian activity, that is,
significantly decreased estrogen production and
cessation of ovulation, causes menopause.
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58. PATHOLOGY
• Prolapse of the uterus
• Carcinoma of uterus, cervix, vagina
• Fibroids
• Uterine malformations
• Infections
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59. THANK YOU
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