female reproductive organ, gross anatomy of uterus, its parts,position, internal structure, its attachments, supports of uterus, blood supply and lymphatic drainage.

1. UTERUS
DR SANA YASEEN
ANATOMY DEPARTMENT

2. Is child bearing organ in women.
Is the organ of gestation in which the fertilized oocytes normally
becomes embedded and the developing organism grows until its
birth.
 Shape: pyramidal shape
 it is 7.5 cm long ,5cm broad, 2.5cm thick
It is divided into two parts
upper 2/3,expanded part Body and lower 1/3,cylindrical part
Cervix.

3. NORMAL POSITION
 Long axis of the uterus forms an angle of about 90 degrees with
the long axis of the vagina. The angle is forward. The forward
bending of uterus relative to the vagina is called ANTEVERSION.
 The uterus is flexed on itself reffered to as ANTEFLEXED .

7. Communication:
Superiorly : supero-
laterally with uterine
tube
Inferiorly : vagina

8. PARTS OF UTERUS
BODY OF UTERUS has;
Fundus
 2 surfaces
Anterior/ vesical surface: Posterior / intestinal surface
 2 lateral borders

10. Fundus ■ Is the rounded dome like part of the uterus located superior
and anterior to the imaginary plane passing thorugh the openings of
uterine tube.
- fundus is convex and coevred by peritoneum.
-The fertilized egg is implanted in the posterior wall of fundus
Body ■ Is the main part of the uterus located inferior to the fundus and
superior to the isthmus. It conatins the uterine cavity.
-The uterine cavity is triangular in the coronal section and is continuous
with the lumina of the uterine tube and with the internal os.

11. Isthmus ■ Is the constricted part of the
uterus located between the body and
cervix of the uterus. It corresponds to the
internal os.
Cervix ■ Is the inferior narrow part of
the uterus that projects into the vagina
and divides into the following regions:
1. Internal os: the junction of the cervical
canal with the uterine body.
2. Cervical canal: the cavity of the cervix
between the internal and external ostia.
3. External os: the opening of the cervical
canal into the vagina.

13. SURFACES
ANTERIOR / VESICAL SURFACE Is flat and directed ddownward and forward
Related to bladder
Covered by peritoneum up to isthmus
where it is reflected on to the upper surface of the urinary bladder forming the uterovesical
pouch.
POSTERIOR/ INTESTINAL WALL
Is related to terminal part of ilieum and sigmoid colon
Covered with peritoneum extending down upto posterior fornix of the vagina
where it reflects on the anterior aspect of the rectum forming rectouterine pouch or pouch of
Douglas

14. RECTOUTERINE POUCH
UTEROVESICAL POUCH

15. BORDERS
LATERAL
BORDERS :
Uterine tubes
Broad ligament
of uterus and its
sub types .
mesosalpinx
mesometrium

17. LAYERS OF WALL OF UTERUS
The thick wall of the uterus has 3 layers:
The endometrium is the inner layer that lines the uterus. It is made up of
glandular cells that make secretions.
The endometrium has three layers: stratum compactum, stratum spongiosum (which
make up the stratum functionalis) and stratum basalis
The myometrium is the middle and thickest layer of the uterus wall. It is
made up mostly of smooth muscle.
The perimetrium is the outer serous layer of the uterus

19. LIGAMENTS OF UTERUS
PERITONEAL LIGAMENTS:
does not provide any support to
the uterus
Anterior ligament
Posterior ligament
Right and left broad ligaments
STRUCTURES PRESENT WITHIN BROAD
LIGAMENTS:
Uterine tube
Round ligaments of uterus
Ligament of ovary
Ovarian and uterine vessels
Uterovaginal and ovarian nerve plexus
Epoophoron
Paroophoron
Lymphnodes and lymph vessels
Dense connective tissue

20. Fibromuscular ligaments/ support of uterus
1. round ligaments of uterus
2. transverse cervical ligaments
3. Uterosacral ligaments

21. BLOOD SUPPLY
Arterial supply
Mainly by uterine artery branch of anterior division of internal
iliac artery
Partially by ovarian artery branch of abdominal aorta
Venous drainage
Venous plexus

24. SUPPORT OF UTERUS
◦ Fibromuscualr / mechanical
support
1. Uterine axis
2. Pubocervical ligaments
3. Transverse cervical ligaments
4. Uterosacral ligament
5. Round ligament of uterus
Primary supports :
◦ Muscular active support
1. Pelvic diaphragm
2. Perineal body
3. Urogenital diaphragm

25. SECONDARY SUPPORT:
1. broad ligament
2. Uterovesical fold of peritoneum
3. rectovaginal fold of peritoneum

26. CLINICAL NOTES

27. UTERINE PROLAPSE
UTERINE PROLAPSE:Uterine prolapse (also called descensus or procidentia) means the uterus has descended
from its normal position in the pelvis farther down into the vagina. Due to waekening of the support of the
uterus.
TYPES OF UTERINE PROLAPSE:
Uterine prolapse can be categorized as incomplete or complete:
Incomplete uterine prolapse: The uterus is partially displaced into the vagina but does not protrude.
Complete uterine prolapse: A portion of the uterus protrudes from the vaginal opening.
The condition is graded by its severity, determined by how far the uterus has descended:
1st grade: descended to the upper vagina
2nd grade: descended to the introitus
3rd grade: cervix has descended outside the introitus
4th grade: cervix and uterus have both descended outside the introitus
More severe cases may need surgery, but in the early stages, exercises may help.

28. Symptoms of Uterine Prolapse
Symptoms will vary with the severity of your case. Mild uterine prolapses sometimes lack any symptoms at all.
For more serious cases, common symptoms include:
Typical symptoms include:
pelvic heaviness or pulling
vaginal bleeding or an increase in vaginal discharge
difficulties with sexual intercourse
urinary leakage, retention or bladder infections
bowel movement difficulties, such as constipation
lower back pain
uterine protrusion from the vaginal opening
sensations of sitting on a ball or that something is falling out of the vagina
weak vaginal tissue
Symptoms may be worse when you stand or sit for a long time, Exercise or lifting may also make symptoms
worse

29. Causes
Pelvic floor muscles can become weak for a number of reasons:
pregnancy
factors related to delivery, including trauma, delivering a large baby, or having a
vaginal delivery
getting older, especially after menopause, when levels of circulating estrogen
drop
frequent heavy lifting
straining during bowel movements
chronic coughing
History of pelvic surgery
Genetic factor leading to weakened connective tissue

30. Anterior vaginal prolapse: (cystocele or urethrocele) happens when
the bladder or urethra falls into the vagina
Posterior vaginal prolapse: (rectocele) is when the wall separating
the rectum from vagina weakens.

31. TREATMENT
Prolapse up to the third degree may spontaneously resolve with excercises.
Self-care measures. If uterine prolapse causes few or no symptoms, simple self-care
measures may provide relief or help prevent worsening prolapse. Self-care measures include
performing Kegel exercises to strengthen your pelvic muscles, losing weight and treating
constipation.
More severe cases may require medical treatment.
Options include:
Vaginal pessary: This is a vaginal device that supports the uterus and keeps it in position. It is
important to follow the instructions on care, removal, and insertion of the pessary. In cases
of severe prolapse, a pessary can cause irritation, ulceration, and sexual problems. Discuss
with your provider if this treatment is right for you.

33. Surgery:
Surgical repair of a prolapsed
uterus can be performed through
the vagina or abdomen. It involves
skin grafting, or using donor tissue
or other material to provide
uterine suspension. A
hysterectomy may be
recommended.

34. A cystocele, also known as a prolapsed bladder, is a medical condition in which a woman's
bladder bulges into her vagina.
Other names: Prolapsed bladder