UTERUS

Uterus
- Synonym
  - Hysteria , womb ,
- Definition
  - Child bearing organ in females
- Situation
  - In pelvis between bladder and rectum
  - Palpated bimanually during a per vaginal examination
  - Protects and provides nutrition to a fertilized ovum
- Size and shape
  - Pyriform
  - 7.5 cm long , 5 cm broad , 2.5 cm thick
  - Weighs 30- 40 grams
- Position and angulation
  - 90 with long axis of vagina
  - Forward tilting of uterus relative to vagina
    - Anteversion
  - Backward tilting of uterus relative to vagina
    - Retroversion
  - Slightly flexed at level of internal os of cervix
    - Anteflexion
      - 125 degree
  - Long axis of uterus corresponds to
    - Axis of pelvic inlet
- Parts
  - Upper expanded part - body
  - Upper 2/3
  - Lower cylindrical part - cervix
  - Lower 1/3
  - Junction of these two parts
    - Isthmus
    - Part of uterus above opening of fallopian tube
      - Fundus
    - Superolateral angle of body projects out
      - Cornua
  - Fundus
    - Convex like a dome
    - Covered with peritoneum
    - Directed forward when bladder is empty
    - Fertilized oocyte is usually
    - Implanted posterior wall of fundus
      - Or Upper part of body of uterus
  - Anterior / vesical surface
    - Body is flat
    - Related to urinary bladder
    - Covered with peritoneum
    - Forms
      - Posterior or superior wall of uterovesical pouch
  - Posterior / intestinal surface
    - Convex
    - Related to coils of terminal ileum and to sigmoid colon
    - Covered with peritoneum and forms anterior wall of rectouterine pouch
  - Lateral border
    - Convex and rounded
    - Provides attachment to broad ligament of uterus
    - Connects to lateral pelvic wall
    - Uterine tube opens in to uterus
      - At upper end of this border
    - End of this border
      - Anteroinferior to tube
        
        Gives attachment to round ligament of uterus
      - Posteroinferior to tube
        
        Ligament of ovary
    - Uterine artery ascends along the lateral border of uterus between two layers of broad ligament
- Cavity of uterus
  - Sagittal section
    - It is a mere slit
    - Compressed anteroposterior
  - Coronal section
    - Triangular in shape
  - At Apex
    - Becomes continuous with canal of cervix
    - Junction called as internal os
- Cervix
  - Supravaginal part
- Relation
  - Anterior
    - Bladder
  - Posterior
    - Rectouterine pouch containing coils of intestine and rectum
  - Each side
    - Ureter and to uterine artery embedded in parametrium
- Vaginal part
  - Projects in to anterior wall of vagina
  - Space between it and vagina
    - Fornices
  - Communication
    - Externally by external os
      - Nulliparous women
        
        Small and circular
      - Multiparous women
        
        Bounded by anterior and posterior lips
- Cervical canal
  - Cavity of cervix.
    - Fusiform in shape
  - Internal os
    - Canal is flattened
      - Anterior wall
      - Posterior wall
      - Walls show
        
        Mucous folds
        
        Arbor vitae uteri
        
        Folds interlock with each other to close the canal
- Ligaments of uterus
  - Peritoneal ligaments
    - Anterior ligament
    - Uterovesical fold of peritoneum
    - Posterior ligament
    - Rectovaginal fold forming rectovaginal pouch of peritoneum
    - Broad ligaments ( right and left )
      - Bladder to lateral pelvic wall
        
        Surfaces
        
        Anterior , posterior
        
        Borders
        
        Upper , lower , medial , lateral
        
        Upper border is free
    - Mesoovarium
      - Attached to posterior later of braod ligament
    - Mesosalpinx
      - Suspensory ligament of ovary or infundibulopelvic ligament
    - Broad ligament consists of following structures
      - Uterine tube
    - Round ligament
    - Ligament of ovary
    - Uterine vessels
    - Ovarian vessels in infundibulopelvic ligament
    - Uterovaginal and ovarian nerve plexus
    - Epoophoron
    - Paraphooron
- Fibromuscular ligaments
  - Round ligament of uterus
  - Transverse cervical ligament
  - Uterosacral ligament
- Arterial supply
  - Uterine artery
  - Division of internal iliac artery
  - Partly by ovarian artery
- Venous drainage
- Lymphatic drainage
- Nerve supply
- Supports of uterus
- Primary supports
  - Muscular or active supports
  - Pelvic diaphragm
  - Perineal body
  - Distal urethral sphincter mechanism
- Fibromuscular or mechanical support
  - Uterine axis
  - Pubocervical ligament
  - Transverse cervical ligament of mackenrodt
  - Uterosacral ligament
  - Round ligament of uterus
- Secondary support
  - Broad ligament
  - Vesicputerine pouch and fold of peritoneum
  - Rectovaginal pouch or rectouterine pouch and fold of peritoneum
- Role of individual supports
  - Pelvic diaphragm
  - Perineal body
  - Urethral sphincter mechanism
  - Uterine axis
  - Pubocervical ligaments
  - Transverse cervical ligaments of mackenrodt
  - Uterosacral ligaments
  - Round ligament of uterus