Recommended
More Related Content
What's hot
What's hot (20)
Similar to Anatomy of uterus and appendages
Similar to Anatomy of uterus and appendages (20)
More from Dr. Sravani kommuru
Recently uploaded
Recently uploaded (20)
Anatomy of uterus and appendages
- 1. Anatomy of Uterus & its Appendages DR. SRAVANI KOMMURU,1ST YR PG DEPT OFOBSTETRICS &GYNAECOLOGY NRIIMS
- 2. UTERUS: thick-walled, muscular organ with narrow lumen. present in the pelvis between the urinary bladder and the rectum. Superiorly, on each side-- uterine tube inferiorly --vagina.Shape and Size : pear-shaped, being flattened anteroposteriorly Measurements: Length: 3 inches (7.5 cm). Breadth (at fundus): 2 inches (5 cm). Thickness: 1 inch (2.5 cm).
- 3. PARTSOFTHEUTERUS: DIvided into two main parts: (a) large upper pear-shaped part—thebody. (b) small lower cylindrical part—the cervix. The body forms upper 2/3rd and cervix forms the lower 1/3rd . Junction between body and cervix is a circular constriction called isthmus (0.5cm). The point of fusion between the uterine tube and body is called cornu of the uterus.
- 4. BODY Above the openings of the uterinetubes,dome-like end is called fundus. smooth muscle tissue of body is 2.5cm thick Outer –longitudinal fibres, middle- crisscross-which contain openings of blood vessels- living ligature. inner –circular muscle fibres. ISTHMUS: • Forms LUS(LOWER UTERINE SEGMENT), at 24weeks & completes at labour. • At term[ 70% isthmus &30%cervix] forms LUS measures 5cm • In labour, LUS measures 10cm
- 5. Anterior surface: flat , directed downward& forward. Covered by the peritoneum up to isthmus, reflects on the upper surface of urinary bladder as uterovesicalpouch. Anterior relations: Body -uterovesical pouch & superior surface of urinary bladder. Supravaginal portion of cervix - posterior surface of urinary bladder –loose areolar tissue. vaginal portion of cervix -anterior fornix of the vagina.
- 6. Posterior surface: • covered by the peritoneum -to posterior fornix. • reflects- anterior aspect of rectum forming rectouterine pouch (or pouch of Douglas). Posterior relations: • Body - rectouterine pouch with coils of ileum and sigmoid colon. • Supravaginal portion of cervix -rectouterine pouch with coils of ileum and sigmoid colon. • Vaginal portion of cervix - posterior fornix.
- 7. Right and left lateral border: rounded and related to the uterine artery provides attachment to the broad ligament of uterus. round ligament is attached anteroinferior to the tube ligament of the ovary is attached posteroinferior to the tube. Mackendrot ligament- from internal os down to supravaginal cervix to lateral vaginal wall. Laterally Body of uterus - broad ligament , uterine artery & vein. Supravaginal portion of cervix - ureter & uterine artery. Vaginal portion of cervix - lateral fornices of the vagina.
- 8. BROAD LIGAMENTS: Double layer peritoneum, Side of uterus to lateral wall of pelvis. 2 layers: posterior layer: forms mesovarium pierced by lateral end of fallopian tube anterior layer: free CONTENTS OF BROAD LIGAMENT: • Fallopian tubes • Ovarian vessels • Uterine vessels • Round ligament &ovarian ligament • Epoophoron & paroophoron • Ovary attatched to posterior layer
- 9. Cervix Cylindrical, measures 2.5cm cervix is divided into two parts: (a) upper supravaginal part. (b) lower vaginal part. • Cervical wall made of outer stroma- connective tissue containing collagen; only 10-15% smooth muscle • Secretions- alkaline,thick ,scanty- rich in mucoprotein, fructose,NaCl.
- 10. Cavity Of The Uterus small in comparison to its size due to thick muscular wall. Base above ,apex below: Cavity of the Body (Uterine Cavity Proper): It is a triangular in coronalsection. The implantation commonly occurs in the upper part of its posterior wall. It is slit in sagittal section, because the uterus is compressed anteroposteriorly and its both walls are almostin contact.
- 11. Cavity of the Cervix (Cervical Canal): It is a spindle-shaped canal, broader in middle, narrow at the ends. nulliparous women-external os is small and circular. multiparous women - external os is large &transverse, and presents anterior and posterior lips. • ANATOMICAL INTERNAL OS: • HISTOLOGICAL INTERNAL OS: slight change in epithelium, lies below anatomical internal os ,distance from isthmus 0.5cm
- 12. Ligaments The ligaments of the uterus are classified into two types: false and true. The false ligaments are peritoneal folds whereas the true ligaments arefibromuscular bands. The false ligaments do not provide support to the uterus while true ligamentsprovide support to the uterus.
- 13. Supports Of The Uterus: UPPER: 1.ROUND LIGAMENT – Fibrous chord (12cm) from uterine end ->internal inguinal ring - >inguinal canal ->external inguinal ring->labia majora • Hooks around Inferior epigastric artery • Peritoneum-processus vaginalis-canal of nuck 2.BROAD LIGAMENT MIDDLE: 1.TRANSVERSE CERVICAL LIGAMENT- supravaginal cervix &vaginal vault ->parietal fascia on pelvic wall 2.PUBOCERVICAL-cervix&vagina->pubic
- 14. LOWER: 3.UTEROSACRAL-cervix ->S2 vertebra • maintain anteversion of uterus. • Hypertrophy-pregnancy, atropy-after menopause 1.UROGENITAL DIAPHRAGM: • Two layered fibrous sheath between ischiopubic rami • Inserted posteriorly b/w 2 ischial tuberosities.
- 15. 2 .LEVATOR ANI: 3.PERINEAL BODY: • Pyramid shaped fibromuscular mass 4*4Cm, • Separates vulva,vagina from anus • Many blend –a)pubococcygeus b)superficial &deep transverse perinei c)eternal anal spinchter d)bulbocavernosus e)posterior border
- 16. DELANCEY’S 3 LEVELS OF SUPPORT:
- 17. Normal Position And Axes Of The Uterus Normally the uterus lies in position of anteversion and anteflexion. Anteversion: The long axis of the cervix is bent on long axis ofvagina at an angle of 90°. Anteflexion: The long axis of the body of uterus is bent at the level of isthmus (internal os) on long axis of cervix forming an angle of 170°.
- 18. • Fundus pointing towards bladder(anteriorly)= ANTEFLEXION • ANGLE of cervix &vagina= straightened obtuse angle =RETROVERSION • Fundus pointing towards rectum = RETROFLEXION
- 19. Arterial Supply The uterus - two uterine arteries and partly by twoovarian arteries. The uterine artery is a branch ofanterior division of internal iliac artery. It crosses the ureter from above,(WATER UNDER THE BRIDGE) Atthe superolateral angle of uterus it turns laterally, runs along the uterine tube, and terminates by anastomosing with the ovarian artery.
- 20. 1. Arcuate branches:surface to outer 1/3rd of myometrium 2. Radial branches: inner 2/3rd of myometrium 3. Basal arteries: basal part of endometrium 4. Spiral arteries:superficial part of endometrium UTERINE ARTERY &ITS BRANCHES: BLOOD SUPPLY OF CERVIX: • DESCENDING CERVICAL ARTERIES AT 3’0 & 9’0 POSITIONS
- 21. VENOUS DRAINAGE : They form venous plexus(pampiniform plexuses) along with ovarian veins drains into internal iliac veins uterine veins 1. The sympathetic fibres -T10–L1 spinal segments. somatic pain distribution in abdomen area of T10-L8 The sympathetic fibres cause uterine contraction and vasoconstriction. 2. The parasympathetic fibres - S2–S4 spinal segments ends in GANGLION FRANKENHAUSER. The parasympathetic fibres inhibit the uterinemuscles and cause vasodilatation. NERVE SUPPLY:
- 22. Dr.Vibhash
- 23. Histology SINGLE LAYER OF COLUMNAR EPITHELIUM & SIMPLE TUBULAR GLANDS SINGLE LAYER OF COLUMNAR EPITHELIUM &COMPOUND RACEMOSE GLANDS STRATIFIED SQUAMOUS EPITHELIUM
- 24. SQUAMO COLUMNAR JUNCTION: • Physiological- metaplasia • As age increases, SCJ move inwards into endocervix. • New SCJ arise from external os • Transformation zone is most dynamic area, pap smear taken from it.
- 25. Ovary: Each ovary is whitish in color,3*2*1cm,intraperitoneal located along lateral wall of the uterus in a region called ovarian fossa. The ovarian fossa is an area of 4 cm x 3 cm x 2 cm in size.The ovaries are surrounded by a capsule, and have an outer cortex and an inner medulla.
- 26. Ovary is attatched to lateral pelvic wall by infundibulo-pelvic ligament carries blood vessels. Volume of ovary: • In reproductive age normal upto 20cc (avg 7-8cc) • Postmenopausal age normal upto10cc(avg 3-4cc)
- 27. HISTOLOGY OF OVARY • CAPSULE: lining epithelium- single layer of cuboidal epithelium • CORTEX: contains different stages of follicles • MEDULLA: vascular layer • No. of oocytes at birth 2 million • At puberty, 4lakhs • Ovulate during life 100, • Undergo atresia- 1000/every month
- 28. BLOOD SUPPLY: • Ovarian artery –branch of Abdominal Aorta at L2 • Ovarian vein -on left side drains into Left Renal vein • -on right side drains into IVC LYMPHATIC DRAINAGE: NERVE SUPPLY: • Sympathetic T10,T11 by Aorticorenal plexuses.(OVARIES ARE SENSITIVE TO MANUAL SQUEEZING) • Parasympathetic by left and right inferior
- 29. FALLOPIAN TUBES ITS different segments are (lateral to medial): • the infundibulum with its associated fimbriae near the ovary • the ampullary(5cm) region is the major portion of the lateral tube(WIDEST 6mm), • the isthmus(3cm) segment is the narrower part(1mm) • the interstitial(1-2cm) (also Known as intramural) part is narrowest(0.7mm). • The ostium is the point where the tubal canal meets the peritoneal cavity, • The average length of a fallopian tube is 11- 12 cm.
- 30. The uterine tubes receive both sympathetic and parasympathetic innervation via nerve fibres from the ovarian and uterine (pelvic) plexuses. Sensory afferent fibres run from T11- L1. NERVE SUPPLY BLOOD SUPPLY: • Dual blood supply • Medial 2/3rd- uterine artery • Lateral 1/3rd-ovarian artery LYMPHATIC DRAINAGE: • Ostia &interstitial part : Superficial Inguinal LN • Rest of tube: Para Aortic LN DECREASED PERISTALSIS IS RISK FOR ECTOPIC PREGNANCY.
- 31. REFERENCES: 1. GRAY’S ANATOMY . 2. MUDALIAR & MENON TEXTBOOK OF OBSTETRICS.