III.

UTERUS
 a.k.a Womb
 Embryonic Origin: Mullerian Duct
 Area where the embryo and the fetus develops
 It is also the site of reception and nutrition of the fertilized ovum
 Usual position of the adult uterus:
 ANTEVERTED in relation to the VAGINA tipped 90 degrees
anterosuperiorly relative to the axis of the vagina
 ANTEFLEXED in relation to the CERVIX flexed or bent
anteriorly relative to the cervix, creating the angle of flexion,
so its mass lies over the bladder

Figure __. Different Uterine Positions

Figure __. Uterus and Vagina
B. PARTS OF THE UTERUS
 Cornu/ Uterine horns: superolateral regions of the uterine
A. UTERINE DISPLACEMENT cavity, that opens to the fallopian/uterine tube
 RETROVERSION
 Body of Uterus: rounded part that lies between the layers of the
 Occurs when the fundus and the body are bent BACKWARDS broad ligament and is freely movable.
on the vagina so that they lie in the retrouterine pouch.
 Forms the superior two thirds of the organ
 It has 3 degrees:
 Two surfaces: Vesical (bladder) and Intestinal
 1st degree: the cervix corpus axis is anterior to vaginal axis
 Fundus of the uterus:
 2nd degree: along the vaginal axis
 Part of the body; the rounded part that lies superior to the
 3rd degree: beyond the vaginal axis
uterine ostia.
 RETRODISPLACEMENT
 Superior part of the cornu
 Causes:
 Isthmus: a relatively constricted segment, approximately 1 cm
 Parturition “act of giving birth”
long, that demarcated the body from the cervix
 Adhesion of tumor or infection
 Cervix: the cylindrical, relative narrow inferior third of the uterus
 Age
 Atrophy or loss of muscle tone  Lower most portion of the uterus
 Two parts: supravaginal (between the isthmus and vagina)
and vaginal (which protrudes into the superiormost anterior
Note:
vaginal wall
1. Retroversion is the posterior bending backward of the body on
the cervix  The rounded vaginal part surrounds the external os of the
2. Retrocession is the slumping backward of the cervix and uterus and is surrounded in turn by a narrow recess, the
vaginal apex to the coccyx vaginal fornix
3. Anteflexion is the bending forward of the body of the cervix  The supravaginal part is separated from the bladder anteriorly
by loose connective tissue and from the rectum posteriorly by
the recto – uterine pouch
 The amount of muscular tissue here is markedly less than in
the body of the uterus
 It is mostly fibrous and composed mainly of collagen with a
small amount of smooth muscle and elastin
 Uterine Cavity: slit – like, approximately 6 cm in length from the
external os to the wall of the fundus; continues inferiorly as the
cervical canal.
 The fusiform canal extends from a narrowing inside the
isthmus of the uterine body, the anatomical internal os,
through the supravaginal and vaginal parts of the cervix,
communicating with the lumen of the vagina through the
external os.

TRANS Ilagan, R., Infantado, Isidro, Isuriña, Jiao CORE Huplo, Ignacio, Limjoco, Macatangay, Medina K. REP Fernandez L. (09175821193)
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 The uterine cavity (in particular, the cervical canal) and the  Muscles and structures that make up the pelvic
lumen of the vagina together constitute the birth canal, diaphragm:
through which the fetus passes at the end of gestation.  Levator ani muscle (PIP):
 Pubococcygeus
 Iliococcygeus
 Puborectalis
 Superior and inferior fascial layer of the urogenital diaphragm
 Coccygeus (ischiococcygeus)

Figure __. Muscles compressing the urethra and vagina

 Ligaments:
 Ligament of the ovary
 Attaches to the uterus postero – inferior to the utero –
tubal junction
 Round ligament of the uterus (ligamentum teres uteri)
 Most anterior-inferior portion of the uterus pass into the
inguinal canal and insert itself into the labia majora
 The spermatic cord is the homologue of the round
Figure__. Internal female genital organs ligaments
 Helps keep the uterus anteverted and anteflexed
C. WALLS/ LAYERS OF THE BODY OF THE UTERUS  Will hypertrophy during pregnancy, giving stability to the
 Perimetrium: the serosa or outer serous coat, consisting of uterus; stretching causes pain to pregnant women at
peritoneum supported by a thin layer of connective tissue term
 Myometrium: the middle layer/coat of smooth muscle, consisting  Sampson Artery, a branch of the uterine artery runs
of smooth muscle. It becomes greatly distended and thinner within the round ligament
during pregnancy  Together with the ligaments of the ovary, they form the
 The main branches of the blood vessels and nerves of the vestiges of the ovary gubernaculum, related to the
uterus are within this layer relocation of the gonad from its developmental position on
 During childbirth, contraction of the myometrium is hormonally the posterior abdominal wall
stimulated at intervals of decreasing length to dilate the  Transverse cervical (Mackenrodt’s) or Cardinal Ligament
cervical os and expel the fetus and placenta  Contains the uterine artery
 Endometrium: the inner mucous layer/coat that is firmly  Attaches to the cervix, to that of the isthmus from the
adherent to the underlying myometrium. cervix to the lateral pelvic wall
 If conception occurs, the blastocyst becomes implanted in this  Main support of the uterus, and damage to this ligament
layer; if conception does not occur, the inner surface of this causes prolapsed uterus
coat is shed during menstruation.  Broad Ligaments of the Uterus (4 Regions of the Broad
 2 layers: Ligament):
 Stratum Basale  Double layer of peritoneum (mesentery) that extends from
 Contains straight arteries the sides of the uterus to the lateral walls and floor of the
 Stratum Functionale pelvis
 Assists in keeping the uterus in position
 Only layer that is shed during menstruation
 The 2 layers of broad ligament are continuous with each
 Contains spiral arteries
other at the free edge that surrounds the uterine tube
 Mesosalpinx
D. SUPPORTS OF THE UTERUS  A small mesentery, contains the uterine tubes
 Pelvic diaphragm  Lies in the anterosuperior free border of the broad
 Most dynamic support that is given to the uterus during birth ligament
and delivery  Mesovarium

TRANS Ilagan, R., Infantado, Isidro, Isuriña, Jiao CORE Huplo, Ignacio, Limjoco, Macatangay, Medina K. REP Fernandez L. (09175821193)
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 A small mesentery that contains the ovary  A CS cut done at the area of the isthmus following the
 Lies in the posterior aspect of the broad ligament orientation of muscle fibers offers the advantage of having a
 Mesometrium normal vaginal delivery on the next delivery due to less
 Largest part of the broad ligament, inferior to the disruption of the muscle fibers.
mesosalpinx and mesovarium  The vertical classical cesarean section does not follow the
 Serves as a mesentery for the uterus itself schema of musculature, causing more scarring, which makes
 Suspensory ligament of the ovaries it prone to rupture
 Derivative of the broad ligament
 Prolonged superiorly over the vessels, located laterally
to the peritoneum of the broad ligament
***The cervix has no broad ligament
o Pampiniform plexus, a collection several veins are
located here
o With the uterus, it forms a septum that divides the
cavity of the lesser pelvis into 2 parts: Anterior
(contains the urinary bladder) and Posterior
(contains the rectum, terminal ileum and part of
the sigmoid colon)
 Dynamic and Passive support of the uterus:
 Principal supports of the uterus holding it in position and to
resist the tendency for the uterus to fall or be pushed through
the vagina
 Dynamic or Active support
 Provided by the pelvic diaphragm
 Passive support
 Provided by its position – the way in which the normally
anteverted and anteflexed uterus rests on top of the
bladder
 The cervix is the least mobile part of the uterus
because of the passive support provided by attached Figure __. Schema of Musculature
condensations of endopelvic fascia (ligaments), which
may also contain smooth muscles: E. RELATIONS OF THE UTERUS
o Uterosacral or Sacrocervical ligament  Peritonium covers the uterus anteriorly and superiorly, except
 Keeps Uterus attached to the sacrum for the cervix
 Palpable during rectal examination on lean  Anteriorly (antero-inferiorly in its normal anteverted position)
patients  Vesicouterine pouch: separates uterus and bladder; cut
o Cardinal or Transverse cervical ligament during caesarian section to avoid dissecting the bladder
 Extend from the supravaginal cervix and lateral  Posteriorly
parts of the fornix of the vagina to the lateral walls  The recto-uterine pouch or pouch of Douglas containing
of the pelvis loops of small intestine and the anterior surface of rectum
(important in hysterectomy)
 Laterally
 The peritoneal broad ligament flanking the uterine body and
the fascial cardinal ligaments on each side of the cervix and
vagina
 With the Uterine Artery:
 From the internal iliac artery, it runs medially in the broad
ligament → crosses above the ureter → reaches cervix at the
level of the internal os → anastomose with ovarian artery.
 Important clinically because it is closely related to the course
of the ureter. In hysterectomy, the uterine artery is ligated
(but if dissection is done more laterally then the ureter may
be accidentally cut).
Water (ureter) under the bridge (uterine artery): the uterine
artery will cross over the ureter

Figure __. Supports and ligaments of the uterus

E. SCHEMA OF MUSCULATURE
 Direction is deep, spiral, circular fibers both clockwise & counter-
clockwise (from fundus to body of the uterus)
 Level of the isthmus to the cervix, horizontally or transversely
oriented fibers
• Clinical Implications:

TRANS Ilagan, R., Infantado, Isidro, Isuriña, Jiao CORE Huplo, Ignacio, Limjoco, Macatangay, Medina K. REP Fernandez L. (09175821193)
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Figure __. Blood supply and venous drainage of the internal

Figure __. Relations of the female pelvic viscera
female genital organs

G. ARTERIAL SUPPLY I. LYMPHATIC DRAINAGE

 The blood supply of the uterus derives mainly from the uterine
 External and Internal Iliac Nodes
arteries (which are highly responsive to hormones) with
 Superficial Inguinal Nodes
collateral supply from the ovarian arteries
 At the level of the isthmus, it will give off branches:
 Cervicovaginal branch: supplies the lower cervix and upper
vagina; divides at the supravaginal portion of the cervix
 Main uterine branch (ascending branch): ascends upward
underneath the serosal layer of the uterus; branches off
before it reaches the fallopian tube.
 Tubal branch (mesosalpinx)
 Fundal branch
 Ovarian branch
 Will give off small branches to and fallopian tubes
 Anastamoses with the ovarian and tubal branches of
the ovarian artery
 Along its ascending branches, it will give off transverse
branches that will form arcuate arteries
 Arcuate arteries: beneath the serosa; will send smaller
branches that will penetrate onto the myometrium called
radial arteries
 Radial arteries or straight arteries: penetrate directly inside
the myometrium and will divide into straight arterioles and
spiral arterioles before entering the endometrium:
 Basal arterioles
 Only deep 1/3 of endometrium; ends as horizontal
twigs
 Maintain continuous circulation in stratum basale
 Not affected by hormones
 Spiral arterioles
 Reach endometrial surface
 Responds to hormones
 Supply stratum functionale
 Descending branch (cervicovaginal branch)
 Supplies upper 1/3 and middle 1/3 of vagina and cervix

H. VENOUS DRAINAGE
 Venous drainage is through the uterine veins or the
pampiniform plexus (a branch of the internal iliac vein)
 Location is beside the uterine artery
 The uterine veins enter the broad ligament with the arteries and
form a uterine venous plexus on each side of the cervix
 Plexus forms from the cornu to the body, and lastly to the vagina
 Veins from the uterine plexus drain into the internal iliac veins

TRANS Ilagan, R., Infantado, Isidro, Isuriña, Jiao CORE Huplo, Ignacio, Limjoco, Macatangay, Medina K. REP Fernandez L. (09175821193)
ANATOMY 4 of 4