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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
TRANS Ilagan, R., Infantado, Isidro, Isuriña, Jiao CORE Huplo, Ignacio, Limjoco, Macatangay, Medina K. REP Fernandez L. (09175821193)
ANATOMY 1 of 4
5.04 Female Reproductive System: Gross LE 5 TRANS 4
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)
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)
ANATOMY 2 of 4
5.04 Female Reproductive System: Gross LE 5 TRANS 4
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
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)
ANATOMY 3 of 4
5.04 Female Reproductive System: Gross LE 5 TRANS 4
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