This chapter should be cited as follows: Sokol, E, Glob. Libr. Women"s med.,(ISSN: 1756-2228) 2011; DOI 10.3843/
Eric R. Sokol, MDAssistant Professor of Obstetrics and Gynecology,Assistant Professor of Urology (by Courtesy),Co-Chief, Urogynecology and also Pelvic rebuild Surgery,Stanford University school of Medicine, Stanford, California, USA

The femalereproductive organsinclude the uterus, fallopian tubes, and the ovaries (Fig. 1). Your position, size, and also anatomic connections vary substantially with age and also the physiologic alters of menstruation, pregnancy, and menopause.

You are watching: The superior rounded region of the uterus above the entrance of the uterine tubes is called the:

Fig. 2. Photomicrograph (low power) the the epithelial lining in ~ the junction of the cervix and also vagina in the human. The glands of the cervix are certainly evident. There space no glands basic the squamous epithelium that the vagina. (After R. Shroder.)

The endometrial cavity lies over the interior cervical os. It is approximately triangular in shape and measures about 3.5 cm in length. Ordinarily, the anterior and also posterior wall surfaces of the uterus lied in apposition therefore that tiny if any actual cavity is present. At every cornu or horn of the uterus,thecavity that the uterusbecomes constant with the lumen that a fallopian tube. Peritoneum covers many of the corpus of the uterus and the posterior cervix and also is known as the serosa. Laterally, the broad ligament, a double layer of peritoneum extending the neurovascular supply to the uterus, inserts right into the cervix and corpus. Anteriorly, the bladder lies over the isthmic and also cervical an ar of the uterus.

The “positions” of the uterus are of significant interest but of much less importance in gynecologic practice than 50 years ago. The most usual position of the uterus in a nulligravid female is in center anteflexion or bent slightly anteriorly, and the uterus together a entirety is inclined towards the symphysis in ante version versus the bladder, adapting its place as the last organ distends or empties (Fig. 3 and Fig. 4). In a variable number of women, the uterus is retroverted or lean posteriorly or retroflexed toward the sacrum. Rather a few disabilities were attributed to this “malpositions” in the past including dysmenorrhea, functional uterine bleeding, backache, dyspareunia, and leukorrhea. Numerous normal uteri room in mid position, through the axis the uterus being nearly parallel come the spine.

Fig. 3. Dissection showing the cephalic element of the woman genitalia and also their relationships.

Fig. 4. Transverse ar of the abdomen above the crests that the ilia. This ar is 1 inch above the pubis and also extends with the disk between the sacrum and the last lumbar vertebra.

The peritoneum consist of the uterus and is separated from the uterine musculature by a slim layer the periuterine fascia, i beg your pardon is a continuation and extension of the transversalis fascia. This mobile fascial class is areolar tissue and is easily separated other than for a midline seam or raphe between the uterus and also bladder anteriorly and between uterus and peritoneum posteriorly at the level that the isthmus. Posteriorly it sweeps down over the posterior vaginal wall and the cul-de-sac.

The blood supply of the uterus is obtained chiefly native the uterine arteries (Fig. 5). This arise indigenous the hypogastric artery and swing towards the uterus, i m sorry they with at roughly the level of the interior os (Fig. 6 and Fig. 7). Here the uterine arteries divide, the descending limb coursing downward follow me the cervix and also lateral wall of the vagina. The ascending body passes upward alongside the uterus and continues listed below the fallopian tube. Regular anterior and posterior branches walk to vagina, cervix, and also uterus.

Fig. 5. Arterial blood it is provided of the regular tube, ovary, and also uterus. (Courtesy of Dr man A. Sampson.) (From Norris: Gonorrhoea in Women. Philadelphia: Saunders.)

Fig. 6. Ventral see of a deep dissection of the urinary bladder and also the blood it is provided to the left side of the interior genitalia, mirroring the relation of the uterine vessels to the ureter.

Fig. 7. Blood supply of thereproductive organswith relation to the ureter and also trigone of the urinary bladder.

The ovarian artery, i m sorry ordinarily occurs from the aorta, passes follow me the ovary, separating into a number of branches. In ~ several locations in the large ligament there space anastomotic connections in between the tubal branch that the uterine artery and the ovarian artery. A branch the the uterine artery nourishes the round ligament. The veinsgenerally companion the arteries.

Using injection and also microradiographic and also histologic approaches to research the vascular anatomy that the uterus, Farrer-Brown et al.1 showed that the uterine arteries run a tortuous course in between the two layers the the vast ligament follow me the lateral next of the uterus and also turn laterally in ~ the junction that the uterus and fallopian tube, run towards the hilum of the ovary, and also terminate by joining the ovarian arteries. In the large ligament every uterine artery gives lateral branches that immediately enter the uterus and give turn off tortuous anterior and posterior arcuate divisions, which operation circumferentially in the myometrium roughly at the junction of its outer and middle thirds. In the midline the terminal branches the both arcuate arteries anastomose with those of the contralateral side.

Each arcuate artery throughout its course gives off plenty of branches to run both centrifugally in the direction of the serosa and also centripetally in the direction of the endometrium. The arteries come the serosa at firstare command radially and also then frequently became more circumferential. Over there is a plexus of tiny arterial radicals through a radial distribution located automatically below the serosa. The inner two-thirds of the myometrium is gave by tortuous radial branches the the arcuate arteries. They provide numerous branches end in a capillary network i beg your pardon surrounds groups of muscle fibers. One abrupt readjust in the density of the arterial pattern occurs at the junction the the basal layer of the endometrium with the subjacent myometrium. The endometrial vessels are fairly sparse in comparison with those that the myometrium at every stages the the menstrual cycle.

The uterus is partially supported by 3 pairs the ligaments. The paired round ligaments extend from the anterosuperior surface of the uterus through the internal inguinal rings and through the inguinal canals to finish in the labia majors. They space composed that muscle fibers, connective tissue, blood vessels, nerves, and also lymphatics. The ring ligaments stretch with relative ease, an especially in pregnancy. The uterosacral ligaments space condensations that endopelvic fascia the arise native the posterior wall of the uterus in ~ the level of the interior cervical os. They pan out in the retroperitoneal layer and also attach extensively at the second, third, and also fourth segments of the sacrum.They space predominately written of smoothmuscle but also containconnective tissue, blood vessels, lymphatics, and parasympathetic nerve fibers.2 The paired cardinal (Mackenrodt"s) or transverse cervical ligaments arise indigenous the anterior and also posterior marginal walls of the cervix andfan the end laterally come insert right into the fascia overlying the obturator muscles and also the levator ani muscles. The cardinal ligaments type the base of the large ligament.They room composed of perivascular connective tissue and also nerves that surround the uterine artery and also veins. The cardinal and uterosacral ligament facility is collectively called the parametrium.

The vast ligament is developed by wrinkle of peritoneum extending the fallopian tubes, the infundibulopelvic vessels, and the hilus of the ovary. It has a number of structures: fallopian tube, ring ligament, ovarian ligament, uterine and also ovarian blood vessels, nerves, lymphatics, and also mesonephric remnants. Below the infundibulopelvic structures, the anterior and posterior pipeline of peritoneum lie in apposition, leaving a clear room below the tube with its tubal branch that the uterine artery. This avascular area is valuable to the operated doctor in isolating the adnexal structures and also in avoiding blood vessels while performing tubal ligations.

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The endometrium present the uterine cavity and is thought about to have actually three layers: the pars basalis, the zona spongiosa, and the superficial zona compacta. The right branches the the radial arteries the the uterus terminate in capillaries in the basal layer, while the spiral or coiled branches pass through to the surface ar epithelium, where they provide rise come superficial capillaries. Sinus-like dilatations the the capillaries in the superficial class are referred to as “lakes.” these vascular lakes and capillaries space drained by small veins.

The endometrium different greatly depending upon the step of the menstrual cycle. Proliferation that the endometrium occurs under the affect of estrogen; maturation occurs under the influence of progesterone. The uterine endometrial cycle deserve to be divided into three phases: the follicular or proliferative phase, the luteal or secretory phase, and also the menstrual phase. The follicular, or proliferative phase, spans from the finish of the menstruation until ovulation. Boosting levels of estrogen induce proliferation of the functionalis indigenous stem cells of the basalis, proliferation of endometrial glands, and also proliferation the stromal connective tissue. Endometrial glands space elongated through narrow lumens and also their epithelial cell contain some glycogen. Glycogen, however, is not secreted throughout the follicular phase. Spiral arteries elongate and also span the length of the endometrium.

After development of the corpus luteum, the endometrial glands grow, come to be tortuous, and secrete. The luteal, or secretory, phase begins at ovulation and lasts till the menstrual step of the following cycle (Fig. 8). At the start of the luteal phase, progesterone cause the endometrial glands come secrete glycogen, mucus, and also other substances. This glands come to be tortuous and have huge lumens because of increased secretory activity. The spiral arteries extend into the superficial great of the endometrium. The spiral capillaries build a terminal network of superficial capillaries. These changes an outcome in the development of a predeciduum all set for the arrival of the trophoblast.