Cover slide

Uterus, Broad Ligament, Ovary MOB TCD Uterus, Broad Ligament, Ovary Professor Emeritus Moira O’Brien FRCPI, FFSEM, FFSEM (UK), FTCD Trinity College Dublin

Uterus Pear-shaped muscular organ 8 cm long 5 cm wide 3 cm thick MOB TCD Pear-shaped muscular organ 8 cm long 5 cm wide 3 cm thick Non-pregnant state Pelvic organ

Uterus MOB TCD

Uterus Fundus Body Cervix opens into vault or fornices of vagina MOB TCD Fundus Body Cervix opens into vault or fornices of vagina Fundus is the portion above entrance of uterine tubes Covered with peritoneum Triangular cavity

Cervix MOB TCD Supravaginal Isthmus is a circular borderline area between the body and cervix Isthmus is the supra vaginal portion of cervix lower uterine segment Intravaginal is surrounded by gutter fornices Posterior is deeper covered with peritoneum

Cervix Internal os is the opening from the body Spindle shaped cavity MOB TCD Internal os is the opening from the body Spindle shaped cavity External os is the opening into vagina Cervix lined columnar epithelium Arbor vitae in nullipara Intravaginal portion of cervix covered by stratified epithelium

Cervix External os Junction of columnar of the cervical canal MOB TCD External os Junction of columnar of the cervical canal Stratified epithelium of the intravaginal portion Site of cancer of cervix Cervical smear

Cervix At birth cervix is larger than the body MOB TCD At birth cervix is larger than the body Fully developed cervix is one third of body

Peritoneum Reflected from the superior surface of the bladder MOB TCD Reflected from the superior surface of the bladder Junction of the supravaginal portion of the cervix and the body of the uterus Uterovesical pouch Covers body, fundus Covers the posterior surface body and the supravaginal portion of cervix Upper third of posterior surface of vagina

Pouch of Douglas MOB TCD Upper third of posterior surface of vagina (posterior fornix) Peritoneum reflected on to junction of upper two thirds and lower third of rectum Pouch of Douglas is most dependent part of female peritoneal cavity Broad ligament is lateral

Uterus Uterus is anteverted MOB TCD Uterus is anteverted i.e. anterior to vertical plane going through the vagina Posterior fornix deeper Anteflexed Bent anteriorly at junction of body and cervix

Uterus Serous layer Myometrium No submucous layer Endometrium MOB TCD Serous layer Myometrium No submucous layer Endometrium Three layers Basal Spongy Compact at surface of uterine cavity

Myometrium Myometrium makes up bulk of uterine wall MOB TCD Myometrium makes up bulk of uterine wall Blood vessels more evident in middle layer

Myometrium MOB TCD

Uterine Muscle MOB TCD

Blood Supply Uterine Ovarian Vaginal arteries MOB TCD Uterine Ovarian Vaginal arteries Anterior and posterior arcuate run in middle layer

Blood Supply Radial branches Basal layer MOB TCD Radial branches Basal layer Spiral branches to superficial two layers Veins below artery Plexus in lower edge broad ligament into internal iliac

Blood Supply MOB TCD

Nerve Supply of Uterus Pain from cervix via parasympathetic S2,3 MOB TCD Pain from cervix via parasympathetic S2,3 Pain from body via sympathetic to T11 and T12

Lymphatics MOB TCD

Supports of Uterus Upper Round ligament Broad ligament anteverted MOB TCD Upper Round ligament Broad ligament anteverted Middle Transverse ligament Pubocervical Uterosacral Lower Levator ani, coccygeus Perineal body

Round Ligament Round ligament and Ligament of ovary MOB TCD Round ligament and Ligament of ovary develop from the gubernaculum Side of uterus, junction fundus and body Inguinal canal to labium majus Anteversion

Broad Ligament MOB TCD Fold of peritoneum from side of uterus to side wall of pelvis Framework of pelvic fascia Parametric fat Anterior surface looks inferiorly Free upper border Base on pelvic floor

Broad Ligament Uterine tubes Ovarian vessels Uterine vessels MOB TCD Uterine tubes Ovarian vessels Uterine vessels Epoophoron Paroophoron Round ligament of uterus and ligament of ovary Transverse ligament Ovary attached to posterior layer Ureter in base below artery

Broad Ligament MOB TCD Uterine tube lies in medial four fifths of free border of broad ligament Lateral one fifth Contains ovarian vessels Infundibulo-pelvic or suspensory ligament of ovary

Broad Ligament Mesosalpinx Mesometrium Mesoovarian Epoophoron MOB TCD Mesosalpinx Mesometrium Mesoovarian Epoophoron Parallel tubules Gaertners duct remains mesonephric tubules and duct, may form cysts

Uterine Artery MOB TCD Uterine artery lies superior to the ureter at lateral fornix of vagina Base of broad ligament

Pubocervical Ligament MOB TCD Attached Anteriorly to posterior aspect of body of body of pubis Passes to neck of bladder Anterior fornix of vagina

Pubocervical Ligament MOB TCD Pubocervical ligaments help to maintain normal angle of 45°between the vagina and horizontal Decrease may cause a cystocoele

Transverse Ligament Transverse or cardinal or mackenrodt ligament MOB TCD Transverse or cardinal or mackenrodt ligament Thickening of visceral layer of pelvic fascia around uterine artery Lateral to medial in base of broad ligament

Uterosacral Ligament Uterosacral contains fibrous tissue MOB TCD Uterosacral contains fibrous tissue Nonstriated muscle Attached from the cervix to the middle of sacrum Contains lymphatics draining cervix to sacral glands

Uterosacral Ligament Uterosacral help to keep uterus anteverted MOB TCD Uterosacral help to keep uterus anteverted If uterus is anteverted it cannot prolapse

Uterine Tube Intramural Isthmus Ampulla Infundibulum MOB TCD Intramural Isthmus Ampulla Infundibulum Lined ciliated columnar epithelium Beats towards uterus

Uterine Tube Peritoneum Loosely attached to ampulla Tightly to isthmus MOB TCD Peritoneum Loosely attached to ampulla Tightly to isthmus Fimbria surrounding opening into peritoneal cavity Ovarian fimbria

Embryology of Uterus MOB TCD

Ovary Attached to posterior layer of broad ligament mesoovarian MOB TCD Attached to posterior layer of broad ligament mesoovarian Covered with germinal epithelium Side wall of pelvis covered with peritoneum Obturator internus muscle Obturator nerve supplies the parietal peritoneum Ureter posterior Ligament of ovary medially

Ovary Obturator nerve supplies the parietal peritoneum MOB TCD Obturator nerve supplies the parietal peritoneum Irritation of the peritoneum of the side wall by bleeding at ovulation or by lesions involving the ovary, may result in referred pain to medial side of the thigh or the knee

Ovary Blood supply One ovarian artery from lateral aspects of aorta L2 MOB TCD Blood supply One ovarian artery from lateral aspects of aorta L2 Right vein drains into IVC Left drains into left renal vein Lymphatics into paraaortic glands L2

Vagina Fornices surround cervix Anterior wall shorter posterior MOB TCD Fornices surround cervix Anterior wall shorter posterior Walls in contact except superior External os Opens into vestibule of vagina

Vagina Pelvis Lateral uterine artery above ureter Levator ani MOB TCD Pelvis Lateral uterine artery above ureter Levator ani Deep pouch Sphincter urethrae Bulbs of vestibule Greater vestibular glands

Vagina Urethra embedded in lower two thirds of anterior wall MOB TCD Urethra embedded in lower two thirds of anterior wall Posterior fornix peritoneum of pouch of Douglas Rectum Perineal body

Vagina Pelvic fascia Erectile tissue Muscular wall MOB TCD Pelvic fascia Erectile tissue Muscular wall Non-keratinised stratified squamous epithelium

Blood and Nerve Supply Vagina MOB TCD Uterine artery Vaginal Internal pudendal Labial Ilio Inguinal nerve supplies the anterior wall Labial nerves supply the posterior wall

Lymphatics of Vagina Internal iliac Lower third MOB TCD Internal iliac Lower third Medial group of proximal superficial inguinal glands

Pelvic Sympathetic MOB TCD

Pelvic Plexuses Supply pelvic organs Contains Sympathetic MOB TCD Supply pelvic organs Contains Sympathetic Preganglionic parasympathetic nerves Lateral column S2,3,4

Pelvic Plexus Hypogastric plexus Lumbar splanchnics Presacral nerve MOB TCD Hypogastric plexus Lumbar splanchnics Presacral nerve Anterior to body of L5 Divide into pelvic plexuses Postganglionic of sympathetic that relayed in lumbar and sacral ganglia

Sympathetic Ejaculation is via sympathetic impulses from L1-L2 MOB TCD Ejaculation is via sympathetic impulses from L1-L2 Contraction of sphincters of bladder and anal canal

Pelvic Parasympathetic MOB TCD Preganglionic have cell bodies in lateral column of segments S2,3,4 Ganglia found close to or in wall of organ Supplies intestine from splenic flexure to upper two thirds of anal canal

Pelvic Parasympathetic MOB TCD Supplies bladder Rectum Motor to walls inhibitory to sphincters Male and female genitalia Parasympathetic causes erection

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