1. Cover slide

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

3. 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

4. Uterus
MOB TCD

5. 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

6. 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

7. 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

8. 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

9. 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

10. 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

11. 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

12. 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

13. 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

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

15. Myometrium
MOB TCD

16. Uterine Muscle
MOB TCD

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

18. 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

19. Blood Supply
MOB TCD

20. 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

21. Lymphatics
MOB TCD

22. 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

23. 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

24. 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

25. 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

26. 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

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

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

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

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

31. 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

32. 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

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

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

35. 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

36. Embryology of Uterus
MOB TCD

37. 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

38. 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

39. 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

40. 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

41. 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

42. 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

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

44. 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

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

46. Pelvic Sympathetic
MOB TCD

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

48. 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

49. 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

50. 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

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

52. “BMJ Publishing Group Limited (“BMJ Group”) 2012. All rights reserved
Copyright slide