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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

• Non-pregnant state

• Pelvic organ

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• Fundus• Body

• Cervix opens into vault or

fornices of vagina

• Fundus is the portion aboveentrance of uterine tubes

• Covered with peritoneum

• Body

• Triangular cavity

UterusMOB TCD



Cervix

• Supravaginal• Isthmus is a circular borderline

area between the body and

cervix

• Isthmus is the supra vaginalportion of cervix lower uterine

segment

• Intravaginal is surrounded by

gutter fornices

• Posterior is deeper covered

with peritoneum

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• Internal os is the opening fromthe body

• Spindle shaped cavity

• External os is the opening into

vagina• Cervix lined columnar

epithelium

• Arbor vitae in nullipara

• Intravaginal portion of cervixcovered by stratified epithelium

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• External os• Junction of columnar of the

cervical canal

• Stratified epithelium of the

intravaginal portion• Site of cancer of cervix

• Cervical smear

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• At birth cervix is larger thanthe body

• Fully developed cervix is

one third of body

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Peritoneum

• 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 portionof cervix

• Upper third of posterior surface of

vagina

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Pouch of Douglas

• 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

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• 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

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• Serous layer • Myometrium

• No submucous layer

• Endometrium

• Three layers• Basal

• Spongy

• Compact at surface of uterine

cavity

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Myometrium

• Myometrium makes up bulk of uterine wall

• Blood vessels more evident in

middle layer

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MyometriumMOB TCD



Uterine MuscleMOB TCD



Blood Supply

• Uterine• Ovarian

• Vaginal arteries

• Anterior and posterior

arcuate run in middle layer

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• Radial branches• Basal layer

• Spiral branches to superficial

two layers

• Veins below artery• Plexus in lower edge broad

ligament into internal iliac

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Blood SupplyMOB TCD



Nerve Supply of Uterus

• Pain from cervix viaparasympathetic S2,3

• Pain from body via

sympathetic to T11

and T12

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Supports of Uterus

Upper • Round ligament

• Broad ligament anteverted

Middle

• Transverse ligament• Pubocervical

• Uterosacral

Lower

• Levator ani, coccygeus

• Perineal body

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Round Ligament

• Round ligament and• Ligament of ovary

• develop from the

gubernaculum

• Side of uterus, junction fundus and

body

• Inguinal canal to

labium majus• Anteversion

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Broad Ligament

• Fold of peritoneum from sideof uterus to side wall of

pelvis

• Framework of pelvic fascia

• Parametric fat• Anterior surface looks

inferiorly

• Free upper border

• Base on pelvic floor

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• 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

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• Uterine tube lies in medialfour fifths of free border of

broad ligament

• Lateral one fifth

• Contains ovarian vessels• Infundibulo-pelvic or

suspensory ligament of

ovary


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• Mesosalpinx• Mesometrium

• Mesoovarian

• Epoophoron

• Parallel tubules• Gaertners duct remains

mesonephric tubules and

duct, may form cysts


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Uterine Artery

• Uterine artery lies superior tothe ureter at lateral fornix of

vagina

• Base of broad ligament

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Pubocervical Ligament

• Attached• Anteriorly to posterior aspect

of body of body of pubis

• Passes to neck of bladder

• Anterior fornix of vagina

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• Pubocervical ligaments help tomaintain normal angle of

45°between the vagina and

horizontal

• Decrease may cause a

cystocoele

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Transverse Ligament

• Transverse or cardinal or mackenrodt ligament

• Thickening of visceral layer

of pelvic fascia around

uterine artery

• Lateral to medial in base of

broad ligament

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Uterosacral Ligament

• Uterosacral contains fibroustissue

• Nonstriated muscle

• Attached from the cervix to

the middle of sacrum• Contains lymphatics draining

cervix to sacral glands

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• Uterosacral help to keep uterusanteverted

• If uterus is anteverted it cannot

prolapse

Uterosacral LigamentO C

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Uterine Tube

• Intramural• Isthmus

• Ampulla

• Infundibulum

• Lined ciliated columnar epithelium• Beats towards uterus

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• Peritoneum• Loosely attached to ampulla

• Tightly to isthmus

• Fimbria surrounding opening into

peritoneal cavity• Ovarian fimbria

Uterine Tube

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Embryology of Uterus

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Ovary

• 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

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• Obturator nerve supplies theparietal 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

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• 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

Ovary

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Vagina

• Fornices surround cervix

• Anterior wall shorter posterior

• Walls in contact except superior

• External os

• Opens into vestibule of vagina

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• Pelvis

• Lateral uterine artery above

ureter

• Levator ani

• Deep pouch• Sphincter urethrae

• Bulbs of vestibule

• Greater vestibular glands

Vagina

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• Urethra embedded in lower two thirds of anterior wall

• Posterior fornix

peritoneum of pouch of

Douglas

• Rectum

• Perineal body

Vagina

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• Pelvic fascia• Erectile tissue

• Muscular wall

• Non-keratinised stratified squamous

epithelium

Vagina

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Blood and Nerve Supply Vagina

• Uterine artery

• Vaginal

• Internal pudendal

• Labial

• Ilio Inguinal nerve supplies theanterior wall

• Labial nerves supply the

posterior wall

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Lymphatics of Vagina

• Internal iliac• Lower third

• Medial group of proximal

superficial inguinal glands

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Pelvic Sympathetic

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Pelvic Plexuses

• Supply pelvic organs• Contains

• Sympathetic

• Preganglionic parasympathetic

nerves• Lateral column S2,3,4

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• 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

Pelvic Plexus

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Sympathetic

• Ejaculation is viasympathetic impulses from

L1-L2

• Contraction of sphincters of

bladder and anal canal

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Pelvic Parasympathetic

• 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

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• Supplies bladder

• Rectum

• Motor to walls inhibitory to

sphincters

• Male and female genitalia• Parasympathetic causes

erection

Pelvic Parasympathetic