MOB TCD
Uterus, Broad Ligament, Ovary
Professor Emeritus Moira O’Brien
FRCPI, FFSEM, FFSEM (UK), FTCD
Trinity College
Dublin
MOB TCD
Uterus
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Pear-shaped muscular organ
8 cm long
5 cm wide
3 cm thick
Non-pregnant state
Pelvic organ
MOB TCD
Uterus
MOB TCD
Uterus
• Fundus
• Body
• Cervix opens into vault or
fornices of vagina
• Fundus is the portion above
entrance of uterine tubes
• Covered with peritoneum
• Body
• Triangular cavity
MOB TCD
Cervix
• 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
MOB TCD
Cervix
• 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
MOB TCD
Cervix
• External os
• Junction of columnar of the
cervical canal
• Stratified epithelium of the
intravaginal portion
• Site of cancer of cervix
• Cervical smear
MOB TCD
Cervix
• At birth cervix is larger than
the body
• Fully developed cervix is
one third of body
MOB TCD
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 portion
of cervix
• Upper third of posterior surface of
vagina
MOB TCD
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
MOB TCD
Uterus
• 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
MOB TCD
Uterus
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Serous layer
Myometrium
No submucous layer
Endometrium
Three layers
Basal
Spongy
Compact at surface of uterine
cavity
MOB TCD
Myometrium
• Myometrium makes up bulk of
uterine wall
• Blood vessels more evident in
middle layer
MOB TCD
Myometrium
MOB TCD
Uterine Muscle
MOB TCD
Blood Supply
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Uterine
Ovarian
Vaginal arteries
Anterior and posterior
arcuate run in middle layer
MOB TCD
Blood Supply
• Radial branches
• Basal layer
• Spiral branches to superficial
two layers
• Veins below artery
• Plexus in lower edge broad
ligament into internal iliac
MOB TCD
Blood Supply
MOB TCD
Nerve Supply of Uterus
• Pain from cervix via
parasympathetic S2,3
• Pain from body via
sympathetic to T11
and T12
MOB TCD
Lymphatics
MOB TCD
Supports of Uterus
Upper
• Round ligament
• Broad ligament anteverted
Middle
• Transverse ligament
• Pubocervical
• Uterosacral
Lower
• Levator ani, coccygeus
• Perineal body
MOB TCD
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
MOB TCD
Broad Ligament
• 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
MOB TCD
Broad Ligament
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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
MOB TCD
Broad Ligament
• 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
MOB TCD
Broad Ligament
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Mesosalpinx
Mesometrium
Mesoovarian
Epoophoron
Parallel tubules
Gaertners duct remains
mesonephric tubules and
duct, may form cysts
MOB TCD
Uterine Artery
• Uterine artery lies superior to
the ureter at lateral fornix of
vagina
• Base of broad ligament
MOB TCD
Pubocervical Ligament
• Attached
• Anteriorly to posterior aspect
of body of body of pubis
• Passes to neck of bladder
• Anterior fornix of vagina
MOB TCD
Pubocervical Ligament
• Pubocervical ligaments help to
maintain normal angle of
45°between the vagina and
horizontal
• Decrease may cause a
cystocoele
MOB TCD
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
MOB TCD
Uterosacral Ligament
• Uterosacral contains fibrous
tissue
• Nonstriated muscle
• Attached from the cervix to
the middle of sacrum
• Contains lymphatics draining
cervix to sacral glands
MOB TCD
Uterosacral Ligament
• Uterosacral help to keep uterus
anteverted
• If uterus is anteverted it cannot
prolapse
MOB TCD
Uterine Tube
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Intramural
Isthmus
Ampulla
Infundibulum
Lined ciliated columnar epithelium
Beats towards uterus
MOB TCD
Uterine Tube
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Peritoneum
Loosely attached to ampulla
Tightly to isthmus
Fimbria surrounding opening into
peritoneal cavity
• Ovarian fimbria
MOB TCD
Embryology of Uterus
MOB TCD
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
MOB TCD
Ovary
• 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
MOB TCD
Ovary
• 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
MOB TCD
Vagina
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Fornices surround cervix
Anterior wall shorter posterior
Walls in contact except superior
External os
Opens into vestibule of vagina
MOB TCD
Vagina
• Pelvis
• Lateral uterine artery above
ureter
• Levator ani
• Deep pouch
• Sphincter urethrae
• Bulbs of vestibule
• Greater vestibular glands
MOB TCD
Vagina
• Urethra embedded in lower
two thirds of anterior wall
• Posterior fornix
peritoneum of pouch of
Douglas
• Rectum
• Perineal body
MOB TCD
Vagina
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Pelvic fascia
Erectile tissue
Muscular wall
Non-keratinised stratified squamous
epithelium
MOB TCD
Blood and Nerve Supply Vagina
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Uterine artery
Vaginal
Internal pudendal
Labial
Ilio Inguinal nerve supplies the
anterior wall
• Labial nerves supply the
posterior wall
MOB TCD
Lymphatics of Vagina
• Internal iliac
• Lower third
• Medial group of proximal
superficial inguinal glands
MOB TCD
Pelvic Sympathetic
MOB TCD
Pelvic Plexuses
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Supply pelvic organs
Contains
Sympathetic
Preganglionic parasympathetic
nerves
• Lateral column S2,3,4
MOB TCD
Pelvic Plexus
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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
MOB TCD
Sympathetic
• Ejaculation is via
sympathetic impulses from
L1-L2
• Contraction of sphincters of
bladder and anal canal
MOB TCD
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
MOB TCD
Pelvic Parasympathetic
• Supplies bladder
• Rectum
• Motor to walls inhibitory to
sphincters
• Male and female genitalia
• Parasympathetic causes
erection
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