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Uterus – Uterus
3.3 Uterine surfaces and position
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Surfaces
• 1 Intestinal surface (facies intestinalis) – the dorso-cranial surface facing the intestinal loops • 2 Vesical surface (facies vesicalis) – the ventro-caudal surface facing the urinary bladder Position
• 3 Anteflexion – the longitudinal axis of the body of the uterus and the longitudinal cervical axis 2 form an obtuse angle of 160°–170° open ventrally with the vertex at the isthmus of the uterus • 4 Anteversion – the longitudinal axis of the body of the uterus and the longitudinal axis of the vagina form an angle of 70°–100° open ventrally with the vertex at the external os of the uterus 5 Dextroversion – the uterus is often slightly turned to the right with its left border lying closer to the midline and pushed forward
The supporting apparatus of the uterus consists of the muscles of the pelvic floor. These are more important than the parametral ligaments. 1 Levator ani/pubovaginalis 2 Ischiococcygeus 3 Perineal muscles
Broad ligament of uterus (ligamentum latum uteri) – is a double peritoneal fold located in the frontal plane of the lesser pelvis, consists of the three parts – it is attached to the uterine border medially and is laterally continuous with the parietal peritoneum of the pelvic wall 1 Mesovarium (dorsally) – a peritoneal fold of the ovary 2 Mesosalpinx (cranially) – a peritoneal fold of the uterine tube 3 Mesometrium (caudally) – a peritoneal fold of the uterus
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Sagittal section of the uterus and cranial part of vagina
Supporting apparatus of the uterus
Peritoneal folds
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Female genitalia, oblique view 8
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Parametrial ligaments The parametrial ligaments hold the uterus in its proper position in the pelvis. 4 Round ligament of uterus (ligamentum teres uteri) – keeps the uterus in anteversion during pregnancy 5 Cardinal ligament / Mackenrodt’s ligament / transverse cervical ligament (ligamentum cardinale Mackenrodti / ligamentum transversum cervicis) – a paired fibrous band extending laterally from the cervix and isthmus to the pelvic wall 5 – enables antero-posterior movements of the uterus 6 Pubocervical ligament (ligamentum pubocervicale) – extends from the pubic symphysis to the cervix 7 Vesico-uterine ligament (ligamentum vesicouterinum)– extends from the uterus to the urinary bladder 7.1 Pubovesical ligament (ligamentum pubovesicale) – the continuation of the vesicouterine ligament to the pubis 8 Recto-uterine ligament (ligamentum rectouterinum) – extends from the rectum to the uterus 9 Uterosacral ligaments (ligamenta sacrouterina) – the continuation of the recto-uterine ligament to the sacrum, contain the inferior hypogastric plexus
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Parametral ligaments inside the pelvis
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Blood supply 3
Arterial supply: the internal iliac artery
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1 Uterine artery – approaches the isthmus from the side and ascends tortuously along the uterine border Venous drainage: the uterine venous plexus (into the uterine vein and internal iliac vein)
Lymphatic drainage:
• 2 Body of uterus: the internal iliac nodes • 3 Fundus of uterus: the lumbar nodes • 4 Border of uterus: the superficial inguinal nodes along the round ligament of the uterus • 5 Ventral aspect of cervix: the internal iliac nodes • 6 Dorsal aspect of cervix: the sacral nodes
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Innervation Sympathetic system: the uterovaginal plexus from the inferior hypogastric plexus Parasympathetic system: the uterovaginal plexus from the inferior hypogastric plexus Viscerosensory system: nerve fibers in both plexuses
Blood supply of the female genitalia
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