UTERUS DR SAVITA KADAM KHISTE ASSOCIATE PROFESSOR MGM

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UTERUS DR. SAVITA KADAM (KHISTE) ASSOCIATE PROFESSOR MGM MEDICAL COLLEGE AURANGABAD

UTERUS DR. SAVITA KADAM (KHISTE) ASSOCIATE PROFESSOR MGM MEDICAL COLLEGE AURANGABAD

Female reproductive system • External genital organs • Internal genital organs

Female reproductive system • External genital organs • Internal genital organs

Internal genital organs consist of – • Pair of fallopian tubes • Pair of

Internal genital organs consist of – • Pair of fallopian tubes • Pair of ovaries • Uterus • Vagina

INTRODUCTION • The uterus is a dynamic female reproductive organ responsible for several reproductive

INTRODUCTION • The uterus is a dynamic female reproductive organ responsible for several reproductive functions including menses , implantation, gestation, labour and delivery. • It remains in a relatively quiescent state during the prepubertal and postmenopausal years.

LOCATION • Uterus is situated in pelvic cavity with bladder in front and rectum

LOCATION • Uterus is situated in pelvic cavity with bladder in front and rectum behind • Thick walled muscular organ and firm in consistency Three layers • Endometrium • Myometrium • Perimetrium

SHAPE AND SIZE • Pyriform / pear shaped • Total length – 7. 5

SHAPE AND SIZE • Pyriform / pear shaped • Total length – 7. 5 cm • Breadth – 5 cm • Thickness – 2. 5 cm • Weight – 30 -40 gms

PARTS OF UTERUS Two parts 1. Body 2. Cervix Junction of body and cervix

PARTS OF UTERUS Two parts 1. Body 2. Cervix Junction of body and cervix Isthmus (corresponds with internal os of cervical canal)

PRESENTING PARTS OF BODY 1. Fundus 2. Body proper FUNDUS –Expanded upper part above

PRESENTING PARTS OF BODY 1. Fundus 2. Body proper FUNDUS –Expanded upper part above opening of uterine tubes BODY– extends from fundus—isthmus has cavity Two surfaces → ant /vesical ↘ post /intestinal Two lateral borders

Sagittal and coronal section of uterus

Sagittal and coronal section of uterus

Cornu of uterus

Cornu of uterus

Cervix of uterus • Cylindrical part • Less mobile and more fixed • Fusiform

Cervix of uterus • Cylindrical part • Less mobile and more fixed • Fusiform shaped • Length— 2. 5 cm • Two parts → Supra-vaginal ↘Vaginal Relations Anteriorly: bladder Posteriorly: rectouterine pouch On sides: ureter and uterine A.

Vaginal Part • Conical in shape • Rest on posterior vaginal wall • Divides

Vaginal Part • Conical in shape • Rest on posterior vaginal wall • Divides vagina into fornices

Nalliparous cervix Multiparous cervix Arbor vitae uteri

Nalliparous cervix Multiparous cervix Arbor vitae uteri

 • In adult body and cervix ratio is 2: 1 • In new

• In adult body and cervix ratio is 2: 1 • In new born body and cervix ratio is 1: 2

NORMAL POSITION • AVAF Provided rectum and bladder are empty • Long axis of

NORMAL POSITION • AVAF Provided rectum and bladder are empty • Long axis of vagina corresponds to axis of pelvic outlet • Long axis of uterus corresponds to axis of pelvic inlet

Antevertion • Vertion is relation of long axis of cervix with vagina • It

Antevertion • Vertion is relation of long axis of cervix with vagina • It occurs around transverse axis passing through ex. os • It is maintained by 1. Forward pull on fundus by traction of Round Ligament 2. Backward pull on cervix by traction of Uterosacral Ligament

 • Ante flexion forward angle bet body and cervix at isthmus(125) • Flexion

• Ante flexion forward angle bet body and cervix at isthmus(125) • Flexion of uterus takes place around transverse axis passing through the internal os • When uterus rotated anteriorly –Anteflexion • When rotated posteriorly –Retroflexion

 • Fundus tilted to Rt side –Dextro-rotation • Fundus tilted to Lt –Levo

• Fundus tilted to Rt side –Dextro-rotation • Fundus tilted to Lt –Levo -rotation

LIGAMENTS OF UTERUS 1. Peritonial 2. Fibromuscular

LIGAMENTS OF UTERUS 1. Peritonial 2. Fibromuscular

PERITONIAL LIGAMENTS • Do not support • Anterior false ligament (uterovesical fold ) •

PERITONIAL LIGAMENTS • Do not support • Anterior false ligament (uterovesical fold ) • Posterior false ligament (rectovaginal fold ) • Broad ligament

BROAD LIGAMENT • Fold of peritoneum • Extends from lateral border of uterus to

BROAD LIGAMENT • Fold of peritoneum • Extends from lateral border of uterus to lateral pelvic wall • Divides pelvic cavity into • Anterior compartment for bladder • Posterior compartment for rectum and sigmoid colon

SUB-DIVISIONS 1 Meso-salpinx 2 Meso-metrium 3 Meso –ovarium 4 Suspensory ligament of ovary

SUB-DIVISIONS 1 Meso-salpinx 2 Meso-metrium 3 Meso –ovarium 4 Suspensory ligament of ovary

CONTENTS OF BROAD –LIGAMENT One tube : Uterine tube Two ligaments : 1. Round

CONTENTS OF BROAD –LIGAMENT One tube : Uterine tube Two ligaments : 1. Round ligament of uterus 2. Ligament of ovary Two vessels : 1. Uterine vessels 2. Ovarian vessels Two plexus of nerves : 1. Utero-vaginal plexus 2. Ovarian plexus Three embryological remnants 1. Epo-ophoron 2. Par-ophoron 3. Vesicular appendicies Other structures : 1. Lymph vessel and lymphnodes 2. Parametrium on sides of uterus

FIBRO-MUSCULAR LIGAMENTS • Round ligament • Uterosacral ligament • Mackenrodt’s ligament • Pubocervical ligament

FIBRO-MUSCULAR LIGAMENTS • Round ligament • Uterosacral ligament • Mackenrodt’s ligament • Pubocervical ligament

ROUND LIGAMENT • Fibro muscular band • 10 -12 cm • Extent–cornu of Uterus

ROUND LIGAMENT • Fibro muscular band • 10 -12 cm • Extent–cornu of Uterus passes through inguinal canal splits into fibrous threads and attaches to labia majora • Developementaly remnant of distal part of gubernaculam of ovary • Pulls fundus forward

UTEROSACRAL LIGAMENT • Condensation of endopelvic fascia • Extend –back of cervix to periosteum

UTEROSACRAL LIGAMENT • Condensation of endopelvic fascia • Extend –back of cervix to periosteum of sacrum (S 2 , S 3) • Pulls cervix backward

MACKENRODT’S LIGAMENT • Fan shaped fibromuscular band • Extent –cervicovaginal junction to lateral pelvic

MACKENRODT’S LIGAMENT • Fan shaped fibromuscular band • Extent –cervicovaginal junction to lateral pelvic wall • Keep cervix in median position and prevent downward displacement of uterus.

PUBOCERVICAL LIGAMENT • Connect anterior surface of cervix to inner surface of pubic symphysis

PUBOCERVICAL LIGAMENT • Connect anterior surface of cervix to inner surface of pubic symphysis • Keep the cervix in midline

uterosacral Cardinal Lig pubocervical

uterosacral Cardinal Lig pubocervical

BLOOD SUPPLY • Uterine artery • Ovarian artery

BLOOD SUPPLY • Uterine artery • Ovarian artery

VENOUS DRAINAGE Internal iliac veins

VENOUS DRAINAGE Internal iliac veins

NERVE SUPPLY • SYMPATHETIC NERVES –T 12 -L 1 • Causes uterine contraction and

NERVE SUPPLY • SYMPATHETIC NERVES –T 12 -L 1 • Causes uterine contraction and vasoconstriction • PARASYMPATHATIC NERVES –S 2 3 4 • Causes vasodilatation and uterine inhibition • Pain sensation from body is carried by sympathetic • Pain sensation from cervix is carried by parasympathetic

LYMPHATIC DRAINAGE • Consist of three intercommunicating plexus • Endometrial • Myometrial • Subperitonial

LYMPHATIC DRAINAGE • Consist of three intercommunicating plexus • Endometrial • Myometrial • Subperitonial • Upper part—aortic LN • Middle part– external iliac nodes • Lower part—external, internal and superficial inguinal nodes

SUPPORTS OF UTERUS • SECONDARY SUPPORTS PRIMARY SUPPORTS MUSCULAR/ ACTIVE -PELVIC DIAPHRAGM -UROGENITAL DIAPHRAGM

SUPPORTS OF UTERUS • SECONDARY SUPPORTS PRIMARY SUPPORTS MUSCULAR/ ACTIVE -PELVIC DIAPHRAGM -UROGENITAL DIAPHRAGM -PERINEAL BODY FIBROMUSCULAR/ MECHANICAL -UTERINE AXIS -PUBOCERVICAL LIGAMENT -MACKENRODT LIGAMENT -UTROSACRAL LIGAMENT -ROUND LIGAMENT -BROAD LIGAMENT -UTROVASICALE FOLD -RECTOVAGINAL FOLD

Resists increase intra-abdominal pressure

Resists increase intra-abdominal pressure

PERINEAL BODY Acts as anchor for pelvic diaphragm Maintains integrity of pelvic floor

PERINEAL BODY Acts as anchor for pelvic diaphragm Maintains integrity of pelvic floor

FUNCTIONAL SUPPORTS Acting from above-Peritonial folds Acting from below-Levator Ani Acting from sides- Mackenrodt’s

FUNCTIONAL SUPPORTS Acting from above-Peritonial folds Acting from below-Levator Ani Acting from sides- Mackenrodt’s Maintaining the Anteversion and Anteflexion- Round, Utrosacral and pubocervical ligaments • Loose packing Material –Parametric tissue • •

INVESTIGATIONS • PELVIC ULTRASOUND • HYSTEROSALPHYNGOGRAM • MRI • LAPROSCOPY • HYSTEROSCOPY • COLPOSCOPY

INVESTIGATIONS • PELVIC ULTRASOUND • HYSTEROSALPHYNGOGRAM • MRI • LAPROSCOPY • HYSTEROSCOPY • COLPOSCOPY

USG

USG

HYSTROSALPHINGOGRAM • Defination • H. S. G. is a radiological procedure to visualise interior

HYSTROSALPHINGOGRAM • Defination • H. S. G. is a radiological procedure to visualise interior of the uterus and fallopian tube to access its patency. • Indications– Infertility

APPLIED ANATOMY • • Endometritis IUCD D AND C ENDOMETRIOSIS PID HYSTEROTOMY HYSTERECTOMY •

APPLIED ANATOMY • • Endometritis IUCD D AND C ENDOMETRIOSIS PID HYSTEROTOMY HYSTERECTOMY • • COLPOTOMY PROLAPSE UTERUS UTERINE FIBROIDS CARCINOMAS

ENDOMETRIOSIS • Endometriosispresence and proliferation of endometrial tissue outside the uterine cavity • Major

ENDOMETRIOSIS • Endometriosispresence and proliferation of endometrial tissue outside the uterine cavity • Major symptomsdysmenorrhoea, infertility

IUCD

IUCD

PID

PID

HYSTEROTOMY

HYSTEROTOMY

HYSTERECTOMY

HYSTERECTOMY

COLPOTOMY

COLPOTOMY

UTERINE FIBIROIDS leiomyomas –myometrial –submucosal, –subserosal –Pedenculated

UTERINE FIBIROIDS leiomyomas –myometrial –submucosal, –subserosal –Pedenculated

PROLAPSED UTERUS

PROLAPSED UTERUS

ENDOMETRIAL CANCER

ENDOMETRIAL CANCER

L. S. C. S

L. S. C. S

 • At the end of lecture students should able to 1. enumerate functions

• At the end of lecture students should able to 1. enumerate functions of uterus 2. Enumerate parts of uterus 3. Describe the position of uterus with its applied importance 4. Explain the peritonial reflections 5. Clinical importance of POD 6. Enumerate various supports of uterus 7. Describe HSG 8. Describe blood supply , nerve supply 9. Describe lymphatic drainage with its clinical importance 10. Enumerate clinical conditions of uterus