the

Gross Anatomy of Uterus

all right so here we are gonna discuss a

very important female organ of the

reproductive system and that is known as

uterus it's in layman's terms it's also

known as the boom because it it houses a

growing offspring or fetus so as you can

see over here I have a small clay model

in front of you this is a model of the

uterus representing its shape and

roughly its size it's a pear-shaped

organ fibromuscular mainly muscular

organ it's the I would say that is the

huge collection of largest collection of

smooth muscle in the body so it's a

muscular organ of pear-shaped mostly in

a non-pregnant state it's lying within

the true or the lesser pelvis and I'll

show you in a couple of minutes I'll

show you its position inside the body

when it when we talk about the

dimensions of the uterus it's a like in

a non-pregnant nulliparous state it's

length is almost up to 8 centimeters its

width is up to 4 centimeters and the

thickness of the wall of the uterus of

it like a non-pregnant uterus is Right 2

to 2.5 centimeters okay

um uterus it's like it's the house for

the fetus obviously as the pregnancy

progresses it has to expect and that's

why I just told you it's the huge

collection of smooth muscle fibers which

are which have a capability to stretch

beyond limits okay we'll talk about the

regions the the structural regions or

the anatomical regions of a uterus we

know that the two tubes also known as

the uterine tubes or the ovarian tubes

and they are opening up into the walls

of the uterus on either side so imagine

these pipe cleaners are the uterine

tubes first we have to visualize this

concept okay so the to you trying or the

ovarian tubes of the fallopian tubes are

opening into the walls of the uterus or

the cavity of the uterus by the way

uterus is hollow from inside although

it's a it's cavity normally is is

anteroposterior compressed in a

non-pregnant non gravity state okay the

the anterior wall and the posterior wall

are approximating each other so it's

collapsed except for a region where the

two uterine tubes are opening the entire

uterus in a non pregnant state it's

generally collapsed okay but it has a

cavity it has to have a cavity so when

we talk about the regions mainly the

uterus is divided into a body and a

lower segment which is known as service

but we further subdivide the body okay

the part of the body which is lying

above the entry or the entrance point of

the two fallopian tubes is known as the

fundus because because it's like a

balloon shaped region

it's it is a part of the body but it is

nine above the entry points of the two

fallopian tubes and it is like a don't

okay it's facing the the above of you

know overlying abdominal cavity although

it's lined with in be the lesser pelvis

but it's facing the abdominal cavity and

it's covered by protein okay then the

part of the body which is receiving the

two fallopian tubes it's also known as

core noon you try and corn or or the

uterine forms because it looks like

bull's horns okay so this region which

is receiving the two fallopian tubes on

either side is known as the you trying

core new or you trying forms then the

part of the bottle which is lying below

the level of entry of Loken tubes is

known as the body and as it is narrow

I'll show you the cut section through

the the uterus on a drawing so you will

be able to appreciate that it's the

narrow region as compared to the fundus

and the cornu so this region is also

known as isthmus okay any narrow region

is also known as isthmus so the body of

the uterus is having three segments or

three regions fundus which is applying

above the entry point of the fallopian

tube the cornu which are receiving the

two fallopian tubes and the ystem as' or

a proper body which is lying below the

entry point of slope in tubes the part

which is like a neck as if it's neck of

the uterus so we call it cervix cervical

or cervix okay so this narrowed of

region is is the cervix for the lower

most part or region of the uterus cervix

we'll talk about it in detail it

eventually enters another hollow

fibromuscular tube which is known as

a vagina okay so a part of the cervix is

in continuation with the body above and

the part it's it's entering the the

vagina or it's like protruding into the

vagina okay so we have named the cervix

in like two different ways the endo

cervix and the ecto cervix I'll talk

about it in a couple of minutes okay now

um these were the regions of a normal

uterus and nulliparous uterus or a non

rabbit uterus okay but these regions of

course they change their shape they they

get expanded in Gravatt state like for

example if I talk about the fundus the

fundus of the uterus is normally in line

with in the lesser pelvis or the true

pelvis it's lying like it's a it's a

pelvic organ it's a pelvic component but

as the pregnancy advances like up if I

talk about the term complete like at the

ninth month of pregnancy the this fundus

of the uterus can reach up to the Sepoy

process or the dzifa sternum off the the

breast bone so it this is how it just

you know balloons up and goes up into

the abdominal cavity in after the third

in fact in the second trimester of

pregnancy the uterus is no more a pelvic

organ it's not considered as a public

organ it just expands so much that it

enters the abdominal cavity and it keeps

on expanding and reaches up to the level

of dzifa sternum at turn okay so the

normal position of the uterus in the

body is you you definitely have read it

at many places the it's and they worded

and it flexed anti means forward word it

forward Li bent and forward reflex of

a so imagine my hand I'm trying to

explain the position the way it's been

lying inside the pelvic cavity this is

the wrist region is the vagina my palm

is the cervix and my fingers are the

like body and the front is like

different regions of the body

okay so vagina cervix and the bottom

keep this fact in mind okay

these landmarks when I say I'm gay worth

it so there is an angle between the

cervix and vagina okay and you word it

it's almost 90 degrees so the cervix is

bent over the vagina

at 90 degrees this is and reversion okay

then there is another angle between the

cervix and the body that is an

deflection okay

so now imagine the other fist of my hand

is the urinary bladder this is how the

uterus has been placed and you are

viewing it from sideways so the vagina

cervix and deflection oriented version

and then cervix and the body and

deflection and this is the bladder so

that is how the body and the fundus part

of the uterus is is resting on top of

the bladder on the superior surface of

the batter okay so it's like a swan you

know somewhat like a swan this is how

the uterus is in placed in the pile this

this placement or position these two

angles are playing a pivotal role they

are very

okay if we lose these two angles or

either one of them they work there would

be problems okay sometimes genetically

or congenitally babies have a gradual

worded retro means behind so this angle

is lost the island between the cervix

and the vagina is lost so the the uterus

is me facing backward instead of forward

backward okay

retro version and and in some people it

is also very flexed so it's like this

okay so this is the glare but the uterus

is not lying on top of it instead it's

lying inside like at the back between

the bladder and the rectum okay so this

is not a normal position and many emails

who are suffering from this congenital

malformation it's really difficult for

them to conceive actually conception is

easy but to retain that conception so

they suffer from a miscarriages

abortions in eight original stages why

it is normally in a normally placed

uterus and diverted and and reflects the

beacon sectors is get it gets implanted

into the posterior superior wall of the

uterus and due to these two angles like

there is an angle between the cervix and

the bottle so that the conceptus has

been implanted here okay and then there

is another angle between the cervix and

vagina so there are less chances of

slipping off because as the conceptus

would be growing inside the DES lining

the epithelium of the uterus if it would

be increasing in size so there are there

are like equal of you

getting early abortions in cases of a

retro worded and retroflex features okay

normally you have to keep in mind in in

a woman and not in a like in a gravity

state the uterus this and the flexed

angles being lost as the conceptus is

growing into an embryo and then embryo

becomes a features so there is an

infection it's like you know it's losing

the uterus the fundus is facing upward

to bird species Easterner it's moving up

you know going into the abdominal cavity

expanded like a balloon and then

eventually this engine and the version

is also lost okay but that is a gravity

truce Anan rabbit uterus is maintaining

this these two shapes are these two

positions okay so here you can see on

this model the the position the normal

non rabbit position of the uterus is

anti flexed and anti virtute okay that

the angle between the vagina and the

cervix and the angle between the body

and the cervix so this angle okay these

two angles and this is the urinary

bladder the top surface of the bladder

it's a sagittal midsagittal section

through the pelvis mmm so this is

symphysis pubis just behind the

symphysis pubis is the urinary bladder

on top of the bladder is resting the

fungus and remaining body of the uterus

and then the cervix and then if you look

in the posterior relations this is the

rectum the last part of the

gastrointestinal tract or the large

intestine okay so if I say the uterus is

anteriorly related to the urinary

bladder the base of the bladder and

posteriorly related to the rectum I

won't be wrong okay of the cervix

is continuing itself into the vagina

it's the lowest part of the uterus

vagina is is a separate tube and it

embryologically also it develops

separately from a separate source while

the uterus and the cervix they are

developing from one source

okay so we'll be talking about it ah

when we talk about the supports how how

does this uterus maintain this shape or

disposition as well as it's just meant

it maintains its shape in normal

circumstances with the help of many

ligaments muscles organs as we can see

it's a compact region okay so first of

all supports coming from the other

district so anteriorly it's getting the

support from the urinary bladder also

the base of the bladder and posteriorly

it is getting support from the rectum

and the anal canal these two organs are

you know flanking the uterus from front

and from behind then there is a

structure which is here and you can see

this region is the is the pelvic

diaphragm or the pelvic floor okay so

because the uterus is continuing as as

as of a Jolyon like into the vagina so

it's getting support from the pelvic

diaphragm also okay which is a muscular

sheet then um the thing which is keeping

or maintaining this anti flexed position

this position the two structures if you

remember I earlier I have mentioned

those two structures are the ligaments

the round ligaments of uterus okay they

are the remnants of the gubin Acula okay

so the round ligaments when they are

coming on sides like so the round

ligaments are coming

from front like from above the you

ovaries were descending and remember

that the part of the you burn a Coulomb

which is lying between the ovaries and

the uterus the lateral wall of the

uterus is the ovarian round ligament of

the ovary and then the part of the given

a column which passes through the

inguinal canal in females and attaches

into the labia majora

in the perineum is known as the round

ligament of uterus because it is passing

from the side walls of the uterus

through the inguinal canal and attaches

or anchors into the labia measure so

what it is doing it is you know you know

pulling the uterus especially the top

part of the you choose which is lying

above the cervix the body and the fundus

is pulling them forward towards the

bladder so that it would be correct if I

will say the wrong ligaments of uterus

right and left are maintaining the anti

flexed position of the uterus okay if

something happens to the wrong ligaments

if they have been chopped off the anti

flexion or the angle between the body

and the cervix will be lost so we are

back to our plastinated specimen again

and I want you to appreciate the

position of a non pregnant uterus uterus

is a very small organ it's a hollow

muscular fibromuscular organ it's in its

non-pregnant state it resembles up here

it spear shaped and it's roughly up to

seven to eight centimeters long okay

and you can appreciate the fact that

it's lying inside the lesser pelvis or

the truth and the cavity okay because

here is the these are the great repelled

by this is the this is the region of the

greater pelvis or the false pelvis

and this is the region of the true

pelvis because here is our pelvic brim

or the pelvic Inlet and these organs are

all of them the reproductive organs are

the pelvic organs okay so this is the

position of a non-pregnant uterus but if

in case of pregnancy it has such an

great power of expansion this organ

because it's mainly made up of a great

huge collection of smooth muscle fibers

and elastic fibers so it can come up to

the level actually it does come up to

the level of the xiphoid process a tip

of the dzifa sternum at term like in the

last stages of pregnancy it can climb up

to the level of default process okay

cover up covering up the entire

abdominal cavity while in a non-pregnant

state it stays within the true pelvis

now we will talk about the different

parts of the uterus over an illustration

mainly the uterus is act like you can

you can see a longitudinally sectioned

uterus in this illustration it's also

revealing the the uterine cavity or the

uterine canal which is lying inside okay

so in general the uterus is being

divided into two parts a body and a

cervix okay the body is receiving the

right and left fallopian tubes the

regions are the extensions of the body

which is receiving on either side is

receiving the fallopian tubes or the

uterine tubes is known as the uterine

horns so there is a right you train horn

and a left hand train horn the portion

of the body of uterus lying above the

horn is known as the fundus why because

it looks like a dome just like the

fundus of the urinary bladder it's like

a dome shaped region of the body that

makes in the last stages of pregnancy

it makes the upper segment of the uterus

but it's participate in the formation of

the upper segment of uterus in the

obstetricians terms okay so the part of

the body above the horns is the fundus

and the part line between the horn and

the cervix is actually the true body and

it is its narrowing down if you look at

the cervix

look at the the uterine canal or you try

and cavity you can you can easily

appreciate that the body the cavity of

the body papers done as it is going

towards the cervix it is tapering off

this tapered off region is known as

instuments because it's the narrowest

region of the uterine cavity you try it

now this is Thomas it just creates or

provides a divide okay it's it's it

creates a line of division between the

upper segment and the lower segment of

uterus in during labor or during

pregnancy so this at the time of

delivery in case of of a cesarean

section is Thomas is the region which

has been taken as you know the most of

the cesarean section incisions are made

in the region of this timís the

narrowest part of the uterine canal okay

so then comes to cervix that cervix is

is the the lowest the lower 3

centimeters of the uterus which actually

is joining the vagina or it's opening up

into the vagina okay cervix is is mainly

a is having a narrow vertical canal and

it's connected that the cavity of the

cervix is is communicating with the

cavity

interests room an internal us and it's

connecting or communicating with the

cavity of vagina through external us so

the part of the canal line between the

internal and external us is known as the

cervical canal or the end of cervix

depending upon the lining epithelium so

it's it's known as the endo cervix while

the portion of the cervix which is

protruding into the vaginal cavity or in

the into the vaginal wall is known as

active service cervix take the vaginal

part of the cervix is also known as

active service the Supra vaginal part of

the cervix is known as endocervical so

with that relation we can call it the

end of cervical canal the cervix the

wall of the cervix in contrast to the

wall of the uterus is made up of more

more fibrous and elastic tissue as

compared to the smooth muscle tissue

okay

in this section we can also appreciate

the three layers present in the ball or

they are making the ball of the uterus

the innermost layer is known as the

endometrium it's a specialized form of

epithelium and it's lining the entire

cavity starting from the fundus till the

cervix the endometrium and after the

endometrium is the myometrium myometrium

is the thickest layer of the uterine

wall and this is the layer which holds

the network the plexuses of blood

vessels which will be supplying the the

individual so it's a very important

layer and this this is the layer which

gets hypertrophied in case of pregnancy

and so and so as I have told you that

the uterus is starting from the lesser

pelvis or the truth deficit can reach up

to the

ozzie Freud process to be at the end of

pregnancy so there would be a huge

extensive hypertrophy of the smooth

musculature of my Metron

okay then covering the myometrium from

top is the perimetry when we will look

at the side of the relations of the

uterus we will find that the peritoneal

cavity or detergent the plutonium is not

covering the uterus completely but it's

covering it partial so the entir surface

of the uterus is mainly covered by

adventitia the surface which is clasped

between the soupy a surface of urinary

bladder and the uterus has been covered

by the application while the surface

which is lying between the rectum and

the abdominal facing the abdominal

cavity would be lined by the cartoonist

the serous layer so the the very

material is in 2/3 of uterus and is made

up of this zeros layer while an tier

leader is been covered by adventitia

so on either side are the right and left

lateral furnaces I hope that you are

able to see okay yeah

the lateral furnaces so if I insert my

finger for examination and if I'm

palpating through the lateral fornix

remember that in front of the uterus is

the bladder and at the back of the

bladder the two ureters are coming and

they are opening into the urinary

bladder so through the lateral fornix I

would be able to palpate the ureter and

which vessel is related to the ureter in

females is the uterine artery okay so

the uterine artery and the ureter can be

palpated by like through the lateral

fornix okay now we are left with the

posterior fornix this one the biggest

the largest one the deepest point rather

okay this posterior fornix if I insert

my finger

let me use the model now okay here first

focus on this the vestibule of vagina

which is lying below the pelvic floor

okay this is the vaginal cavity cavity

of the tube and focus on the relations

anteriorly because this is the symphysis

pubis urinary bladder this is the neck

of the bladder and then your throw

okay so vagina basically is anteriorly

related to the neck of the bladder and

the urethra while posteriorly it is

related the vagina is related to the

anal canal this is the anal canal okay

now if I am entering through the vaginal

vestibule entering through the kuraki

like in the vagina lumen this is the

region look at this this is the cervix

act of cervix so the antia fornix which

I just have described and you can see

the relationship if I examine the end

here for necks through anti f1x I will

be able to palpate the bladder the

lateral fonox

is not very much evident because it's a

it's a midsagittal plane it's a section

longitudinal section so you can't see

the lateral Fornax but we know it does

exist on either side then the deepest

one is the posterior fornix and through

the posterior fornix i would be able to

palpate the anal canal or the rectum and

like I can I can perform a rectal

examination like through the posture

fornix and you know this fornix is most

commonly used for the

cause it's in pieces if I am inserting a

needle through the vagina enter the

fornix the pasta upon X and here you

remember that there is the cul-de-sac or

the pouch of Douglas between the uterus

and the rectum the rector you train

pouch so I can and I can insert my

needle into the cavity of the cul-de-sac

through the posterior fornix plus your

vagina and fornix okay also in Kate when

we talk about the palpation I can

palpate through the posterior Phonics I

can palpate the sacral pramana tree the

coccyx

you know they and also the two ligaments

the utero sacral ligaments remember that

the ligaments which were holding back

the uterus in into its retro sorry in

anti verted position so that the right

and left neutral sacred ligaments can be

palpated through the bastia fornix so

this is that the the vagina cornices are

like wing like expansions which are

inserting the vagina sorry they are

inserting the cervix and they they are

like they provide recesses the rest of

the vagina is normally collapsed and

when it comes to the epithelial lining

or the mucosa of the vagina

we just have discussed that due to its

acidic ph there would be stratified

squamous epithelium covering the entire

vagina okay Sartre sometimes due to the

weakening of the ligaments the

supporting elements of the bladder there

is there could be a sisters you and that

means there would be herniation of a

part of bladder into the anterior fornix

of vagina so there would be you know a

protrusion of the urinary bladder into

the

auntie fornix of vagina that is known as

the sister seal at times there they

could be wrecked OC oh that would be the

herniation of the rectum into the first

year phonics so these are the clinical

conditions they like they are not very

good and you know they usually result

from a weakening of weakness of the

supporting elements of the talaq talaq

floor like the levator ni muscle and the

uterine measurements so all of them are

giving up they're providing exceptional

support in case of multiple difficult

deliveries females lose much of this

with the support system so they can

suffer from a sister seal or a rectal

seal and if the the gynecologist is

examining the lady for vagina she can

palpate through the antia fornix she can

palpate the protruding part of the

bladder through the bastia fornix can

palpate the protruding part of the

rectum okay so that's it