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Structure

Uterus

Not medically reviewed · Content last updated · 2 min read ·

This is the date the draft was written, not a medical review date.

The uterus is a thick-walled muscular organ of the female pelvis that receives the fertilised ovum, houses the developing fetus and expels it at birth. Its size varies with age, parity and hormonal state.

Terminologia Anatomica (Latin): Uterus · Open in the 3D atlas

Location

It lies in the lesser pelvis between the bladder anteriorly and the rectum posteriorly. It is usually anteverted (tilted forward relative to the vagina) and anteflexed (bent forward at the isthmus), though retroverted uteri are a normal variant in a minority of women.

Structure

The uterus has a fundus, body, isthmus and cervix. The wall comprises endometrium (functional and basal layers), thick myometrium and an outer perimetrium (peritoneum). It is supported by the pelvic floor, the cardinal (transverse cervical), uterosacral and pubocervical ligaments, with the broad and round ligaments providing positional stability rather than major support.

Blood supply

The uterine artery from the internal iliac artery runs in the base of the broad ligament, crossing above and in front of the ureter, and anastomoses with the ovarian artery along the side of the uterus. Veins drain through the uterine venous plexus to the internal iliac veins. Lymph drains to iliac, para-aortic and, from the fundus along the round ligament, superficial inguinal nodes.

Innervation

Autonomic supply comes from the uterovaginal plexus (inferior hypogastric plexus): sympathetic fibres T10-L2 and parasympathetic S2-S4. Uterine body pain follows sympathetic afferents (T10-L1), whereas cervical pain follows pelvic splanchnic nerves (S2-S4).

Function

The endometrium undergoes cyclic proliferation, secretion and shedding under ovarian hormones and supports implantation and placentation. The myometrium provides the contractile force for labour, and the cervix acts as a barrier and as the birth canal opening.

Clinical correlations

Common conditions include leiomyomas (fibroids), endometriosis and adenomyosis, endometrial and cervical carcinoma (cervical screening is HPV- or cytology-based according to local policy), and pelvic organ prolapse. In hysterectomy the ureter lies close to the uterine artery and must be identified.

Common exam points

  • Parts: fundus, body, isthmus, cervix; wall layers endometrium, myometrium, perimetrium.
  • Normal position: anteverted and anteflexed.
  • Uterine artery crosses over the ureter (water under the bridge).
  • Main support: cardinal and uterosacral ligaments with the pelvic floor; round ligament passes through the inguinal canal to the labium majus.
  • Broad ligament contains the uterine tube, ovarian ligament, round ligament and uterine vessels.

References

  1. Drake RL, Vogl AW, Mitchell AWM. Gray's Anatomy for Students. Elsevier — Tier 3 (textbook)
  2. Moore KL, Dalley AF, Agur AMR. Clinically Oriented Anatomy. Wolters Kluwer, 8th edition (2018) — Tier 3 (textbook)
  3. Netter FH. Atlas of Human Anatomy. Elsevier — Tier 3 (textbook)

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