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Uterus

  1. The prepubertal uterus varies in length from 2.5 to 3.5 cm. The uterus of adult nulliparous women is from 6 to 8 cm in length and that of multiparous women is from 9 to 10 cm. Uteri of nulliparous women average 50-70 g and those of parous women average 80 g.
  2. The cervix-to-corpus ratio is
     
    2:1 before puberty
     
    1:2 at puberty
     
    1:3 in adults
  3. Pregnancy-induced uterine changes: Pregnancy stimulates remarkable uterine growth due to hypertrophy of muscle fibers. The weight of uterus increases from 70 g to about 1100 g at term. Its total volume averages about 5 liters.

Cervix

  1. Before childbirth, the external cervical os is a small,' regular, oval opening. After childbirth, the orifice is converted into a transverse slit that is divided such that there are the so-called anterior and posterior lips of the cervix.
  2. The mucosa of the cervical canal is composed of a single layer of very high ciliated columnar epithelium that rests on a thin basement membrane.
  3. The cervical glands secrete alkaline mucus with pH 7.8. The mucus is rich in fructose, glycoprotein, and mucopolysaccharides. It also contains sodium chloride.

Fallopian Tube

Total length = 10 cm

 

Parts

Length (cm)

Diameter of lumen (mm)

Intramural

1.25

1

Isthmus

2.5

2.5

Ampulla

5

6

Infundibulum

1.25

6

 

Mucous membrane is lined by columnar epithelium, partly ciliated, others secretory nonciliated and 'Peg' cells.

Ovary

  1. 3 cm (L) x 2 cm (B) x 1 cm (T)
  2. They lie on the ovarian fossa on the lateral pelvic wall.

Relations of ovarian fossa

  1. Superior: External iliac vein
  2. Posterior: Ureter and internal iliac vessels
  3. Lateral: Obturator vessels and nerve

Vagina

  1. The canal is directed upward and backward, forming an angle of 45° with the horizontal in erect posture.
  2. Looks 'H' shaped on transverse section.
  3. Length of anterior wall: 7 cm
  4. Length of posterior wall: 9 cm

Period

 pH

Birth-2 weeks

 4-5

2 weeks-prepuberty

 >7

Puberty

 Shifts from alkaline to acid

Reproductive period

 4-5

Postmenopause

 Neutral or alkaline 6 to >7

Uteroplacental Blood Flow

Uteroplacental blood flow increases progressively during pregnancy, ranging from approximately 700 to 900 mL/min near term.

Blood Supply of Genital Tract

Int iliac artery

 

also called as hypogastric artery and can be ligated in severe uncontrollable PPH to save the life of the patient.

 

Site of ligation: 2.5-3 cm distal to bifurcation of the common iliac artery to preserve the posterior division of the artery and thereby preserving blood supply to lower limb. The dissection should be done laterally to medially to avoid damaging the hypogastric vein.

Principle of Internal Iliac Artery Ligation

Whenever internal iliac artery ligation is done, the pulse pressure across the ligated vessel decreases by 80% and this converts an arterial system to venous system (the blood now flows as in veins) and thus the blood begins to clot and hemostasis is achieved.

Branches of the Internal Iliac Artery

Anterior Division

Posterior Division

 Uterine

 Superior gluteal

 Obliterated umbilical

 Lateral sacral

 Superior & inferior vesical

 Iliolumbar

 Obturator

 

 Internal pudendal

 

 Inferior gluteal

 

 Middle rectal

 

 Vaginal

 

 

Uterine artery is a branch of anterior division of internal iliac artery. In cases of severe hemorrhage when the
internal iliac artery ligation is done, the anterior division should be ligated.

Blood Supply (Organwise)

Organ

Arterial

Venous

Vagina

  • Cervicovaginal branch of uterine
  • Vaginal
  • Middle rectal
  • Internal pudendal
  • Azygos (anterior, posterior)

Internal iliac and internal pudendal veins

Uterus

• Uterine artery

  • Ovarian and vaginal arteries

Uterine vein → internal iliac vein

Fallopian tube

• Uterine artery

  • Ovarian

Pampiniform plexus ovarian veins

Ovary

Ovarian artery

(branch of abdominal aorta)

Left ovarian vein left renal vein

Right ovarian vein IVC

Lymphatic Drainage

Organ

Lymphatic drainage

Uterus (fundus)

Along ovarian lymphatics>superior lumbar (para-aortic)

Uterus (cornu)

Along round ligament superficial inguinal (horizontal group)

Uterus (body)

External Iliac

Cervix

Parametrial (paracervical)

Internal iliac

Obturator

External iliac

Presacral

Common iliac

Superior lumbar

Fallopian tube

Same as uterine fundus

Ovaries

Para-aortic and preaortic

Vagina

Upper 2/3rd

Same as cervix

Lower 1/3rd

Inguinal and ext iliac

Vulva

L. Majora (anterior 1/2)

L. Majora (posterior 1/2)

L. Minora and prepuce of clitoris

Glans of clitoris

Bartholin's glands

Superficial inguinal

Superficial inguinal deep inguinal external iliac

Superficial inguinal

Deep inguinal and ext iliac

Superficial inguinal and anorectal

Vaginal epithelium is stratified squamous epithelium and has the following layers

Layer

Cells seen

Characteristic

Basal & Parabasal

Small, round & basophilic cells

This layer is dominant when there is lack of any hormonal activity as in childhood uptil puberty, postpartum & after menopause

Intermediate cells

Transparent & basophilic cells

This layer is dominant under the influence of Progesterone, Androgen, Corticosteroid or if patient is on OCP's. It is the predominant layer at birth; during pregnancy or can be seen also at menopause.

Superficial cells

Large cells with pyknotic nucleus, Acidophilic on staining

This layer is dominant under the influence of oestroqen & is predominant layer in reproductive period & during preovulatory phase





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