Anatomical features of the uterus. Uterus: structure, changes during pregnancy and childbirth

The uterus (from lat. uterus, metra) - an unpaired hollow muscular organ in which the fetus develops during pregnancy. The uterus, as well as the ovaries, fallopian tubes and vagina are classified as internal female genital organs.

Location and shape of the uterus

The uterus is located in the pelvic cavity between bladder front and rectum behind. The shape of the uterus is compared to a pear flattened from front to back. Its length is about 8 cm, weight 50-70 g. In the uterus, the body is distinguished, the upper convex part is the bottom and the lower narrowed part is the neck. The cervix protrudes into the upper part of the vagina. In a newborn girl, the cervix is ​​longer than the body of the uterus, but during puberty, the body of the uterus grows faster and reaches 6-7 cm, the neck - 2.5 cm. In old age, the uterus atrophies and noticeably decreases.

The body of the uterus forms an angle with the cervix, open anteriorly (to the bladder) - this is a normal physiological position. Several ligaments hold the uterus, the main of which - the wide ligaments of the uterus - are located on its sides and pass to the side walls of the pelvis. Depending on the filling of neighboring organs, the position of the uterus may change. So, with a full bladder, the uterus deviates backwards and straightens. Constipation, intestinal overflow also affect the position and condition of the uterus. That is why it is important for a woman to empty both the bladder and the rectum on time.

The uterine cavity is small compared to the size of the organ and has a triangular shape in the cut. In the corners of the base of the triangle (on the border between the bottom and the body of the uterus), the openings of the fallopian tubes open. From top to bottom, the uterine cavity passes into the cervical canal, which opens into the vaginal cavity with the opening of the uterus. In nulliparous women, this hole has a round or oval shape; in those who have given birth, it looks like a transverse slit with healed tears.

The structure of the uterine wall

The wall of the uterus consists of 3 membranes: internal - mucous (endometrium), middle - muscular (myometrium) and external - serous (perimetry), represented by the peritoneum.

The structure of the endometrium
The lining of the uterus is covered ciliated epithelium and has simple tubular glands. With the onset of puberty, it undergoes periodic changes associated with the maturation of eggs in the ovary - female germ cells. A mature egg from the surface of the ovary through the fallopian tube is sent to the uterine cavity. If the egg is fertilized in the fallopian tube (the fusion of the egg and sperm - the male germ cell), then the embryo that has begun to form is introduced into the uterine mucosa, where it further develops, that is, pregnancy begins. At the 3rd month of pregnancy, a placenta, or a child's place, is formed in the uterus - a special formation through which the fetus receives nutrients and oxygen from the mother's body.

In the absence of fertilization, the endometrium undergoes complex cyclic changes, which are commonly called the menstrual cycle. At the beginning of the cycle, structural transformations take place aimed at preparing the endometrium for receiving a fertilized egg: the thickness of the endometrium increases by 4-5 times, its blood supply increases. If fertilization of the egg does not occur, menstruation occurs - the rejection of the surface part of the endometrium and its removal from the body along with the unfertilized egg. The menstrual cycle lasts about 28 days, of which menstruation itself takes 4-6 days. In the postmenstrual phase (until the 11-14th day from the onset of menstruation), a new egg matures in the ovary, and the surface layer of the mucous membrane is restored in the uterus. The next premenstrual phase is characterized by a new thickening of the uterine mucosa and preparing it to receive a fertilized egg (from the 14th to the 28th day).

Cyclic changes in the structure of the endometrium occur under the influence of ovarian hormones. In the ovary, the so-called corpus luteum develops in place of the mature and released egg. In the absence of fertilization of the egg, it exists for 12-14 days. In case of fertilization of the egg and the onset of pregnancy, the corpus luteum remains for 6 months. Cells of the corpus luteum produce the hormone progesterone, which affects the condition of the uterine mucosa and the restructuring of the mother's body during gestation.

The structure of the myometrium
The muscular membrane of the uterus, myometrium, makes up its main mass and has a thickness of 1.5 to 2 cm. The myometrium is built from smooth muscle tissue, the fibers of which are located in 3 layers (outer and inner - longitudinal, middle, most powerful - circular). During pregnancy, the myometrial fibers greatly increase in size (up to 10 times in length and several times in thickness), therefore, by the end of pregnancy, the mass of the uterus reaches 1 kg. The shape of the uterus becomes rounded, and the length increases to 30 cm. Everyone can imagine changes in the size of the abdomen of a pregnant woman. Such a powerful development of the muscular membrane of the uterus is necessary for the implementation of childbirth, when the ripe fetus is excreted from the mother's body by contraction of the uterus and abdominal muscles. After childbirth, the reverse development of the uterus occurs, which ends after 6-8 weeks.

Thus, the uterus is an organ that periodically changes throughout life, which is associated with the menstrual cycle, pregnancy and childbirth.

The structure of the uterus: options are out of the norm

Interesting data on individual variants of the shape and position of the uterus. The absence of half of the uterus, complete or partial closure of the uterine cavity are described. Extremely rare doubling of the uterus, the presence of a partition in its cavity. Sometimes the septum is present only in the region of the fundus of the uterus and is expressed to varying degrees (saddle-shaped, bicornuate uterus). The septum may extend to the vagina. The uterus often remains small, not reaching adult size (infantile uterus), which is combined with underdevelopment of the ovaries.

All these variants of the structure of the uterus are associated with the peculiarities of its development in the embryo from 2 tubes merging with each other (Müllerian ducts). The non-fusion of these ducts leads to a doubling of the uterus and even the vagina, and a delay in the development of one of the ducts underlies the appearance of an asymmetric, or unicornuate, uterus. Nonunion of the ducts throughout one or another of their departments leads to the appearance of partitions in the uterine cavity and vagina.

Rudiment of the male body: prostatic uterus

Men also have a uterus - a punctate depression on the wall of the urethra in its prostatic part, not far from the place where the vas deferens enters the urethra. This prostatic uterus is a rudimentary remnant of the Mullerian ducts, which are laid in the embryo, but simply do not develop in the male body.

The length of the uterus in an adult woman is on average 7-8 cm, width - 4 cm, thickness - 2-3 cm. 4-6 cm.

The uterus as an organ is largely mobile and, depending on the state of neighboring organs, can occupy a different position. Normally, the longitudinal axis of the uterus is oriented along the axis of the pelvis. Most of the surface of the uterus is covered by the peritoneum, with the exception of the vaginal part of the cervix. The uterus is pear-shaped, flattened in the anteroposterior direction.

Anatomy

Parts of the uterus

Parts of the uterus

The uterus consists of the following parts:

• Fundus of the uterus- This is the upper convex part of the uterus, protruding above the line where the fallopian tubes enter the uterus.
• The body of the uterus- The middle (largest) part of the organ has a conical shape.
• Cervix- The lower narrowed rounded part of the uterus.

Functions

The uterus is the organ in which the development of the embryo and gestation takes place. Due to the high elasticity of the walls, the uterus can increase in volume several times during pregnancy. Being an organ with developed muscles, the uterus is actively involved in the expulsion of the fetus during childbirth.

Pathologies

Anomalies of development

• Aplasia (Agenesia) of the uterus- extremely rarely, the uterus may be completely absent. There may be a small infantile uterus, usually with a pronounced anterior fold.
• Doubling of the body of the uterus- a defect in the development of the uterus, which is characterized by a doubling of the uterus or its body, which occurs due to the incomplete fusion of the two Müllerian ducts at the stage of early embryonic development. As a result, a woman with a double uterus may have one or two cervixes and one vagina. With complete non-fusion of these ducts, two uteruses with two necks and two vaginas develop.
• Intrauterine septum- incomplete fusion of the embryonic rudiments of the uterus in various variants, can lead to the presence of a septum in the uterus - a "bicornuate" uterus with a clearly visible sagittal depression at the bottom or a "saddle" uterus without a septum in the cavity, but with a notch at the bottom. With a bicornuate uterus, one of the horns may be very small, rudimentary, and sometimes laced.

Diseases

• Prolapse and prolapse of the uterus- Prolapse of the uterus or a change in its position in the pelvic cavity and its displacement down the inguinal canal is called complete or partial prolapse of the uterus. In rare cases, the uterus slips right into the vagina. In mild cases of uterine prolapse, the cervix protrudes forward at the bottom of the genital fissure. In some cases, the cervix falls into the genital gap, and in especially severe cases, the entire uterus falls out. Uterine prolapse is described depending on which part of the uterus protrudes forward. Patients often complain about the sensation of a foreign body in the genital slit. Treatment can be either conservative or surgical, depending on the individual case.
• uterine fibroids- A benign tumor that develops in the muscular membrane of the uterus. It consists mainly of elements of muscle tissue, and partly of connective tissue, also called fibromyoma.

• Polyps of the uterus- Pathological proliferation of the glandular epithelium, endometrium or endocervix against the background of chronic inflammatory process. In the genesis of polyps, especially uterine ones, hormonal disorders play a role.

• Uterine cancer- Malignant neoplasms in the uterus.
  • Cancer of the body of the uterus- cancer of the body of the uterus means cancer of the endometrium (the lining of the uterus), which spreads to the walls of the uterus.
  • Cancer cervix - a malignant tumor, localized in the region of the cervix.

• endometritis- Inflammation of the lining of the uterus. In this case, the disease affects the functional and basal layers of the uterine mucosa. When inflammation of the muscular layer of the uterus joins it, they talk about endomyometritis.

• Cervical erosion- This is a defect in the epithelial lining of the vaginal part of the cervix. There are true and false erosion of the cervix:
  • true erosion- related to acute inflammatory diseases female genital organs and is frequent companion cervicitis and vaginitis. It occurs, as a rule, against the background of general inflammation in the cervix caused by sexually transmitted infections or the conditionally pathogenic flora of the vagina, under the influence of mechanical factors, malnutrition of the cervical tissue, menstrual irregularities, and hormonal levels.
  • Ectopia (pseudo-erosion)- there is a common misconception that ectopia is a response of the body to the appearance of erosion, as the body tries to replace the defect in the mucous membrane of the vaginal (outer) part of the cervix with a cylindrical epithelium lining the uterine (inner) part of the cervical canal. Often this confusion arises from the outdated point of view of some doctors. In fact, ectopia is an independent disease that has little to do with true erosion. The following types of pseudo-erosion are divided:
    • congenital ectopia- in which the cylindrical epithelium can be located outward from the external cervical os in newborns or move there during puberty.
    • Acquired ectopia- ruptures of the cervix during abortions lead to deformation of the cervical canal, resulting in post-traumatic ectopia of the cylindrical epithelium (ectopion). Often (but not always) accompanied by an inflammatory process.

Diagnostics

Operations

• Abortion(not to be confused with the term "spontaneous abortion", meaning " miscarriage") - an operation aimed at terminating a pregnancy, performed in her first 12 weeks in a hospital at the request of a woman. It is a mechanical destruction of the embryo with further curettage of the uterine cavity. There are clinical (in a hospital) and criminal abortions. Any abortion can lead to serious complications. Criminal abortion can be the cause of a woman's death.
• Vacuum aspiration or the so-called "mini-abortion" - an intervention aimed at terminating a pregnancy at an extra early date - from twenty to twenty-five days of the absence of an expected menstruation. Refers to minimally invasive operations, can be performed on an outpatient basis.
• C-section(lat. caesarea "royal" and sectio "incision") - childbirth with the help of abdominal surgery, in which the newborn is removed not through the natural birth canal, but through an incision in the abdominal wall of the uterus. Previously, caesarean section was performed only for medical reasons, but now more and more often the operation is performed at the request of the woman in labor.
• Hysterectomy- (Greek hystera uterus + Greek ectome ectomy, removal; it is possible to write hysterectomy; another common name is extirpation of the uterus) - a gynecological operation in which a woman's uterus is removed.

Links

1. BSE.sci-lib.com. - The meaning of the word "womb" in the Great Soviet Encyclopedia. Retrieved September 2, 2008.

uterus(Greek metra s. hystera), is an unpaired hollow muscular organ located in the pelvic cavity between the bladder in front and the rectum in the back. The egg entering the uterine cavity through the fallopian tubes, in case of fertilization, undergoes further development here until the removal of the mature fetus during childbirth. In addition to this generative function, the uterus also performs menstrual function.

A fully developed virgin uterus is pear-shaped, flattened from front to back. It distinguishes the bottom, body and neck.

Bottom, fundus uteri, called the upper part, protruding above the line of entry into the uterus of the fallopian tubes. Body, corpus uteri, has a triangular outline, tapering gradually towards the neck. The neck, cervix uteri, is a continuation of the body, but more round and narrower than the latter.

The cervix, with its outer end, protrudes into the upper part of the vagina, and the part of the cervix protruding into the vagina is called vaginal part, portio vaginalis (cervicis). The upper segment of the neck, adjacent directly to the body, is called portio supravaginalis (cervicis).

The front and back surfaces are separated from each other by edges, margo uteri (dexter et sinister). Due to the significant wall thickness uterus, its cavity, savitas uteri, is small in comparison with the size of the organ.

On the frontal section, the uterine cavity looks like a triangle, the base of which is facing the bottom of the uterus, and the top is facing the cervix. Pipes open at the corners of the base, and at the top of the triangle, the uterine cavity continues into the cavity, or canal, of the cervix, canalis cervicis uteri. The place where the uterus passes into the cervix is ​​narrowed and is called isthmus of the uterus, isthmus uteri.

The cervical canal opens into the vaginal cavity uterine opening, ostium uteri. The uterine opening in nulliparous has a round or transverse-oval shape, in those who have given birth it appears in the form of a transverse slit with healed tears along the edges. The cervical canal in nulliparous has a spindle shape. The uterine opening, or pharynx of the uterus, is limited two lips, labium anterius et posterius.

The posterior lip is thinner and protrudes less downward than the thicker anterior. The posterior lip seems to be longer, since the vagina is attached higher on it than on the anterior one. In the cavity of the body of the uterus, the mucous membrane is smooth, without folds, in the cervical canal there are folds, plicae palmatae, which consist of two longitudinal elevations on the anterior and posterior surfaces and a number of lateral ones, directed laterally and upward.

The wall of the uterus consists of three main layers:

1. Outer, perimetrium,- this is the visceral peritoneum, fused with the uterus and forming its serous membrane, tunica serosa. (In practical terms, it is important to distinguish perimetrium, i.e. visceral peritoneum, from parameter, i.e., from the periuterine fatty tissue lying on the anterior surface and on the sides of the cervix, between the sheets of the peritoneum, which forms the broad ligament of the uterus.)

2. Middle, myometrium,- this is the muscular membrane, tunica muscularis. The muscular membrane, which makes up the main part of the wall, consists of unstriated fibers intertwining with each other in various directions.

3. Internal, endometrium, is the mucous membrane, tunica mucosa. Covered with ciliated epithelium and not having folds, the mucous membrane of the body of the uterus is equipped with simple tubular glands, glandulae uterinae that penetrate the muscle layer. In the thicker mucous membrane of the cervix, in addition to the tubular glands, there are mucous glands, g11. cervicales.

Medium mature uterus length outside the state of pregnancy, it is 6 - 7.5 cm, of which 2.5 cm falls on the neck. In a newborn girl, the neck is longer than the body of the uterus, but the latter undergoes increased growth during puberty.

During pregnancy, the uterus changes rapidly in size and shape. On the 8th month, it reaches 18 - 20 cm and takes a rounded-oval shape, spreading the leaves of the broad ligament as it grows. Individual muscle fibers not only multiply in number, but also increase in size. After childbirth, the uterus gradually, but rather quickly, decreases in size, almost returning to its previous state, but retaining a slightly larger size. The enlarged muscle fibers undergo fatty degeneration.

In old age, atrophy is found in the uterus, its tissue becomes paler and denser to the touch.

Educational video of the anatomy of the uterus (uterus)

The uterus is recognized as the main organ of the female reproductive system. The structure determines its functions, the main of which is the bearing and subsequent expulsion of the fetus. The uterus plays a direct role in the menstrual cycle, is able to change size, shape and position, depending on the processes occurring in the body.

Anatomy and size of the uterus: a photo with a description

Unpaired reproductive organ characterized by a smooth muscle structure and a pear-shaped shape. What is the uterus, its structure and a description of the individual parts are shown in the picture.

In gynecology, the departments of the organ are distinguished:

• bottom- area above the fallopian tubes;
• body- middle cone-shaped area;
• neck- the narrowed part, the outer part of which is located in the vagina.

The uterus (in Latin matricis) is covered on the outside with perimetry - a modified peritoneum, from the inside - with endometrium, which acts as its mucous layer. The muscular layer of the organ is the myometrium.

The uterus is supplemented by ovaries, which are connected to it through the fallopian tubes. The peculiarity of the physiology of the organ lies in mobility. The uterus is held in the body due to the muscular and ligamentous apparatus.

A detailed and detailed image of the female reproductive organ in the section is shown in the picture.

The size of the uterus changes throughout the cycle, depending on age and other features.

Determine the parameter by ultrasound pelvic organs. The norm is 4-5 cm in the period after the completion of menstruation. In a pregnant girl, the diameter of the uterus can reach 26 centimeters, the length is 38 centimeters.

After childbirth, the organ decreases, but remains 1-2 centimeters larger than before conception, the weight becomes 100 grams. The normal average size of the uterus is shown in the table.

In a newborn girl, the length of the organ is 4 cm, from the age of 7 it gradually increases. During menopause, the intact uterus decreases, the walls become thinner, the muscular and ligamentous apparatus weakens. 5 years after the end of menstruation, it becomes the same size as at birth.

The figure shows the development of an organ throughout life.

The thickness of the walls of the uterus varies from 2 to 4 cm, depending on the day of the cycle. The mass of an organ in a nulliparous woman is about 50 grams; during pregnancy, the weight increases to 1-2 kilograms.

Neck

The lower narrow segment of the uterus is called the cervix (in Latin cervix uteri) and is a continuation of the organ.

Connective tissue covers this part. The area of ​​the uterus leading to the cervix is ​​called the isthmus. The entrance to the cervical canal from the side of the cavity opens the internal pharynx. The department ends with the vaginal part, where the external pharynx is located.

The detailed structure of the neck is shown in the figure.

In the cervical canal (endocervix), in addition to folds, there are tubular glands. They and the mucous membrane produce mucus. Covers this section of the cylindrical epithelium.

In the vaginal part of the neck (exocervix) there is a multilayer squamous epithelium characteristic of this area. The area where one type of mucosal cells changes to another is called the transition zone (transformation).

Types of epithelium are depicted large in the picture.

The vaginal part of the organ is accessible to visual inspection.

Regular examination by a doctor allows you to identify and eliminate pathologies at an early stage: erosion, dysplasia, cancer, and others.

A special tool - a colposcope - conducts a detailed examination of the organ on the gynecological chair. The photo shows a close-up of a healthy cervix and with pathological changes.

An important indicator is the length of the cervix. The normal value is 3.5-4 centimeters.

The structure of the neck is given Special attention during pregnancy. Narrow or small (short) breasts increase the risk of miscarriage. With isthmic-cervical insufficiency, it becomes difficult for the cervix to withstand the load created by the fetus.

Bottom

The structure of the uterus includes its body and neck. These 2 parts are connected by an isthmus. The highest region of the body of the reproductive organ is convex in shape, called the bottom. This area protrudes beyond the entry line of the fallopian tubes.

An important indicator is the height of the fundus of the uterus (VDM) - the distance from the pubic bone to the upper point of the organ. It is taken into account when assessing the development of the fetus during pregnancy. The size of the bottom of the uterus shows the growth of the organ, and normally the value ranges from 10 centimeters for a period of 10 weeks to 35 centimeters at the end of the gestation period. The indicator is determined by the doctor during palpation.

Body

This part is recognized as the main one in the structure of the uterus. The body consists of a triangular cavity and its walls.

The lower segment is connected to the neck at an obtuse angle with a normal structure, the upper segment passes into the bottom, directed to the side abdominal cavity.

The fallopian tubes adjoin the lateral areas, wide uterine ligaments are attached to the right and left edges. The anatomical parts of the body also include the anterior or vesicular surface, which is adjacent to the bladder, the posterior one borders on the rectum.

Ligaments and muscles

The uterus is a relatively mobile organ, since it is held in the body by muscles and ligaments.

They perform the following functions:

• hanging- attachment to the pelvic bones;
• fixing- giving the uterus a stable position;
• supportive- creation of support for internal organs.

Suspension apparatus

The function of attaching an organ is performed by ligaments:

• round- 100-120 mm long, located from the corners of the uterus to the inguinal canal and tilt the bottom anteriorly;
• wide- resemble a "sail" stretched from the pelvic walls to the sides of the uterus;
• suspensory ligaments of the ovaries- proceed from the lateral part of the broad ligament between the ampulla of the tube and the pelvic wall in the area of ​​the sacroiliac joint;
• ownovarian ligaments- attach the ovary to the side of the uterus.

fixing apparatus

Links include:

• cardinal(transverse)- consist of smooth muscle and connective tissues, are reinforced wide ligaments;
• uterovesical (cervical)- directed from the cervix and go around the bladder, prevent the uterus from tilting back;
• sacro-uterine ligaments- do not allow the organ to move towards the pubis, go from the posterior uterine wall, go around the rectum and attach to the sacrum.

Muscles and fascia

The supporting apparatus of the organ is represented by the perineum, which includes the urogenital and pelvic diaphragms, which consist of several muscle layers and fascia.

The anatomy of the pelvic floor includes muscles that perform a supporting function for the organs of the genitourinary system:

• sciatic-cavernous;
• bulbous-spongy;
• external;
• superficial transverse;
• deep transverse;
• pubic-coccygeal;
• iliococcygeal;
• ischiococcygeal.

Layers

The structure of the uterine wall includes 3 layers:

• serous membrane (perimetry) - represents the peritoneum;
• internal mucous tissue - endometrium;
• muscular layer - myometrium.

There is also a parametrium - a layer of pelvic tissue, which is located at the level of the cervix at the base of the broad ligaments of the uterus, between the layers of the peritoneum. The location between the organs provides the necessary mobility.

endometrium

The layer structure is shown in the figure.

The mucous epithelium is rich in glands, is characterized by good blood supply, and is sensitive to damage and inflammatory processes.

The endometrium has 2 layers: basal and functional. The thickness of the inner shell reaches 3 millimeters.

Myometrium

The muscular coat is represented by intertwined smooth muscle cells. Contractions of sections of the myometrium in different days cycle is regulated by the autonomic nervous system.

Perimetry

The serous outer shell is located on the anterior wall of the body of the uterus, completely covering it.

At the border with the neck, the layer bends and is transferred to the bladder, forming the vesicouterine space. In addition to the surface of the body behind, the peritoneum covers a small area of ​​​​the posterior fornix of the vagina, the rectum, forming a recto-uterine pocket.

These recesses, the location of the uterus in relation to the peritoneum are marked in the figure depicting the topography of the female genital organs.

Where is

The uterus is located in the lower abdomen, its longitudinal axis is parallel to the axis of the pelvic bones. At what distance it is from the entrance in the depths of the vagina depends on the structural features, usually it is 8-12 centimeters. The diagram shows the position of the uterus, ovary, tubes in the female body.

Since the organ is mobile, it is easily displaced in relation to others and when they are affected. The uterus is located between the bladder in front and the loop small intestine, the rectum in the posterior region, its location can be determined using ultrasound.

The reproductive organ is to some extent deviated forward and has a curved shape. In this case, the angle between the neck and the body is 70-100 degrees. The adjacent bladder and intestines affect the position of the uterus. The body deviates to the side, depending on the filling of the organs.

If the bladder is empty, the anterior surface of the uterus is directed forward and slightly downward. In this case, an acute angle is formed between the body and the neck, open anteriorly. This position is called anteversio.

When the bladder is filled with urine, the uterus deviates backwards. In this case, the angle between the neck and the body becomes deployed. This state is determined by retroversion.

There are also types of bends of the body:

• anteflexio - an obtuse angle is formed between the neck and the body, the uterus deviates forward;
• retroflexio - the neck is directed forward, the body is posterior, an acute angle is formed between them, open back;
• lateroflexio - bend to the pelvic wall.

Appendages of the uterus

The complement of the female reproductive organ is its appendages. The detailed structure is shown in the figure.

ovaries

Paired glandular organs are located along the lateral ribs (sides) of the uterus and are connected to it through the fallopian tubes.

The appearance of the ovaries resembles a flattened egg, they are fixed with the help of a suspensory ligament and a mesentery. The organ consists of the outer cortical layer, where the follicles mature, and the inner granular (medulla) containing the egg, blood vessels and nerves.

How much it weighs and the size of the ovary depends on the day of the menstrual cycle. The average weight is 7-10 grams, length - 25-45 millimeters, width - 20-30 millimeters.

The hormonal function of the body is the production of estrogens, progestogens, testosterone.

During the cycle, the mature follicle in the ovary bursts and transforms into the corpus luteum. In this case, the egg passes through the fallopian tubes into the uterine cavity.

If pregnancy occurs, the corpus luteum performs intrasecretory functions, in the absence of fertilization, it gradually disappears. How the ovary is arranged, its structure is visible in the picture.

The fallopian tubes

A paired muscular organ connects the uterus to the ovaries. Its length is 100-120 millimeters, diameter is from 2 to 10 millimeters.

Sections of the fallopian tube:

• isthmus (isthmic part);
• ampoule;
• funnel - contains a fringe that guides the movement of the egg;
• uterine part - connection with the organ cavity.

The wall of the fallopian tube is predominantly composed of myocytes and is contractile. This is due to its function - transporting the egg to the uterine cavity.

Sometimes there is a life-threatening complication for a woman - an ectopic (ectopic) pregnancy. In this case, the fertilized egg remains inside the tube and causes a rupture of its wall and bleeding. In this case, it is urgent to operate the patient.

Features of the structure and function

The device and location of the uterus are subject to frequent changes. She is influenced internal organs, the period of bearing a child, the processes that occur every menstrual cycle.

The condition of the cervix determines the onset of ovulation. During this period, its surface becomes loose, the mucus becomes viscous, it falls lower than on other days of the cycle.

In the absence of conception, menstruation occurs. At this time, the upper layer of the uterine cavity, the endometrium, is separated. In this case, the internal pharynx expands for the release of blood and part of the mucous membrane.

After the cessation of menstruation, the pharynx narrows, the layer is restored.

The functions for which the uterus is needed are defined:

• reproductive- ensuring the development, gestation and subsequent expulsion of the fetus, participation in the formation of the placenta;
• menstrual- cleansing function removes part of the unnecessary layer from the body;
• protective- the neck prevents the penetration of pathogenic flora;
• secretory- mucus production;
• support- the uterus acts as a support for other organs (intestines, bladder);
• endocrine- synthesis of prostaglandins, relaxin, sex hormones.

uterus during pregnancy

The most significant changes undergo the female organ during the period of bearing a child.

At the initial stage, the appearance of the uterus remains the same, but already in the second month it becomes spherical, the size and mass increase several times. By the end of pregnancy, the average weight is about 1 kilogram.

At this time, the volume of the endometrium and myometrium increases, the blood supply increases, the ligaments stretch during pregnancy and sometimes even hurt.

indicator of health and proper development fetus is the height of the uterine fundus, depending on the term. The norms are given in the table.

Another important indicator is the length of the cervix. It is evaluated to avoid the development of complications of gestation and premature birth. The norms of the length of the neck by weeks of pregnancy are indicated in the table.

By the end of the gestation period, the uterus stands high, reaches the level of the navel, has the shape of a spherical muscular formation with thin walls, slight asymmetry is possible - this is not a pathology. However, due to the advancement of the fetus to the birth canal, the organ gradually begins to descend.

Muscular contractions of the uterus are possible during pregnancy. The reasons are the tone of the organ (hypertonicity with the threat of miscarriage), training contractions.

Strong contractions occur during childbirth to expel the fetus from the uterine cavity. The gradual opening of the cervix releases the baby out. The placenta comes out next. The neck of a woman giving birth after stretching does not return to its original shape.

Circulation

The genital organs have an extensive circulatory network. The structure of the blood circulation of the uterus and appendages with a description is shown in the figure.

The main arteries are:

• mother- is a branch of the internal iliac artery.
• Ovarian- departs from the aorta on the left side. The right ovarian artery is more often considered a branch of the renal artery.

Venous outflow from the upper sections of the uterus, tubes, ovaries on the right occurs into the inferior vena cava, on the left - into the left renal vein. Blood from the lower uterus, cervix, vagina enters the internal iliac vein.

The main lymph nodes of the genital organs are the lumbar. Iliac and sacral provide lymph outflow from the neck and lower body. A slight outflow occurs in the inguinal The lymph nodes.

innervation

The genital organs are characterized by sensitive autonomic innervation, which is provided by the pudendal nerve, which is a branch of the sacral plexus. This means that uterine activity is not controlled by volitional efforts.

The body of the organ has predominantly sympathetic innervation, the neck - parasympathetic. The contractions are due to the influence of the nerves of the superior hypogastric plexus.

Movements occur under the influence of neurovegetative processes. The uterus is characterized by innervation from the uterovaginal plexus, the ovary - from the ovarian plexus, the tube - from both types of plexus.

action nervous system expressed pain during childbirth. The innervation of the genital organs of a pregnant woman is shown in the figure.

Pathological and abnormal changes

Diseases change the structure of the body and the structure of its individual components. One of the pathologies why a woman's uterus can be enlarged is fibroids - benign tumor, able to grow to an impressive size (over 20 centimeters).

With a small volume, such formations are subject to observation, large ones are removed with the help of an operation. The symptom of a "dense uterus", in which its walls thicken, is characteristic of adenomyosis - internal endometriosis, when the endometrium grows into the muscle layer.

Also, the structure of the organ is changed by polyps, cysts, fibromas, pathologies of the cervix. The latter include erosion, dysplasia, cancer. Regular inspection significantly reduces the risk of their development. With dysplasia of 2-3 degrees, conization of the neck is indicated, in which its cone-shaped fragment is removed.

"Rabies" of the uterus (hypersexuality) can also be a symptom of problems in the reproductive system. Pathologies, anomalies, features of the body can cause infertility. For example, with a "hostile uterus" (immunoactive), immunity prevents the fertilization of the egg, destroying the spermatozoa.

In addition to pathological phenomena that change the structure of the organ, there are anomalies in the structure of the uterus:

• small (children's) - its length is less than 8 centimeters;
• infantile - the neck is elongated, the size of the organ is 3-5 centimeters;
• one-horned and two-horned;
• double;
• saddle and so on.

Doubling

In addition to the presence of 2 uterus, there is a doubling of the vagina. In this case, the development of the fetus is possible in two organs.

bicorn

Outwardly, it resembles a heart; in the bottom area, the horned uterus is divided in two and connected in the neck area. One of the horns is underdeveloped.

Saddle (arc-shaped)

A variant of a bicornuate uterus, the bifurcation of the bottom is minimally expressed in the form of a depression. Often asymptomatic.

Intrauterine septum

The uterus is completely divided in two. With a complete septum, the cavities are isolated from each other, with an incomplete one they are connected in the neck area.

Omission

Displacement of the uterus below the anatomical boundary due to weakness of the muscles and ligaments. It is observed after childbirth, during menopause, in old age.

elevation

The organ is located above the upper pelvic plane. The reasons are adhesions, tumors of the rectum, ovary (as in the photo).

Turn

In this case, the rotation of the uterus is distinguished, when the entire organ with the neck is rotated or torsion (twisting), in which the vagina remains in place.

eversion

An everted uterus is rare in real gynecological practice and is usually a complication of childbirth.

A completely inverted organ is characterized by the output of the neck, the body of the vagina. Partially inside-out is manifested by incomplete descent of the uterine fundus beyond the boundaries of the internal opening.

Bias

The anomaly is characterized by the displacement of the organ forward, backward, to the right or to the left. The figure schematically shows a curved uterus, deviated in opposite directions.

Dropping out

Pathology occurs when the muscles and ligaments are weak and is characterized by a displacement of the uterus down to the vagina or out through the labia.

At reproductive age, the position of the organ is restored by the method surgical intervention. If it fell out completely, deletion is shown.

Uterus removal

Extirpation of an organ (hysterectomy) is performed according to serious indications: with large fibroids, uterine oncology, widespread adenomyosis, heavy bleeding, and so on.

During the operation, it is possible to preserve the ovaries and uterine cervix. In this case, no replacement is assigned. hormone therapy, eggs from the ovaries are suitable for use in surrogacy.

Options for removing the uterus are briefly shown in the photo, after the operation, the bladder moves back, the intestines down.

The rehabilitation period is characterized by pain in the area of ​​the excised organ, bleeding, which gradually subside. Not only physical, but also moral discomfort is possible. Negative consequences are associated with the displacement of organs due to the removed uterus

The structure of the internal genital organs is schematically shown in fig. 1.2.

Vagina(vagina) - a stretchable muscular-fibrous tube about 10 cm long. It is somewhat curved, the bulge is facing backwards. The upper edge of the vagina covers the cervix, and the lower edge opens into the vestibule of the vagina.

The anterior and posterior walls of the vagina are in contact with each other. The cervix protrudes into the vaginal cavity, a trough-like space is formed around the cervix - the vaginal vault (fortnix vaginae). It distinguishes between the posterior arch (deeper), the anterior (flatter) and the lateral arches (right and left). The anterior wall of the vagina in the upper part is adjacent to the bottom of the bladder and is separated from it by loose fiber, and the lower part is in contact with the urethra. The upper quarter of the posterior wall of the vagina from the side of the abdominal cavity is covered with peritoneum (rectal-uterine cavity - excavatio retrouterina); below the back wall of the vagina is adjacent to the rectum.

The walls of the vagina consist of three layers: the outer layer (dense connective tissue), the middle one (thin muscle fibers crossing in different directions) and the inner one (the vaginal mucosa covered with stratified squamous epithelium). There are no glands in the mucous membrane of the vagina. In the lateral parts of the vaginal walls, there are sometimes remnants of wolf passages (Gartner canals). These rudimentary formations can serve as a starting point for the development of vaginal cysts.

Uterus(uterus, s. metra, s. hysteria) - an unpaired hollow muscular organ located in the small pelvis between the bladder (front) and the rectum (rear). The uterus is pear-shaped, flattened in the anteroposterior direction, about 7–9 cm long in a nulliparous woman and 9–11 cm in a woman who has given birth; the width of the uterus at the level of the fallopian tubes is approximately 4 - 5 cm; the thickness of the uterus (from the anterior surface to the posterior) does not exceed 2 - 3 cm; the thickness of the walls of the uterus is equal to 1 - 2 cm; its average weight ranges from 50 g in nulliparous women to 100 g in multiparous women. The position of the uterus in the pelvis is not constant. It can vary depending on a number of physiological and pathological factors, for example, during pregnancy or the presence of various inflammatory and neoplastic processes in the uterus itself, and in its appendages, as well as abdominal organs (tumors, cysts, etc.).

In the uterus, the body (corpus), isthmus (istmus) and neck (cervix) are distinguished, shown in Fig. 1.3. The body of the uterus has a triangular shape, gradually narrowing towards the neck (see Fig. 1.3, a). The organ is divided by a pronounced constriction like a waist, about 10 mm wide. In the neck, supravaginal (upper 2/3) and vaginal (lower 1/3) parts are distinguished.

The upper part of the uterus, protruding above the level of the fallopian tubes, forms the bottom of the uterus (fundus uteri). Slightly lower anteriorly from the place of origin of the fallopian tubes, round uterine ligaments (lig. rotundum, s. teres) depart on both sides, and at the same height, their own ligaments of the ovaries (lig. ovarii proprii) are attached behind. In the uterus, the front, or bladder (facies vesicalis), and the back, or intestinal, surface (facies intestinalis), as well as the right and left lateral edges (margo uteri dexter et sinister) are distinguished.

Usually, there is an angle between the body and the cervix, corresponding to an average of 70-100 ", open anteriorly (anteflexio); the entire uterus, in addition, is tilted anteriorly (anteversio). This position of the uterus in the small pelvis is considered normal.

The wall of the uterus consists of the following layers: the mucous membrane (endometrium), the muscular layer (myometrium) and the peritoneal cover (perimrtrium).

The endometrium is represented by two layers: basal (deep) and functional (superficial), facing the uterine cavity. The endometrium lines the uterine cavity from the inside and is fused with the muscular membrane without a submucosal layer. The thickness of the mucosa reaches 1 mm or more. In the stroma of the basal layer, consisting of connective tissue cells, there are excretory parts of the glands located in the functional layer. The epithelium of the glands is single-row cylindrical. The functional layer of the endometrium, consisting of the cytogenic stroma, glands and blood vessels, is extremely sensitive to the action of steroid sex hormones, it is lined with a surface epithelium, similar in structure to the epithelium of the glands (Fig. 1.4).

The muscular layer of the uterus (myometrium) consists of three powerful layers of smooth muscle fibers. Part of the superficial muscle bundles extends to the uterine ligaments. Practically important is the generally accepted scheme of the structure of the myometrium in relation to the predominant direction of its various layers. The outer layer has a mainly longitudinal direction, the middle one is circular and oblique, and the inner one is longitudinal. In the body of the uterus, the circular layer is most developed, while in the cervix it is longitudinal. In the area of ​​​​the external and internal pharynx, as well as the uterine openings of the tubes, muscle fibers are located mainly circularly, forming, as it were, a kind of sphincters.

Rice. 1.3. Anatomical parts of the uterus:

a - frontal section; b - sagittal section; 1 - body of the uterus, 2 - isthmus, 3 - cervix (supravaginal part), 4 - cervix (vaginal part)

Rice. 1.4. The structure of the endometrium (scheme):

I - compact layer of the endometrium; II - spongy layer of the endometrium; III - basal layer of the endometrium; IV - myometrium; A - arteries of the myometrium; B - arteries of the basal layer; B - spiral arteries of the functional layer; G - glands

The body of the uterus and the posterior surface of the supravaginal part of the cervix are covered with peritoneum.

The cervix is ​​an extension of the body. It distinguishes two sections: the vaginal part (portio vaginalis) and the supravaginal part (roquesh supravaginalis), located above the place of attachment to the neck of the vaginal vaults. On the border between the body of the uterus and the cervix, there is a small section - the isthmus (istmus uteri), from which the lower segment of the uterus is formed during pregnancy. The cervical canal has two constrictions. The place of transition of the cervix to the isthmus corresponds to the internal os. In the vagina, the cervical canal opens with an external os. This opening is round in nulliparous women and transversely oval in those who have given birth. The vaginal part of the cervix, located in front of the external pharynx, is called the anterior lip, and the part of the cervix behind the external pharynx is called the posterior lip.

Topographically, the uterus is in the center of the small pelvis - the correct position. Inflammatory or neoplastic processes of the pelvic organs can displace the uterus anteriorly (antepositio), posteriorly (retropositio), to the left (sinistropositio) or to the right (dextropositio). In addition, with a typical location, the uterus is entirely tilted anteriorly (anteversio), and the body and cervix form an angle of 130-145 °, open in front (anteflexio).

UTERINE ADDITIONS:

The fallopian tubes(tuba uterinae) depart on both sides from the lateral surfaces of the bottom of the uterus (see Fig. 1.2). This paired tubular organ, 10-12 cm long, is enclosed in a fold of the peritoneum, which makes up the upper part of the wide uterine ligament and is called the mesentery of the tube (mesosalpinx). There are four divisions of it.

The uterine (interstitial, intramural) part of the tube (pars uterina) is the narrowest (diameter of the lumen in the atom section but more than 1 mm), is located in the thickness of the uterine wall and opens into its cavity (ostium uterinum tube). The length of the interstitial part of the tube ranges from 1 to 3 cm.

Isthmus of the fallopian tube (istmus tubae uterinae) - a short segment of the tube after it exits the uterine wall. Its length is not more than 3-4 cm, however, the wall thickness of this section of the pipe is the largest.

The ampulla of the fallopian tube (ampulla tubae uterinae) is the convoluted and longest part of the tube (about 8 cm) that expands outwards. Its diameter is on average 0.6-1 cm. The wall thickness is less than the isthmus.

Funnel of the fallopian tube (infundibulum tubae uterinae) - the widest end gave the tube, ending with many outgrowths or fringes (fimbriae tubae) about 1-1.6 cm long, bordering the abdominal opening of the fallopian tube and surrounding the ovary; the longest of the fringes, about 2-3 cm long, is often located along the outer edge of the ovary, is fixed to it and is called ovarian (fimbriae ovarica).

The wall of the fallopian tube consists of four layers.

1. Outer, or serous, shell (tunica serosa).

2. Subserous tissue (tela subserosa) - a loose connective tissue membrane, weakly expressed only in the area of ​​​​the isthmus of the ampoule; on the uterine part and in the funnel of the tube, subserous tissue is practically absent.

3. The muscular membrane (tunica muscularis) consists of three layers of smooth muscles: a very thin outer - longitudinal, a more significant middle - circular and internal - longitudinal. All three layers of the muscular membrane of the tube are closely intertwined with each other and directly pass into the corresponding layers of the uterine myometrium.

4. The mucous membrane (tunica mucosa) forms in the lumen of the tube longitudinally arranged tube folds, more pronounced in the region of the ampoule.

The main function of the fallopian tubes is to transport the fertilized egg to the uterus due to peristaltic contractions of the muscular layer.

Ovary(ovarium) - a paired organ, which is the female gonad. It is usually located on the side wall of the pelvis in the deepening of the parietal peritoneum, at the place where the common iliac artery divides into external and internal - in the so-called ovarian fossa (fossa ovarica).

The ovary is 3 cm long, 2 cm wide, and 1-1.5 cm thick (see Fig. 1.2). It has two surfaces, two poles and two edges. The inner surface of the ovary faces the midline of the body, the outer surface looks down and out. One pole of the ovary (uterine) is connected to the uterus with the help of its own ligament of the ovary (lig. Ovarii proprium). The second pole (pipe) faces the funnel of the pipe, a triangular fold of the peritoneum is attached to it - a ligament that suspends the ovary (lig. Suspensorium ovarii) and descends to it from the boundary line. The ovarian vessels and nerves pass through the ligament. The free rounded edge of the ovary faces the peritoneal cavity, the other edge (straight) forms the gate of the ovary (hilus ovarii), attaching to the posterior leaf of the broad ligament.

On most of the surface, the ovary does not have a serous cover and is covered with germinal (rudimentary) epithelium. Only a slight clean of the mesenteric edge in the area of ​​​​attachment of the mesentery of the ovary has a peritoneal cover in the form of a small whitish rim (the so-called white, or border line, or Farr-Waldeyer ring.

Under the epithelial cover is a protein membrane, consisting of connective tissue. This layer, without a sharp border, passes into a powerful cortical layer, in which there are a large number of germinal (primordial) follicles, follicles at different stages of maturation, atretic follicles, yellow and white bodies. The medulla of the ovary, passing into the gate, is richly supplied with blood vessels and nerves (Fig. 1.5).

Rice. 1.5. Longitudinal section through the ovary (diagram):

1 - peritoneum; 2 - follicles in different stages of maturation; 3 - white body; 4 - corpus luteum; 5 - vessels in the medulla; 6 - nerve trunks

In addition to mesovarium, the following ligaments of the ovary are distinguished.

Suspended ovary(lig. suspensorium ovarii), formerly referred to as the ovarian-pelvic or funnel-pelvic ligament. This ligament is a fold of the peritoneum with blood vessels passing through it (a. et v. ovarica), lymphatic vessels and nerves of the ovary, stretched between the side wall of the pelvis, the lumbar fascia (in the area of ​​division of the common iliac artery into external and internal) and superior ( tubal) end of the ovary.

Own ligament of the ovary(lig. ovarii proprium), presented in the form of a dense fibrous-smooth muscle cord, passes between the sheets of a wide uterine ligament, closer to its posterior leaf, and connects the lower end of the ovary to the lateral edge of the uterus. To the uterus, the proper ligament of the ovary is fixed in the area between the beginning of the fallopian tube and the round ligament, posterior and upward from the latter, and the ligaments pass thicker than rr. ovarii, which are terminal branches of the uterine artery.

Appendicular - ovarian ligament Clado (lig. appendiculoovaricum Clado) stretches from the mesentery of the appendix to the right ovary or wide ligament of the uterus in the form of a fold of the peritoneum containing fibrous connective tissue, muscle fibers, blood and lymphatic vessels. The ligament is unstable and is observed in 1/2 -1/3 of women.

Blood supply to the internal genital organs

Blood supply to the uterus occurs due to the uterine arteries, arteries of the round uterine ligaments and branches of the ovarian arteries (Fig. 1.6).

The uterine artery (а.uterina) departs from the internal iliac artery (а.illiaca interna) in the depths of the small pelvis near the side wall of the pelvis, at a level of 12-16 cm below the innominate line, most often together with the umbilical artery; often the uterine artery begins immediately below the umbilical artery, approaches the lateral surface of the uterus at the level of the internal os. Continuing further up the side wall of the uterus ("rib") to its corner, having a pronounced trunk in this section (about 1.5-2 mm in diameter in nulliparous women and 2.5-3 mm in women who have given birth), the uterine artery is located almost on along its entire length next to the "rib" of the uterus (or is separated from it at a distance of no more than 0.5-1 cm. The uterine artery throughout its entire length gives off from 2 to 14 (on average 8-10) branches of unequal caliber (with a diameter of 0, 3 to 1 mm) to the anterior and posterior walls of the uterus.

Further, the uterine artery is directed medially and forward under the peritoneum above the muscle that raises anus, at the base of the broad ligament of the uterus, where branches usually depart from it to the bladder (rami vesicales). Not reaching 1-2 cm to the uterus, it intersects with the ureter, located above and in front of it and giving it a branch (ramus utericum). Further, the uterine artery divides into two branches: the cervico-vaginal, which feeds the cervix and the upper part of the vagina, and the ascending branch, which goes to the upper corner of the uterus. Having reached the bottom, the uterine artery divides into two terminal branches leading to the tube (ramus tubarius) and to the ovary (ramus ovaricus). In the thickness of the uterus, the branches of the uterine artery anastomose with the same branches of the opposite side. The artery of the round uterine ligament (a.ligamenti teres uteri) is a branch of a.epigastrica inferior. It approaches the uterus as part of the round uterine ligament.

The division of the uterine artery can be carried out according to the main or loose type. The uterine artery anastomoses with the ovarian artery, this fusion is carried out without a visible change in the lumen of both vessels, so it is almost impossible to determine the exact location of the anastomosis.

In the body of the uterus, the direction of the branches of the uterine artery is predominantly oblique: from outside to inside, from bottom to top and towards the middle;

In various pathological processes, the usual direction of the vessels is deformed, and the localization of the pathological focus, in particular in relation to one or another layer of the uterus, is essential. For example, with subserous and protruding above the level of the serous surface of interstitial fibromyomas of the uterus, the vessels in the tumor area seem to flow around it along the upper and lower contours, as a result of which the direction of the vessels, which is usual for this section of the uterus, changes, and their curvature occurs. Moreover, with multiple fibromyomas, such significant changes in the architectonics of the vessels occur that it becomes impossible to determine any regularity.

Anastomoses between the vessels of the right and left half of the uterus at any level are very abundant. In each case, in the uterus of women, 1-2 direct anastomoses can be found between the large branches of the first order. The most permanent of these is a horizontal or slightly arched coronary anastomosis at the isthmus or lower uterine body.

Rice. 1.6. Arteries of the pelvic organs:

1 - abdominal aorta; 2 - inferior mesenteric artery; 3 - common iliac artery; 4 - external iliac artery; 5 - internal iliac artery; 6 - superior gluteal artery; 7 - lower gluteal artery; 8 - uterine artery; 9 - umbilical artery; 10 - cystic arteries; 11 - vaginal artery; 12 - lower genital artery; 13 - perineal artery; 14 - lower rectal artery; 15 - artery of the clitoris; 16 - middle rectal artery; 17 - uterine artery; 18 - pipe branch

uterine artery; 19 - ovarian branch of the uterine artery; 20 - ovarian artery; 21 - lumbar artery

Blood supply to the ovary carried out by the ovarian artery (a.ovarica) and the ovarian branch of the uterine artery (g.ovaricus). The ovarian artery emerges in a long, thin trunk from the abdominal aorta below renal arteries(see fig. 1.6). In some cases, the left ovarian artery may arise from the left renal artery. Descending retroperitoneally along the psoas major muscle, the ovarian artery crosses with the ureter and passes in the ligament that suspends the ovary, giving a branch to the ovary and tube and anastomosing with the final section of the uterine artery.

The fallopian tube receives blood from the branches of the uterine and ovarian arteries, which pass in the mesosalpinx parallel to the tube, anastomosing with each other.

Rice. 1.7. Arterial system of the uterus and appendages (according to M. S. Malinovsky):

1 - uterine artery; 2 - descending section of the uterine artery; 3 - ascending uterine artery; 4 - branches of the uterine artery, going into the thickness of the uterus; 5 - branch of the uterine artery, going to the mesovar; 6 - tubal branch of the uterine artery; 7 - ordinal ovarian branches of the uterine artery; 8 - tubal-ovarian branch of the uterine artery; 9 - ovarian artery; 10, 12 - anastomoses between the uterine and ovarian arteries; 11 - artery of the round uterine ligament

The vagina is supplied with blood vessels of the a.iliaca interna basin: the upper third receives nutrition from the uterine artery cervicovaginalis, the middle third from a. vesicalis inferior, lower third - from a. haemorraidalis and a. pudenda interna.

Thus, the arterial vascular network of the internal genital organs is well developed and extremely rich in anastomoses (Fig. 1.7).

Blood flows from the uterus through the veins that form the uterine plexus - plexus uterinus (Fig. 1.8).

Rice. 1.8. Veins of the pelvic organs:

1 - inferior vena cava; 2 - left renal vein; 3 - left ovarian vein; 4 - inferior mesenteric vein; 5 - superior rectal vein; 6 - common iliac vein; 7 - external iliac vein; 8 - internal iliac vein; 9 - superior gluteal vein; 10 - lower gluteal vein; 11 - uterine veins; 12 - bladder veins; 13 - bladder venous plexus; 14 - inferior pudendal vein; 15 - vaginal venous plexus; 16 - veins of the legs of the clitoris; 17 - lower rectal vein; 18 - bulbous-cavernous veins of the entrance to the vagina; 19 - vein of the clitoris; 20 - vaginal veins; 21 - uterine venous plexus; 22 - venous (pampiniform) plexus; 23 - rectal venous plexus; 24 - median sacral plexus; 25 - right ovarian vein

From this plexus, blood flows in three directions:

1)v. ovarica (from ovary, tube and upper uterus); 2) v. uterina (from the lower half of the body of the uterus and the upper part of the cervix); 3) v. Iliaca interna (from the lower part of the cervix and vagina).

Plexus uterinus anastomoses with the veins of the bladder and rectum. The veins of the ovary correspond to the arteries. Forming a plexus (plexus pampiniformis), they go as part of a ligament that suspends the ovary, flows into the inferior vena cava or renal vein. From the fallopian tubes, blood flows through the veins that accompany the tubal branches of the uterine and ovarian arteries. Numerous veins of the vagina form a plexus - plexus venosus vaginalis. From this plexus, blood flows through the veins that accompany the arteries and flows into the v system. iliaca interna. The venous plexuses of the vagina anastomose with the plexuses of neighboring organs of the small pelvis and with the veins of the external genital organs.

Lymphatic system of the uterus

The lymphatic system of the uterus and the closely related lymphatic system of the fallopian tubes and ovaries is very abundant. It is conventionally divided into intraorganic and extraorganic. and the first gradually passes into the second.

Intraorganic The (intravisceral) lymphatic system begins with the endometrial network of lymphatic vessels; this network is abundantly anostomoeous to each other with the corresponding efferent lymphatic systems, which explains the fact that tumors do not spread along the plane of the endometrium, but mostly outward, towards the uterine appendages.

Extraorganic (extravisceral) efferent lymphatic vessels of the uterus are directed mainly outward from the uterus, along blood vessels in close contact with them.

The outflowing extraorganic lymphatic vessels of the uterus are divided into two groups.

1. The lymphatic vessels of the first (lower) group, which drain lymph from approximately the upper two thirds of the vagina and the lower third of the uterus (mainly from the cervix), are located at the base of the broad ligament of the uterus and flow into the internal iliac, external and common iliac, lumbar, sacral and anorectal The lymph nodes.

2. Lymphatic vessels of the second (upper) group divert lymph from the body of the uterus, ovaries and fallopian tubes; they start mainly from large subserous lymphatic sinuses and go mainly in the upper part of the broad ligament of the uterus, heading to the lumbar and sacral lymph nodes, and partially (mainly from the bottom of the uterus) - along the round uterine ligament to the inguinal lymph nodes.

3. The central location of the lymph nodes of the third stage are the common iliac lymph nodes and nodes located in the area of ​​the aortic bifurcation.

Lymph nodes of the fourth and subsequent stages are located most often: on the right - on the anterior surface of the inferior vena cava, on the left - at the left semicircle of the aorta or directly on it (the so-called paraaortic nodes). On both sides, the lymph nodes lie in the form of chains.

Lymphatic drainage from the ovaries It is carried out through the lymphatic vessels in the area of ​​the gate of the organ, where the subovarian lymphatic plexus (plexus lymphaticus subovaricus) is isolated, to the para-aortic lymph nodes.

The lymphatic system of the right ovary is associated with lymphatic system ileocecal angle and appendix.

Innervation of the female genital organs

The innervation of the internal genital organs is carried out by the autonomic nervous system. Autonomic nerves contain sympathetic and parasympathetic fibers, as well as efferent and afferent. One of the largest efferent autonomic plexuses is the abdominal aortic plexus, which is located along the course of the abdominal aorta. A branch of the abdominal aortic plexus is the ovarian plexus, which innervates the ovary, part of the fallopian tube and the broad ligament of the uterus.

Another branch is the lower hypogastric plexus, which forms organ autonomic plexuses, including the uterovaginal plexus. The uterovaginal plexus of Frankenheiser is located along the uterine vessels as part of the cardinal and sacro-uterine ligaments. This plexus also contains afferent fibers (roots Th1O - L1).

FIXING DEVICE OF THE INTERNAL GENITAL ORGANS OF A WOMAN

The fixing apparatus of the internal genital organs of a woman consists of a suspension, fixing and supporting apparatus, which ensures the physiological position of the uterus, tubes and ovaries (Fig. 61).

Suspension apparatus

It unites a complex of ligaments connecting the uterus, tubes and ovaries with the walls of the pelvis and among themselves. This group includes round, wide ligaments of the uterus, as well as suspensory and own ligaments of the ovary.

Round ligaments of the uterus (lig. teres uteri, dextrum et sinistrum) are a paired cord 10-15 cm long, 3-5 mm thick, consisting of connective tissue and smooth muscle fibers. Starting from the lateral edges of the uterus somewhat lower and anterior to the beginning of the fallopian tubes on each side, the round ligaments pass between the sheets of the wide uterine ligament (intraperitoneally) and go to the side wall of the pelvis, retroperitoneally.

Then they enter the internal opening of the inguinal canal. The distal third of them is located in the canal, then the ligaments exit through the external opening of the inguinal canal and branch out in the subcutaneous tissue of the labia.

Broad ligaments of the uterus (lig. latum uteri, dextrum et sinistrum) are frontally located duplications of the peritoneum, which are a continuation of the serous cover of the anterior and posterior surfaces of the uterus away from its “ribs” and split into sheets of the parietal peritoneum of the side walls of the small pelvis - outside. At the top, the wide ligament of the uterus closes the fallopian tube, located between its two leaves; below, the ligament splits, passing into the parietal peritoneum of the pelvic floor. Between the leaves of the broad ligament (mainly at their base) lies fiber (parametrium), in the lower part of which the uterine artery passes from one side to the other.

The broad ligaments of the uterus lie freely (without tension), follow the movement of the uterus and cannot, of course, play a significant role in keeping the uterus in a physiological position. Speaking of the broad ligament of the uterus, it is impossible not to mention that with intraligamentary tumors of the ovaries located between the sheets of the broad ligament, the usual topography of the pelvic organs is violated to one degree or another.

Suspension ligaments of the testicles ica(lig. suspensorium ovarii, dextrum et. sinistrum) go from the upper (tubular) end of the ovary and fallopian tube to the peritoneum of the side wall of the pelvis. These relatively strong, thanks to the vessels passing through them (a. et v. ovagisae) and nerves, the ligaments keep the ovaries in limbo.

Own ligaments of the ovary A(1ig. Ovarii proprimu, dextrum et. sinistrum) are a very strong short fibrous-glucomuscular cord connecting the lower (uterine) end of the ovary with the uterus, and pass through the thickness of the wide ligament of the uterus.

Fixing, or actually fixing, apparatus (retinaculum uteri) is a "densification zone" consisting of powerful connective tissue strands, elastic and smooth muscle fibers.

In the fixing apparatus, the following parts are distinguished:

The anterior part (pars anterior retinaculi), which includes the pubovesical or pubic-vesical ligaments (ligg. pubovesicalia), continuing further in the form of vesicouterine (vesico-cervical) ligaments (ligg. Vesicouterina s. vesicocervicalia);

The middle part (pars media retinaculi), which is the most powerful in the system of the fixing apparatus; it mainly includes the system of cardinal ligaments (1igg. cardinalia);

The back part (pars posterior retinaculi), which is represented by sacro-uterine ligaments (1igg. sacrouterina).

Some of these links should be considered in more detail.

1. Vesicouterine, or vesicocervical, ligaments are fibromuscular plates that cover the bladder on both sides, fixing it in a certain position, and keeping the cervix from moving backwards.

2. The main, or main (cardinal), ligaments of the uterus are a cluster of intertwined dense fascial and smooth muscle fibers with a large number of vessels and nerves of the uterus, located at the base of the wide uterine ligaments in the frontal plane.

3. The sacro-uterine ligaments consist of muscle bundles and depart from the posterior surface of the cervix, arcuately covering the rectum from the sides (weaving into its side wall), and are fixed to the parietal sheet of the pelvic fascia on the anterior surface of the sacrum. Raising the upper peritoneum, the sacro-uterine ligaments form the recto-uterine folds.

Supporting (supporting) apparatus united by a group of muscles and fascia, forming the bottom of the pelvis, over which the internal genital organs are located.