Tag: Uterus

Amniotic fluid index


Amniotic fluid index


• Imagine the uterus in 4 parts and in these 4 parts measure the single largest vertical pocket.

• Here in this image the uterus is divided into 4 quadrants and the single largest vertical pocket namely A, B, C & D are measured.

• AFI= A+B+C+D= 5-24 (NORMAL)

• >25 cm is polyhydramnios & <5 cm oligohydramnios.

• AFI is not appropriate to use in twin pregnancy. Therefore, the best sensitive method is to measure single Deepest vertical pocket (SDP).

Amniotic fluid index explained with images

Uterus

Uterus


ANATOMY:

  • The uterus is pyriform shape thick-walled muscular organ capable of expansion to accommodate a growing fetus. 
  • Measures 9 cm in length, 6.5 cm in width and 3.5 cm in thickness(3X2X1 Inches3)
  • Uterus develops from Paramesonephric duct( Mullerian duct)
  • It weighs 1 ounce (60 g)
  • It is connected distally to the vagina, and laterally to the uterine tubes.
  • The uterus has 3 parts;
  • Fundus: Top of the uterus, above the entry point of the uterine tubes.
  • Body: Usual site for implantation of the blastocyst.
  • Cervix: Lower part of uterus linking it with the vagina. This part is structurally and functionally different to the rest of the uterus. 

ANATOMICAL POSITION:

  • The exact anatomical location of the uterus varies with the degree of distension of the bladder. In the normal adult uterus, it can be described as anteverted with respect to the vagina, and anteflexed with respect to the cervix:
  • Anteverted: Rotated forward, towards the anterior surface of the body.
  • Anteflexed: Flexed, towards the anterior surface of the body.
  • Thus, the uterus normally lies immediately posterosuperior to the bladder, and anterior to the rectum.

MICROANATOMY:

  • The lining epithelium of uterus is columnar
  • Before menarche the cells are ciliated, but thereafter most of the cells may not have cilia Ciliated columnar epithelium
  • The fundus and body of the uterus are composed of three tissue layers;
  • Peritoneum – Double layered membrane, continuous with the abdominal peritoneum. Also known as the perimetrium.
  • Myometrium – Thick smooth muscle layer. Cells of this layer undergo hypertrophy and hyperplasia during pregnancy in preparation to expel the fetus at birth.

Endometrium  Inner mucous membrane lining the uterus. It can be further subdivided into 2 parts:

  • Deep stratum basalis: Changes little throughout the menstrual cycle and is not shed at menstruation.
  • Superficial stratum functionalis: Proliferates in response to oestrogens, and becomes secretory in response to progesterone. It is shed during menstruation and regenerates from cells in the stratum basalis layer.

LIGAMENTS: 

  • Pelvic diaphragm, Uterosacral ligament & Transverse cervical ligament are primary support of uterus
  • The tone of the pelvic floor provides the primary support for the uterus. Some ligaments provide further support, securing the uterus in place.

They are:

  • Broad Ligament: This is a double layer of peritoneum attaching the sides of the uterus to the pelvis. It acts as a mesentery for the uterus and contributes to maintaining it in position.It do not provide primary support.

CONTENT OF BROAD LIGAMENT

  • Fallopian tube—upper portion
  •  Round ligament—anteriorly
  •  Ovarian ligament—posterior fold
  • Vestigial structures of Wolffian body—epoophoron andparoophoron
  • Vestigial structure of Wolffian duct—Gartner’s duct
  • Ureter
  •  Uterine vessels
  •  Pelvic nerves
  • Parametrial lymph node
  • Pelvic cellular tissue condensed to form Mackenrodt’s ligament
  • Infundibulopelvic ligament
  • Round Ligament: A remnant of the gubernaculum extending from the uterine horns to the labia majora via the Superficial inguinal ring. It functions to maintain the anteverted position of the uterus.
  • Ovarian LigamentJoins the ovaries to the uterus.
  • Cardinal Ligament: Located at the base of the broad ligament, the cardinal ligament extends from the cervix to the lateral pelvic walls. It contains the uterine artery and vein in addition to providing support to the uterus.
  • Uterosacral Ligament: Extends from the cervix to the sacrum. It provides primary support to the uterus.

Supports of the genital organs:

LEVELS STRUCTURE 
I

Uterosacral ligaments and cardinal ligaments
support the uterus and vaginal vault

II

Pelvic facias and paracolpos which connects
the vagina to the white line on the lateral
pelvic wall through arcus tendinous

III

Levator ani muscles support the lower one
third of vagina

BLOOD SUPPLY AND LYMPHATICS:

  • Uterine and ovarian artery
  • Venous drainage is via a plexus in the broad ligament that drains into the uterine veins. 
  • Lymphatic drainage : iliac, sacral, Paraaortic and inguinal lymph nodes.

INNERVATION OF UTERUS:

  • Sympathetic nerve fibres of the uterus arise from the uterovaginal plexus. This largely comprises the anterior and intermediate parts of the inferior hypogastric plexus.
  • Parasympathetic fibres of the uterus are derived from the pelvic splanchnic nerves (S2-S4).
  • The cervix is largely innervated by the inferior nerve fibres of the uterovaginal plexus.
  • The afferent fibres mostly ascend through the inferior hypogastric plexus  to enter the spinal cord via T10-T12 and L1 nerve fibres.
Exam Question
 
  • Size of uterus in inches is 3x2x1
  • Pelvic diaphragm, Uterosacral ligament & Transverse cervical ligament are primary support of uterus
  • Paramesonephric duct forms Uterus
  • Uterus develops from Mullerian duct
  • External iliac , Internal iliac & Superficial inguinal recieves lymphatics from the uterus
  • Uterus, before menarche, is lined by Ciliated columnar epithelium
  • Blood supply of the uterus is by Ovarian  & Uetrine artery
  • Superficial inguinal ring in the female transmits Round ligament of the uterus
  • Uterus reaches up to umbilical level at 24 weeks
  • Fundus of uterus drains into  Paraaortic
Don’t Forget to Solve all the previous Year Question asked on Uterus

Uterus

Uterus

Q. 1

Size of uterus in inches is:

 A

5x4x2

 B

4x3x1

 C

3x2x1

 D

4x2x1

Q. 1

Size of uterus in inches is:

 A

5x4x2

 B

4x3x1

 C

3x2x1

 D

4x2x1

Ans. C

Explanation:

The uterus is a pear-shaped, thick-walled, muscular organ, situated between the base of the bladder and the rectum.

The uterus measures about 8 cm long, 5 cm wide at the fundus and its walls are about 1.25cm thick.

Its weight varies from 50-80 gm. It has got the following parts: 1) Body or corpus 2) Isthmus 3) Cervix.

Note:
The normal length of uterine cavity is 6.5-7 cm.
Ref: Textbook of Obstetrics D.C.Dutta 6th Ed Page 79.

Q. 2

Which of the following structure is not a primary support of uterus?

 A

Pelvic diaphragm

 B

Uterosacral ligament

 C

Transverse cervical ligament

 D

Broad ligament

Q. 2

Which of the following structure is not a primary support of uterus?

 A

Pelvic diaphragm

 B

Uterosacral ligament

 C

Transverse cervical ligament

 D

Broad ligament

Ans. D

Explanation:

Broad ligament is a secondary support of uterus. Structures forming primary support to the uterus are pelvic diaphragm, perineal body, urogenital diaphragm, uterine axis, pubocervical ligament, transverse cervical ligament, uterosacral ligament and round ligament of uterus.


Q. 3

Paramesonephric duct forms which of the following

 A

Ureter

 B

Uterus

 C

Bladder

 D

Penis

Q. 3

Paramesonephric duct forms which of the following

 A

Ureter

 B

Uterus

 C

Bladder

 D

Penis

Ans. B

Explanation:

B. i.e. Uterus 


Q. 4

Uterus develops from-

 A

Mullerian duct

 B

Wolfian duct

 C

Both

 D

None

Q. 4

Uterus develops from-

 A

Mullerian duct

 B

Wolfian duct

 C

Both

 D

None

Ans. A

Explanation:

A i.e. Mullerian duct


Q. 5

The following group of lymph nodes receives lymphatics from the uterus except:

 A

External iliac

 B

Internal iliac

 C

Superficial inguinal.

 D

Deep inguinal

Q. 5

The following group of lymph nodes receives lymphatics from the uterus except:

 A

External iliac

 B

Internal iliac

 C

Superficial inguinal.

 D

Deep inguinal

Ans. D

Explanation:

D i.e. Deep inguinal

The uterus does not drain into the deep inguinal lymph nodes


Q. 6

Uterus, before menarche, is lined by:

September 2011

 A

Ciliated columnar epithelium

 B

Stratifies squamous non-keratinized epithelium

 C

Startifies squamous keratinized epithelium

 D

Cuboidal epithelium

Q. 6

Uterus, before menarche, is lined by:

September 2011

 A

Ciliated columnar epithelium

 B

Stratifies squamous non-keratinized epithelium

 C

Startifies squamous keratinized epithelium

 D

Cuboidal epithelium

Ans. A

Explanation:

Ans. A: Ciliated columnar epithelium

The lining epithelium of uterus is columnar

Before menarche (the age of menstruation) the cells are ciliated, but thereafter most of the cells may not have cilia Ciliated columnar epithelium

  • These cells are rectangular in shape and have between 200 to 300 hair-like protrusions called cilia T
  • The mitochondria are found toward the apical region of the cell while the cell nuceli are found towards the base and are often elongated.
  • Cells are interconnected via desmosomses and tight junctions, creating a semipermeable membrane that is more selective that membrane found in other types of cell.
  • Ciliated columnar epithelial cells are found mainly in the tracheal and bronchial regions of the pulmonary system and also in the fallopian tubes of the female reproductive system.

Q. 7

Blood supply of the uterus is by:  

 A

Ovarian artery

 B

Uetrine artery

 C

Both

 D

None of the above

Q. 7

Blood supply of the uterus is by:  

 A

Ovarian artery

 B

Uetrine artery

 C

Both

 D

None of the above

Ans. C

Explanation:

The uterus is chiefly supplied by the two uterine arteries and partly by ovarian arteries


Q. 8

Superficial inguinal ring in the female transmits:

 A

Broad ligament of uterus

 B

Round ligament of the uterus

 C

Cardinal ligament

 D

None of the above

Q. 8

Superficial inguinal ring in the female transmits:

 A

Broad ligament of uterus

 B

Round ligament of the uterus

 C

Cardinal ligament

 D

None of the above

Ans. B

Explanation:

The superficial inguinal ring is a triangular aperture in the aponeurosis of the external oblique muscle and is situated above and medial to the pubic tubercle.

In the female, the superficial inguinal ring is smaller and difficult to palpate; it transmits the round ligament of the uterus.


Q. 9

Uterus reaches up to umbilical level at:

September 2009

 A

16 weeks

 B

20 weeks

 C

24 weeks

 D

28 weeks

Q. 9

Uterus reaches up to umbilical level at:

September 2009

 A

16 weeks

 B

20 weeks

 C

24 weeks

 D

28 weeks

Ans. C

Explanation:

Ans. C: 24 weeks

The height of the uterus is midway between symphysis pubis and umbilicus at 16th week; at the level of umbilicus at 24th week and at the junction of the lower third and upper two-third of the distance between the umbilicus and ensiform cartilage at 28th week.


Q. 10

Fundus of uterus drains into ‑

 A

External iliac

 B

Inguinal

 C

Paraaortic

 D

Obturator

Q. 10

Fundus of uterus drains into ‑

 A

External iliac

 B

Inguinal

 C

Paraaortic

 D

Obturator

Ans. C

Explanation:

 Paraaortic

  • Cervix (lower lymphatics) :- Lymphatics drain into external iliac, internal iliac, and sacral nodes.
  • Lower part of body (middle lymphatics) :- Lymphatics drain into the external iliac nodes.
  • Fundus and upper part of body (upper lymphatics) :- Lymphatics drain mainly into para-aortic nodes and a few lymphatics from the uterine cornu accompany the round ligaments to reach the superficial inguinal nodes.

Q. 11

The embryological structure shown as 2 in the photograph below forms which of the following ? 

 A

Ureter.

 B

Uterus.

 C

Bladder.

 D

None of the above.

Q. 11

The embryological structure shown as 2 in the photograph below forms which of the following ? 

 A

Ureter.

 B

Uterus.

 C

Bladder.

 D

None of the above.

Ans. B

Explanation:

The embryological structure shown as 2 in the photograph above represents Paramesonephric duct.

Paramesonephric ducts (or Müllerian ducts) are paired ducts of the embryo that run down the lateral sides of the urogenital ridge and terminate at the sinus tubercle in the primitive urogenital sinus. In the female, they will develop to form the uterine tubes, uterus, cervix, and the upper one-third of the vagina. In the male, they are lost. These ducts are made of tissue of mesodermal origin.


Q. 12

All of the following are supports of uterus except‑

 A

Pelvic diaphragm

 B

Utero sacral ligament

 C

Tubo ovarian ligament

 D

Round ligament

Q. 12

All of the following are supports of uterus except‑

 A

Pelvic diaphragm

 B

Utero sacral ligament

 C

Tubo ovarian ligament

 D

Round ligament

Ans. C

Explanation:

Ans. is ‘c’ i.e., Tubo-ovarian ligament 

SUPPORTS OF THE UTERUS

A. PRIMARY SUPPORTS

  • L Muscular (Main) supports
  1. Pelvic diaphragm (levator ani)
  2. Urogenital diaphragm
  3. Perineal body

ILFibromuscular / Mechanical supports

  1. Uterine axis
  2. Pubocervical ligament
  3. Transverse cervical ligament of Mackenrodt
  4. Uterosacral ligament
  5. Round ligament of uterus (weak)

B. SECONDARY SUPPORTS

These are peritoneal folds which have doubtful value in supporting the uterus.

  1. Broad ligament
  2. Uterovesical fold of peritoneum
  3. Rectovaginal fold of peritoneum


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