ANATOMY OF UTERUS, FALLOPIAN

TUBE & OVARY

DR. ASMA AIJAZ

ASSISTANT PROFESSOR
DEPARTMENT OF ANATOMY
KMDC
Learning Objectives
At the end of the lecture, the students will be able :
1.To understand the gross anatomical features of uterus,
fallopian tube and ovaries
2.To describe the histological features of uterus,
fallopian tubes and ovaries
3.To study the arterial supply, venous and lymphatic
drainage an nerve suppy of female reproductive organs
4.To discuss the clinical conditions associated with the
female genital tract
Female reproductive organs
A pair of ovaries
A system of genital ducts
(uterine tubes, uterus
and vagina)
External genitalia
THE UTERUS
A pear shaped hollow
muscular organ
Measuring around 7.5 x 4.0
x 2.5 cm in the longitudinal,
transverse, and
anteroposterior diameters.
It is slightly larger in the
multipara than in the
nullipara.
Divisions
Body or corpus that lies above the internal os
Cervix-cylindrical narrow inferior part of the
uterus that protrudes into the uppermost
part of vagina fundus
cornu
Isthmus relatively constricted segment of
uterus just above internal os
Fundus rounded upper end of the body lies
above the insertion of the tubes
Cornu = the area of insertion of the fallopian
tubes
Three structures are attached to the cornu
◦ round ligament anteriorly,
◦ Fallopian tube centrally,
◦ ovarian ligament posteriorly.
Divisions
2. The isthmus:
◦ an area 4-5 mm in length
that lies between the
anatomical internal os
above, and the histological
internal os below. It is
lined by low columnar
epithelium and few
glands.
◦ The isthmus expands
during pregnancy forming
the lower uterine segment
(10 cm) during the last
trimester.
 Divisions
3. The cervix:
The elongated lower part of the uterus
Measuring 2.5-3.0 cm.
Divided by the vaginal attachment into
◦ supravaginal portion above
◦ vaginal portion (portio-vaginalis)
below.
The cervical canal is the cavity that
communicates above with the uterine
cavity at the internal os and below with
the vagina at the external os.
The external os is round in nulliparas and
slit shaped in multiparas.
 Position
The uterus is kept in an anteverted
anteflexed position (AVF), with the
external os lying at the level of the
ischial spines, by the support of the
cervical ligaments, endopelvic fascia
and pelvic floor muscles (levator ani).
Anteversion: The uterus is inclined
anteriorly to axis of the vagina.
Anteflexion: The body of the uterus
is bent forwards upon the cervix. 
Relations of the Body of the Uterus
Anteriorly:
◦ The bladder and vesico-uterine pouch.

Posteriorly:
◦ The pouch of Douglas.

Laterally:
◦ The broad ligament on each side.
Relations of the Supravaginal
cervix
Anteriorly:
◦ Urinary bladder.

Posteriorly:
◦ Forms the anterior wall of Douglas pouch.

Laterally:
◦ 1/2 an inch lateral to the internal os the
ureter is crossed by the uterine artery (i.e.
ureter below the uterine artery).

The uterosacral, cardinal, and

pubocervical ligaments are attached to
its posterior, lateral, and anterior
surfaces respectively.
Primary muscular supports
 Histology of the Uterus

Three layers:
◦ 1. Endometrium:
(mucosa)
◦ 2. Myometrium
◦ 3. The perimetrium
(serosa)/ adventitia
 Endometrium
The lining epithelium consists of
secretory cells and ciliated cells
Secretory cells: main cells of endometrial
epithelium, produce secretions rich in
glycogen and glycoproteins. Secretions
controlled by female sex hormones
Ciliated cells: 20% of lining epithelium
bears kinocilia
Lamina propria--- endometrial stroma,
simple tubular uterine glands
During reproductive life the
endometrium is divided into 1. Stratum
functionale 2. Stratum basale
 Broad superficial part,
sloughed off during
menstruation

Narrow deeper zone,

retained during
mestruation, serve as a
source of cells for
regenration of
endometrium
Stratum functionalis can be divided
into
Zona compacta---narrow region next
to luminal surface of endometrium,
appears compact b/c of lesser degree
of edema, contain straight narrow
necks of uterine glands
Zona spongiosa----rest of stratum
functionale ( region b/w zona
compacta and stratum basale.
Endometrial stroma becomes
increasingly edematous and vascular.
Glands are dilated and tortuous,
assuming a corkscrew appearance
The dilated uterine glands appear as
irregular spaces, giving deeper part of
stratum functionale a spongy
appearance.
 Histology of the Uterus
Perimetrium.
Pelvic peritoneum covering the outer surface of uterus
It is typical serosa consisting of single layer of mesothelial cells
supported by a thin layer of loose CT. deficient over lower half of
anterior surface of uterus in front of urinary bladder
 Histology of the Cervix
Lowermost cylindrical part of uterus that
projects into vagina
Cervical canal communicates with uterine
cavity at internal os and with vagina at
external os
Cervical canal lined by endocervical mucosa
and outer surface of vaginal part of cervix is
covered by ectocervix
Endocervix: Lined by simple columnar
epithelium with simple tubular branched
mucous secreting glands called cervical
glands. that are liable to chronic infection. It
secretes alkaline cervical mucus.
Muscle layer: bulk of the wall consists
chiefly type 1 collagen and elastic fibers.
Smooth muscles fibers also present.
Ectocervix: lined of stratified
squamous non keratinized epithelium
covering the outer portion of the
cervix. The junction between
squamous and columnar epithelium
at the external os is either abrupt or it
may form a transitional zone 1-3 mm
known as the transformation zone.
The transformation zone during
reproductive life lies just outside the
external os. Before puberty and after
menopause, it lies within cervical
canal.
Nabothian cyst: cystic dilatation of
cervical glands by accumulation of
mucos secrtions due to occlusion of
aperturs of cervical glands
Transformation zone
Common site of
metaplastic changes in
endocervical
epithelium----
precancerous
condition----cervical
cancers
 Premenstrual phase/ischemic phase:
interruption of blood flow in spiral arteries. It
includes last 2 days of menstrual cycle
Premenstrual phase
If fertilization does not occur
Corpus luteum degenerates
Endometrium enters into ischemic phase
Occurs about 12-13 days after ovulation
due to reduction in blood progesterone
level
Spiral arteries undergoes periodic
contractions lasting for several hours---
ischemia of stratum functionale
Strat. Funtionale shrinks in height and
stromal cells become more densely
packed
 Blood Supply
Arterial supply:
THE UTERINE ARTERIES
◦ Arise from the anterior division of
internal iliac artery.
◦ in the base of the broad ligament,
crossing above the ureter 1/2 an
inch lateral to the supravaginal
cervix.

2 branches:
◦ An ascending
◦ A descending branch
 Blood Supply
The ascending branches pass
upwards in a tortuous manner
parallel to the lateral border of
the uterus between the 2 layers
of the broad ligament to end by
anastomosing with branches of
the ovarian arteries near the
uterine cornu.
The descending cervical branch
supplies the lower cervix.
Blood Supply
Venous drainage:
◦ Starts as a plexus between the 2 layers of the broad ligament
(Pampiniform plexus) that communicate with the vesical plexus and
drains into the uterine and ovarian veins.
Lymphatic drainage:
◦ Fundus: To the para-aortic lymph nodes via ovarian vessels.
◦ Cornu: To the superficial inguinal lymph nodes via lymphatics of the
round ligament.
◦ Body: To the internal then external iliac lymph nodes via the uterine
vessels.
◦ Isthmus: As that of the cervix.
◦ Cervix: Two groups of lymphatics:
◦ Primary groups: Paracervical, parametrial, obturator, internal and
external iliac nodes.
◦ Secondary groups: Common iliac, para-aortic, and lateral sacral lymph
nodes.
Nerve supply of the Uterus
The cervix and body are relatively insensitive to touch, cutting and
burning.
The cervix is sensitive to dilatation and the body is sensitive to
distension.
Innervations
◦ Parasympathetic form S2,3,4
◦ Sympathetic from:
◦ T5 and T6 (motor)
◦ T10, T11, T12, and L1 (sensory).

Both reach the uterus through branches of inferior hypogastric plexus. 

FALLOPIAN TUBE :

Also known as oviducts

Tortuous ducts provide suitable environment for fertilization
Transport the ova from ovary to uterus each month.
In case of fertilization, tubes transport the fertilized egg to
uterus for implantation.
LOCATION

Uterine tubes located bilaterally at superior portion of

uterine cavity in the upper free margin of broad ligament of
uterus
10cm in length 1cm in diameter and situated within
mesosalpinix
Parts :
Intramural part Intramural part
Isthmus
Ampulla
Infundibulum
Fimbriae
Blood supply :
Branches of uterine artery ( medial 2/3rd) and ovarian arteries
(lateral 1/3rd )
Veins drain into pampiniform plexus of ovary and uterine veins
Nerve supply :
Both sympathetic and para sympathetic
Sympathetic nerves---From T10-L2 segments are derived from
hypogastric plexus
Parasymp---Vagus nerve for lateral half and pelvic splanchnic
nerve S2, S3 ,S4 for medial half

Lymphatic drainage :
lateral aortic nodes and pre aortic lymph nodes
Microscopic :
 3 layers –
Mucosa---simple columnar epithelium
-lamina propria
Muscularis ---thick inner circular and
thin outer longitudinal layer of
smooth muscle fibers
Serosa---visceral peritoneum

• Cell type within mucosa - columnar

ciliated epithelial cells with kinocilia

• Non ciliated ( peg) cells ---secretory

cells---produce tubal fluid which
contains glucose, proteins and other
subs for nourishment of ovum,
sperms and zygote
 Ovary
Female gonads , primary female sex glands
Analogous to tests in male
Produces oocyte( ovum) and female sex
Hormones (estrogen and progesterone)
Structure :
Whitish to grey in colour
Located along lateral wall of uterus in a
region ovarian fossa
Fossa is beneath external iliac artery ,
bounded anteriorly by obliterated umblical
artery and posteriorly by ureter and
internal iliac artery

EXTERNAL FEATURES :
It has two poles: upper pole ( tubal ) ,
lower pole ( uterine)
Two borders: anterior or mesovarian
border, posterior or free border
Two surfaces: medial and lateral
Ligaments :

Paired ovaries are within pelvic cavity.

The suspensory ligament of the ovary, also known as the
infundibulopelvic ligament, is a thin fold of peritoneum
connecting the lateral margin of the ovary to the lateral pelvic
wall
The ovarian ligament attach medial margin of ovary to the
uterus
OVARIES
TYPES OF OVARIAN FOLLICLES
1, Primordial follicles
2, Growing follicle
- Primary follicle
- Secondary follicle
3, Tertiary ( Graffian)follicle
Growth of the oocyte
Proliferation of follicular cells
Formation of connective tissue (stromal)
capsule
Peritoneal relations
LYMPHATIC DRAINAGE:
Lateral aortic and pre aortic lymph nodes

NERVE SUPPLY:
The ovarian plexus derived from renal, aortic and hypogastric
plexus. It has both sympathetic and parasympathetic nerves.
Sympathetic nerves derived from T10-T11 segments are
afferent for pain as well as efferent or vasomotor
Parasympathetic nerves are derived from S2, S3, S4 are
vasodilator
Ectopic Pregnancy
Endometriosis
Uterine prolapse
Downward displacement of the uterus into vaginal canal or a gradually
descend of the uterus in the axis of vagina taking the vaginal wall with it
Cervical cancer
Cervical cancer