By Martin N. Pernoll
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In contrast to the cervix, the uterine substance (myometrium) is 85% smooth muscle and only 15% connective tissue. Except for the anteroinferior portion of the corpus, which is invested by the bladder, the uterus is covered by peritoneum. The adult nonpregnant uterus weighs about 90 g and is about 7–8 cm long and about 4 cm in its widest diameter. However, considerably larger sizes and increased weight occur with hormonal stimulation and after childbirth. During pregnancy, the uterus, which increases to weigh about 1000 g, literally balloons to accommodate the gestation.
The blood supply is from the vaginal artery (a descending branch of the uterine artery) and from the middle hemorrhoidal and internal pudendal arteries. It is drained by the pudendal, external hemorrhoidal, and uterine veins. FIGURE 2-4. Arteries and nerves of female genitalia. 30 BENSON & PERNOLL’S HANDBOOK OF OBSTETRICS AND GYNECOLOGY The lymphatic drainage of the lower vagina is via the superficial inguinal nodes; that of the upper vagina is to the presacral, external iliac, and hypogastric nodes.
Congenital uterine abnormalities. (From B. Pensky, Review of Medical Embryology. ) CHAPTER 1 THE FEMALE PATIENT 17 TABLE 1-1 ADULT DERIVATIVES AND VESTIGIAL REMAINS OF EMBRYONIC UROGENITAL STRUCTURESa,b Embryonic Structure Indifferent gonad Cortex Medulla Gubernaculum Mesonephric tubules Mesonephric duct Paramesonephric duct Urogenital sinus Male Female Testis Seminiferous tubules Rete testis Gubernaculum testis Ovary Ovarian follicles Ductuli efferentes Paradidymis Appendix of epididymis Ductus epididymidis Ductus deferens Ureter, pelvis, calyces,and collecting tubules Ejaculatory duct and seminal gland (vesicle) Appendix of testis Urinary bladder Urethra (except glandular portion) Prostatic utricle Prostate gland Rete ovarii Ovarian ligament Round ligament of uterus Epoophoron Paroophoron Appendix vesiculosa Duct of epoophoron Duct of Gartner Ureter, pelvis, calyces, and collecting tubules Hydatid (of Morgagni) Fallopian tube Uterus Urinary bladder Urethra Vagina Urethral and paraurethral glands (Continued) BENSON & PERNOLL’S HANDBOOK OF OBSTETRICS AND GYNECOLOGY 18 TABLE 1-1 (Continued) Embryonic Structure Male Female Bulbourethral glands Greater vestibular glands Hymen Mullerian tubercle Seminal colliculus Genital tubercle Penis Glans penis Urogenital folds Labioscrotal swellings Corpora cavernosa penis Corpus spongiosum Ventral (under) aspect of penis Scrotum Clitoris Glans clitoridis Corpora cavernosa clitoridis Bulb of the vestibule Labia minora Labia majora a Modified from K.