By Tim Chard MD, FRCOG, Richard Lilford MB, BCh, MRCOG, MRCP, PhD (auth.)
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Additional resources for Basic Sciences for Obstetrics and Gynaecology
At birth the long axis of the uterus corresponds to that of the vagina, but gradually inclines forwards with growth. Blood Supply The main blood supply is from the uterine artery, which may arise directly from the internal iliac or arise in common with another branch, especially the superior vesical. The uterine artery runs behind the peritoneum and crosses the transverse cervical ligament. 5 cm from the lateral vaginal fornix. It then ascends in a tortuous course between the two layers of the broad ligament on the lateral border of the uterus, giving out branches to the myometrium and anastomosing at the superior angle with the terminal portion of the ovarian artery.
The anterior and posterior relations are shown in Fig. 2. The cavity of the uterus is triangular and that of the cervix, fusiform. The cervical mucosa in nullipara has a series of 'fern-like' folds (arbor vitae). Cervix Pouch of Douglas with peritoneal reflection onto posterior fornix ofvogino Bladder bose Rectovoginol septum Urethro Perineal body Fig. 2. Sagittal, midline section of the pelvis showing the anterior and posterior relations of the uterus . Anteriorly it is related to the bladder, being partly separated by the uterovesical pouch of peritoneum.
The sympathetic nerves provide vasomotor control (vasoconstriction), together with control of the smooth muscle of the uterus and bladder. Afferent autonomic fibres travel in both the hypogastric plexus (sympathetic) and the pelvic splanchnic nerves (parasympathetic) to reach cell bodies in the spinal and cranial ganglia. g. bladder and rectal distension, sexual excitement, cervical stretching, uterine contractions). 5. The Pelvic Skeleton The bony pelvis is made up by the innominate bone, the sacrum and the fifth lumbar vertebra.