Uterine tubes (Tubae uterinae)
The uterine tube is a paired hollow organ connecting the peritoneal cavity to the uterine cavity. The tube lies along the superior margin of the broad ligament of the uterus (lig. latum uteri). The organ wall contains longitudinal and circular smooth muscle bundles that provide necessary peristalsis.
Anatomically, the tube is divided into four parts:
- Uterine part (pars uterina) — includes the uterine opening (ostium uterinum).
- Isthmus (isthmus tubae uterinae).
- Ampulla (ampulla tubae).
- Infundibulum (infundibulum) — borders the abdominal opening (ostium abdominale tubae) and features specialized fimbriae (fimbriae tubae).
The organ is supplied with blood by the uterine (a. uterina) and ovarian (a. ovarica) arteries. The mesosalpinx serves as the mesentery of the tube (mesosalpinx).
Clinical significance: inflammatory processes lead to impaired peristalsis. As a result, the fertilized egg may be retained in the lumen, leading to an ectopic (tubal) pregnancy with a subsequent risk of wall rupture.
Ovaries (Ovaria)
The ovary is a paired organ measuring approximately 1.5 × 1.5 × 1 cm, covered by germinal epithelium. It lies in a depression of the parietal peritoneum called the ovarian fossa (fossa ovarica).
Fixation of the organ is provided by the mesovarium (mesovarium) attached to the posterior surface of the broad ligament of the uterus, as well as the ligamentous apparatus:
- Proper ligament of the ovary (lig. ovarii proprium) — connects the uterine pole of the ovary to the body of the uterus.
- Suspensory ligament of the ovary (lig. suspensorium ovarii) — attaches the tubal end to the peritoneum of the lateral pelvic wall. The ovarian vessels run beneath its peritoneal covering.
Surgical anatomy: the ureter runs medial to the lig. suspensorium ovarii beneath the parietal peritoneum. This creates a high risk of its injury during surgery on the appendages.
The ovary is supplied with blood by the a. ovarica (branching from the abdominal aorta at the L1 level) and branches of the uterine artery. Anastomoses between them lie in the mesovarium below the proper ligament of the ovary. During surgery for ectopic pregnancy, applying a clamp to this ligament is not recommended so as not to disrupt blood flow. Venous blood drains into the inferior vena cava, and lymph drains along the ovarian artery to the para-aortic nodes. Innervation derives from plexuses at the base of the broad ligament.
Vagina (Vagina)
The vagina is located in the lesser pelvis. Its upper end surrounds the cervix of the uterus (cervix uteri), forming the vaginal fornices (fornices vaginae). Anterior and posterior fornices are distinguished, with the posterior one being the deepest. The lower end of the organ opens between the labia minora.
Syntopy of the vagina:
- Anterior wall is adjacent to the urethra and the base of the urinary bladder. They are firmly fused by the vesicovaginal septum (septum vesicovaginale). Consequently, trauma or difficult labor can cause combined injuries and the formation of vesicovaginal fistulas.
- Posterior wall borders the rectum. In the middle lesser pelvis, they are separated by the rectovaginal septum (septum rectovaginale).
The peritoneum descends from the posterior surface of the supravaginal part of the cervix and covers the posterior vaginal fornix for 2 cm.
Blood supply is provided by vaginal branches of the a. uterina and the internal pudendal artery (a. pudenda interna). Veins form a dense venous plexus (plexus venosus vaginalis). The lower part of the organ is innervated by branches of the pudendal nerve (n. pudendus). The topography of this region also involves the pelvic floor muscles, specifically the levator ani muscle (m. levator ani) and the anal sphincters (m. sphincter ani externus et internus).
Briefly: answers to topical questions
Into which veins does venous drainage from the right and left ovary occur?
Venous drainage from the right and left ovary empties into different venous trunks.
- Right ovarian vein (v. ovarica dextra) drains directly into the inferior vena cava.
- Left ovarian vein (v. ovarica sinistra) drains into the left renal vein.
Which nerves and plexuses provide innervation to the vagina along its entire length?
Innervation of the vagina is provided by the uterovaginal plexus and branches of the pudendal nerve.
- Uterovaginal plexus (plexus uterovaginalis): branches of the pelvic nerve (n. pelvicus) approach it; sympathetic and parasympathetic fibers extending from it innervate the vagina (similarly to the innervation of the uterus).
- Pudendal nerve (n. pudendus): its branches innervate the lower part of the vagina.
To memorize the parts of the uterine tube from the uterus to the ovary, use the mnemonic: Uterine part, Isthmus, Ampulla, Infundibulum.
Class and exam questions
Why does the risk of ectopic pregnancy increase with adnexal inflammation?
The inflammatory process disrupts the normal peristalsis of the smooth muscle bundles of the uterine tube. Consequently, the fertilized egg is retained in the lumen, leading to tubal pregnancy and the threat of organ rupture.
Which ligament must not be clamped during surgery for ectopic pregnancy?
It is not recommended to apply a clamp to the proper ligament of the ovary (lig. ovarii proprium). Important arterial anastomoses lie beneath it in the mesentery; damaging them will disrupt the blood supply to the ovary.
What is the surgical hazard of operating in the region of the suspensory ligament of the ovary?
Medial to this ligament (lig. suspensorium ovarii), directly beneath the parietal peritoneum, runs the ureter. There is a high risk of its accidental injury during surgical manipulations.
What else to study on this topic
- Topography of the broad and round ligaments of the uterus
- Structure of the rectovaginal and vesicovaginal septa
- Venous plexuses of the lesser pelvis and drainage pathways
- Lymphatic system of the female genital organs
- Pelvic floor muscles: m. levator ani and sphincters
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