1132 UROGENITAL SYSTEM. 
Position and Relations of the Uterus.— The position occupied by the 
uterus in the pelvis is not always the same, as it varies to some extent with the 
conditions of the neighbouring organs. The lower cervical part is, however, much 
more firmly fixed in place than the body and fundus, which possess a considerable 
amount of mobility. The uterus rarely hes exactly in the mesial plane of the 
body, but usually bends to one or other side, most frequently towards the right. 
The anterior surface of the uterus rests against the bladder, and follows the rising 
or falling of its superior wall as that organ becomes filled or emptied. When the 
bladder is empty the long axis of the uterus points forwards and upwards, and the 
organ is said to be in an anteverted position. Also the long axis of the uterus is 
bent on itself where the body joins the cervix, and so the organ is said to be 
antefleced. The anteflexion is ri to the fact that the more rigid cervix is firmly 
fixed, while the movable upper part of the uterus sinks forwards, following the 
bladder wall. With the empty condition of the bladder the angle formed 
between the long axis of the uterus and that of the vagina is about a right angle. 
When the bladder becomes filled, the antevertion ain anteflexion of as uterus 
become less marked, owing to the body and fundus being pushed backwards. 
Finally, if the rectum be empty and the bladder very much distended, the uterus is 
pushed so much backwards that the long axis of the organ may nearly correspond to 
that of the vagina. The uterus is then said to be retroverted. In the upper part the 
peritoneum intervenes between the anterior surface of the uterus and the bladder, 
on which it hes; lower down the two organs are separated merely by connective 
tissue. The posterior surface looks into the pouch of Douglas, and is usually, like 
the fundus above, in relation to some loops of intestine. Laterally the uterus is 
related to the broad ligaments. The terminal parts of the ureters pass downwards, 
inwards, and a little forwards on each side of the cervix, but are separated from it 
by an interval of about three-quarters of aninch. The lowest part of the cervix is, 
as we have seen, enclosed within the cavity of the vagina. 
On each side of the cervix uteri and upper part of the vagina there is an 
interval in which lie numerous large vessels. These are surrounded by loose fatty 
tissue, which is continued upwards for a considerable distance between the layers 
of the broad ligament. This loose tissue, which is of surgical importance, has 
received the name parametrium. 
Structure of the Uterus.—The thick uterine wall is composed of three chief 
layers, which are termed respectively the serous, the muscular, and the mucous coats. 
The serous coat or perimetrium (tunica serosa), is derived from the peritoneum, and 
covers the whole organ except the anterior surface of the cervix, and the part of the 
cervix which projects into the vagina. At the lateral borders it is continued into the 
broad hgaments. The serous coat of the uterus is very firmly adherent to the deeper 
layers, and cannot be easily peeled off without tearing either it or the underlying muscular 
tissue. 
The muscular coat (tunica muscularis) is composed of unstriped fibres, and forms the 
chief part of the uterine wall. The more superficial layer of this muscular coat sends 
prolongations into the recto-uterine folds, into the round and broad ligaments of the uterus, 
and into the ovarian ligaments. Other fibres join the walls of the Fallopian tubes. The main 
branches of the blood-vessels and nerves of the uterus lie among the muscle fibres. In the 
deeper layers of the muscular coat a considerable amount of connective tissue and some 
elastic fibres are to be found. The muscular coat of the cervix (tunica muscularis 
cervicis) contains more connective and elastic tissue than that of the body, and hence the 
greater firmness and rigidity of the cervical part of the uterus. 
The deeper and thicker part of the muscular tissue of the uterus is considered by some 
anatomists to represent a muscularis mucose, and is therefore described as part of the 
mucous coat. The deep and superficial portions of the muscular coat are, however, quite 
continuous, and there is no representative of a submucous vascular layer of tissue such 
as in the alimentary canal separates the muscular coat from the muscularis mucose. In 
the uterus the blood-vessels lie in the muscular coat. 
The mucous coat (tunica mucosa) in the body of the uterus is smooth and soft, and 
covered by columnar ciliated epithelium. Simple tubular glands (glandule uterine), 
also lined by a ciliated epithelium, are present in the mucous membrane, and penetrate 
in their deeper parts into the muscular coat. In the cervix of the uterus the mucous 
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