THE UTERUS. 



455 



top of the symphysis pubis, the external os being almost at the same level. As the 

 bladder distends and the rectum becomes empty the fundus rises more and more 

 until the axis of the uterus may coincide with that of the vagina, or even pass 

 beyond ; and then it is said to be retroverted. The uterus is normally almost 

 straight or slightly bent forward. As the result of disease it becomes more or less 

 sharply bent at the region of the internal os either forward or backward. It is then 

 said to be anteflexed or retroflexed. When retroflexed the fundus can frequently be 

 felt as a round hard mass behind the upper posterior portion of the vagina. 



Attachments. In addition to being attached to the vagina the uterus has cer- 

 tain folds or ligaments which pass from it to the surrounding parts. Anteriorly the 

 peritoneum is reflected from the uterus at the level of the internal os to the bladder, 

 forming the uterove steal fold. Posteriorly the peritoneum descends from the uterus 

 over the posterior surface of the upper portion of the vagina for i or 2 cm. (^ in.) 

 and thence onto the rectum constituting the recto-vaginal or recto-uterine fold. The 

 deep pouch so formed is called Douglas 1 s pouch. On each side are three ligaments; 



Round ligament^ 



Broad ligament 



Uterovesical fold 



Bladder 



Symphysis 



Urethra 



Infundibulopelvic or 

 suspensory ligament 

 of ovary 



Fallopian tube 



Ovary 



Uterosacral ligament 



Internal os 

 Douglas's pouch 

 Recto-uterine fold 

 Rectum 



Vagina 



FIG. 458. Lateral view of the interior of the female pelvis. 



the broad ligament is the largest and most important. The two broad ligaments and 

 uterus form a diaphragm which extends from one side of the pelvis directly across to 

 the other, thus dividing it into anterior and posterior compartments. On the side of 

 the uterus the broad ligament extends from the round ligament and Fallopian tube 

 above down to below the level of the internal os. The anterior layer blends with the 

 Uterovesical fold at the level of the internal os, while the posterior goes to the bottom 

 of the pouch of Douglas. It passes outward to be attached to the sides of the pelvis 

 from the external iliac vein above down to the floor of the pelvis. Between the two 

 peritoneal layers of the broad ligament at its top is the Fallopian tube, a little lower 

 on the posterior surface is the ovary, going to the ovary are the ovarian vessels; 

 lower still is the round ligament ; and running in the base of the broad ligament are 

 the uterine artery and ureter. At its pelvic attachment the broad ligament widens 

 out, having the round ligament as its anterior edge and the infrmdibulopelvic or sus- 

 pensory ligament of the ovary as its posterior edge. This latter runs not to the 

 uterus but to the fimbriated extremity of the Fallopian tube and ovary and contains 

 the ovarian vessels. A little posterior is the uterosacral ligament (recto-uterine) ; it 



