THE ABDOMEN 887 



Surrounding the vaginal portion of the cervix there is a vaulted 

 recess, which is divided into anterior, posterior, and lateral fornices. 



General Relations of the Uterus. — ^The anterior surface of the 

 body rests upon the superior surface of the bladder, and the anterior 

 surface of the supravaginal portion of the cervix is related to the 

 base of the bladder. The lateral relations are the Fallopian tubes, 

 round hgaments, hgaments of the ovaries, broad ligaments, and a 

 certain amount of adipose tissue, containing large bloodvessels, 

 which hes upon either side of the cervix, and extends upwards over 

 the lateral border between the layers of the broad ligament. This 

 collection is known as the parametrium. The posterior surface of- 

 the body is related to the rectum, and the posterior surface of the 

 supravaginal portion of the cervix forms a part of the anterior 

 boundary of the pouch of Douglas. 



Peritoneal Relations. — ^The following parts of the uterus are 

 covered by peritoneum : the supravaginal portion of the cervix 

 posteriorly, the posterior surface of the body, the fundus, and the 

 anterior surface of the body as low as the front of the cervix. The 

 following parts are free from peritoneal covering : the vaginal 

 portion of the cervix, the supravaginal portion of the cervix 

 anteriorly, and a narrow strip along each lateral border where the 

 two layers of peritoneum pass off to form the broad ligament. The 

 uterine peritoneal folds are as follows : two utero- vesical, sometimes 

 called the anterior uterine ligaments, but they may also be regarded 

 as the posterior false ligaments of the bladder ; the sacro-uterine 

 folds, with the torus uterinu5 ; and the broad hgaments. 



Position of the Uterus. — ^The virgin uterus occupies a position of 

 anteflexion and anteversion, assuming the bladder and rectum to 

 be empty. In speaking of the uterus as being anteflexed it is 

 to be imderstood that the body of the organ is bent forwards at 

 the isthmus in such a manner that it forms with the cervix an 

 angle, which is open anteriorly. This is brought about in the 

 following manner : the cervix uteri is more fixed than the body, 

 from its connection with the vaginal walls and base of the bladder ; 

 and the cervix is less yielding than the body. In speaking of 

 anteversion of the uterus it is to be understood that the entire 

 uterus is inclined forwards, so that its long axis forms an angle 

 with the longitudinal axis of the trunk. The anterior surface has 

 therefore a downward inclination towards the superior sm^face of 

 the bladder, and the posterior surface has an upward inclination, 

 and so supports a portion of the pelvic colon and a few coils of 

 the ileum. WTien the bladder is distended, the position of the 

 uterus becomes altered. The organ is raised along with the dis- 

 tended bladder, the anteflexion and anteversion become less, and 

 the uterus may even assume a vertical position. Any coils of the 

 ilemn lying in contact with its posterior surface, as well as the 

 pelvic colon, would be displaced, and the organ would come to be 

 closely related to the rectum. 



