THE UTEKUS. 1319 



cord, of about one inch in length, which is attached by its lateral end to the 

 uterine pole of the ovary, and by its medial end to the lateral angle of the uterus 

 immediately below and behind the entrance of the uterine tube. This liga- 

 ment, which is largely composed of unstriped muscle fibres continuous with those 

 of the uterus, is enclosed in a slight fold derived from the posterior layer of the 

 broad ligament. 



The ligament of the ovary represents the upper portion of the gubernaculum which appears 

 in the embryo. 



The ligamentum teres uteri, or round ligament of the uterus, is a narrow flat 

 band attached to the uterus just in front of, and a little below, the opening of the 

 uterine tube. Near the uterus it contains numerous smooth muscle fibres, which 

 are continuous with those of the uterus ; more laterally it is composed chiefly of 

 fibrous connective tissue. Lying in the anterior part of the broad ligament, it 

 reaches the wall of the pelvis minor, and is then directed forwards and slightly 

 upwards to cross the obliterated umbilical artery and the pelvic brim. After it has 

 reached the pelvic wall its course is comparable to that of the ductus deferens in the 

 male, and, like the latter, it leaves the abdomen to traverse the inguinal canal (Figs. 

 1028 and 1029). It finally ends in the subcutaneous tissue and skin of the labium 

 majus. Its terminal part is composed of connective tissue only. 



In some cases a small diverticulum of the peritoneal cavity can be traced accompanying the 

 round ligament through the abdominal wall. This is called the processus vaginalis peritonei 

 (O.T. canal of Nuck), and corresponds to the processus vaginalis of the male (p. 1294). 



The round ligament of the uterus represents the lower portion of the gubernaculum testis 

 which appears in the male embryo (see pp. 1294 and 1313). 



Position and Relations of the Uterus. The position occupied by the 

 uterus in the pelvis is not always the same, but varies 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. 

 Usually the level of the external orifice of the uterus will be found to correspond 

 to that of a horizontal plane passing through the upper margin of the symphysis 

 pubis. The uterus rarely lies exactly in the median plane of the body, but usually 

 bends to one or other side, most frequently towards the right. The vesical 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 ^mpty 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 anteflexed. The anteflexion is due 

 to the fact that the more rigid cervix is 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 anteversion 

 and anteflexion of the uterus become less marked, owing to the body and fundus 

 being pushed backwards. Finally, if the, rectum is 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. Superiorly a part of the peritoneal cavity intervenes between the 

 vesical surface of the uterus and the bladder, but lower down the two organs are 

 separated merely by a small quantity of connective tissue. The intestinal surface 

 of the uterus looks into the pouch of Douglas, and is usually, like the fundus, in 

 relation to some loops of the small intestine or pelvic colon. Laterally the uterus 

 is related to the broad ligaments. The terminal parts of the ureters pass downwards, 

 medially, and a little forwards on the lateral aspects of the cervix, but are separated 

 from it by an interval of about three-quarters of an inch. 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. 



84 c 



