390 



The Uterus 



passing from the navel to the coccyx that is with the axis of inlet of 

 the pelvis (p. 364). In the normal state it is suspended within the true 

 pelvis ; thus it cannot be felt above the pubes ; during pregnancy it 

 ascends towards the anterior abdominal wall. 



Relations. The large end is surrounded by coils of small intestine. 

 Posteriorly is the rectum ; and into the recto-vesical pouch of peri- 

 toneum loops of jejunum and ileum descend. In front is the bladder, 

 and laterally are the ovaries and Fallopian tubes, between the layers 

 of the broad ligament. Inferiorly is the vagina, and lower still is the 

 perineum ; after rupture of the perineum the uterus sinks until the cervix 

 and some of the body hang permanently outside the vulva ; this is 

 prolapse of the uterus. 



The presence of the uterus between the bladder and rectum divides 

 the recto-vesical cavity into the antero-uterine and the retro-uterine 

 pouches, each of which contains coils of small intestine ; the retro- 

 uterine cul-de-sac is commonly called Douglas's pouch, which may be 

 reached by the finger through the upper part of the back of the vagina. 



When the bladder is distended the uterus is thrust backwards and 

 upwards ; w 7 hen the rectum is loaded it is pushed forwards. 



The peritoneal covering- of the body of the uterus is complete on 

 the posterior surface ; indeed, the retro-uterine pouch descends con- 

 siderably below the level of the body covering the posterior part of the 

 cervix, which extends above the vagina, and the upper part of the back 

 of the vagina itself. Laterally, the recto-uterine pouch is bounded by 

 the ureters and the obliterated hypogastric arteries. Anteriorly the 

 peritoneum does not descend so far, but, leaving a small part of the 

 uterus bare below, passes forwards to the back of the bladder. 



it, uterus ; c, cervix ; od, oviduct, and / and./?, fimbriated exty. ; /, round ligament ; e>, ovary, 

 and lo, its ligament ; po } parovarium, with small cyst, h. 



The layers of peritoneum from the front and back extend laterally 

 to the side of the pelvis under the name of broad ligaments. The 



