Position | Uterus

Ashley Davidoff MD

Introduction

The normal position of uterus between the bladder and the rectum, and it projects superoanteriorly over the urinary bladder.

Normally and most commonly it is anteverted and anteflexed. The long axis of vagina forms a ninety degree angle with axis of cervix which is directed posteriorly and inferiorly, this is called as anteversion. The body of uterus is folded anteriorly making a 120 degree angle with cervix, this is called as anteflexion. The opposite position of anteversion is called a retroversion and cervix ix directed anteriorly and inferiorly; the opposite of anteflexion is retroflexion. This is sometimes the normal position of the uterus.

Peritoneal Relationships

This diagram in the sagittal plane illustrates the peritoneal covering (light ourple lining) of the uterus reflected posteriorly off the rectum in the region of the fornix of the vagina creating a pouch called the recto-uterine pouch (aka cul de sac. pouch of Douglas recto-vaginal pouch Ehrhardt-Cole recess) This pouch is very important because it is the most posterior and inferior space of the peritoneal cavity and in the supine or upright position it will be the region where fluid will first accumulate. Anteriorly the peritoneal reflection is not as deep but a pouch is also formed called the uterovesical (aka vesico-uterine) pouch

View from the Cul de Sac

The diagram shows the peritoneal covering of the posterior aspect of the uterus and the intraperitoneal location of the ovaries The broad ligament contains the round ligament (superior band), the Fallopian tube, )mauve) and the ovarian ligament. Within the broad ligament the uterine/ovarian artery runs , uterine/ovarian vein lymphatics and nerves.

Normal HSG

Position and Shape Relates to the Position of the Uterus

40 year old female with normal endometrial cavity and cervical canal and fallopian tubes normal anatomy cervix uterus HSG hysterosalpingogram

The Normal Anteverted Uterus with A Filled Bladder

60385c04b.8s The sagittaly reconstructed CT shows an anteverted uterus buoyed and cushioned by partly filled bladder (yellow) In this sagittal view of the uterus an ‘L” shaped structure of the uterus vagina, and the internal cavity is diagrammed in by the pink vectors of the tract. code uterus fundus body lower uterine segment cervix vagina anatomy structure normal tract concepts conceptual frameworks principles Davidoff art Courtesy Ashley Davidoff MD copyright 2010 all rights reserved

Anteverted and “V Shaped Uterus with an Empty Bladder

The diagram represents a sagittal view of the uterus reflecting an ‘V” shaped structure of the uterus and vagina The uterus varies in position and in this case is anteverted, that converts the L shaped structure described to a “V” shaped structure

Retroverted Uterus

The position and axis of the uterus is not always as outlined. The uterus is fairly mobile and in this sagittal MRI it is retrovertedand isnstead of being a “L” or a “V” configuration it is almost an “I”