First principle: know the danger, the supports, and the drainage
Position: usually anteverted (cervix‑to‑vagina angle) + anteflexed (body‑to‑cervix angle). Wall: endometrium → myometrium (fibroid origin) → perimetrium.
The surgical danger point — the ureter:
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Supports (and the prolapse preview)
| Support | Role |
|---|---|
| Cardinal (transverse cervical) ligaments | main lateral cervical support |
| Uterosacral ligaments | main apical/posterior support |
| Levator ani + endopelvic fascia | dynamic pelvic floor |
| Round ligament | maintains anteversion — not an anti‑prolapse support |
Lymphatic drainage (staging logic for Part 8)
| Structure | Nodes |
|---|---|
| Ovary | para‑aortic (follows its high embryological origin) |
| Cervix | pelvic (obturator, internal/external iliac) |
| Uterine fundus | pelvic ± para‑aortic; round‑ligament route to inguinal |
Discriminators / applications
- Posterior fornix abuts the pouch of Douglas (site of culdocentesis, and where endometriosis/pus collects).
- IP ligament = ovarian vessels → clamp it, not the ureter, in oophorectomy.
Pitfalls
- Ligating the uterine artery without identifying the ureter beneath it. 🚩
- Treating the round ligament as a prolapse repair target.
Pearls
- 🎯 Ureter under uterine artery; ovary drains to para‑aortic nodes; cardinal + uterosacral = the apical supports.
- 🩺 Endometriosis loves the uterosacrals and pouch of Douglas — palpate them.
Next → How embryological build‑steps predict every uterine anomaly (Concept 24).