A Text-book of Diseases of WomenPenrose, Charles B. (Charles Bingham)
Science
A Text-book of Diseases of Women
Penrose, Charles B. (Charles Bingham)
Women -- Diseases
[Illustration: FIG. 208.--Posterior view of the uterus, the tubes
and ovaries, and the broad ligaments: _I.P.L._, infundibulo-pelvic
ligament; _O.A._, ovarian artery; _U.A._, uterine artery; _U._, ureter.
The utero-sacral ligaments are seen on each side of the posterior
aspect of the cervix.]
The ovarian artery, which corresponds to the spermatic in the male, is
a branch of the abdominal aorta. It runs tortuously between the layers
of the upper part of the broad ligament, from the pelvic wall to the
upper angle of the uterus. Before reaching the uterus it divides into
two branches. The upper branch supplies the fundus uteri; the lower
branch anastomoses at the side of the uterus with the uterine artery.
During its course in the broad ligament the ovarian artery gives off
branches to the ampulla and the isthmus of the Fallopian tube, to the
ovary, and to the round ligament.
[Illustration: FIG. 209.--Anterior view of the uterus, the tubes and
ovaries, and the broad ligaments. The upper part of the bladder, the
anterior wall of the vagina, and the peritoneum on the anterior aspect
of the broad ligaments have been removed. _U._, ureter; _U.A._, uterine
artery; _O.A._ ovarian artery; _R.L._, round ligament.]
The uterine artery arises from the anterior division of the internal
iliac, and runs downward and inward toward the cervix uteri. The vessel
is tortuous, and is loosely supported by the cellular tissue at the
base of the broad ligament. The lowest point which it reaches is on
a level with the external os uteri, and at this point it crosses the
ureter.
At about this point it gives off the circular artery of the cervix,
which anastomoses with its fellow of the opposite side. The uterine
artery then passes upward, and reaches the uterus near the level of the
internal os. It passes along the side of the uterus in a very tortuous
manner, and anastomoses with the ovarian artery.
The vaginal arteries usually arise from the anterior division of the
internal iliac artery. They sometimes arise from the uterine or middle
hemorrhoidal artery.
The ureter passes behind and beneath the uterine artery. The uterine
artery crosses the ureter at about the level of the external os uteri.
At this point the ureter is ⅗ of an inch distant from the cervix. The
distance between the ureter and the artery at the point of crossing
is about ⅖ of an inch. It is important to remember these relations in
applying a ligature to the uterine artery.
It must not be forgotten that the anatomical relations are altered
by any displacement of the uterus from its normal position. Such
displacement occurs in disease and when the uterus is dragged upward or
downward during operation.
In conditions, such as cancer, which are accompanied by hypertrophy
of the cervix, the distance between the ureter and the cervix is much
diminished.
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