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The Normal Uterus
The Normal Uterus
The Normal Uterus
The uterus is a thick, pear-shaped muscular organ located between the two layers of the broad ligament laterally, the urinary
bladder anterior and the rectosigmoid colon posteriorly.
The fundus is the superior area above the entrance of the fallopian tubes.
The body (corpus) is the expanded portion and forms the major bulk of the uterus.
The isthmus is the slightly constricted lower portion that separates the body from the cervix.
The cervix is the lowermost portion that undergoes progressive thinning during pregnancy but maintains a constant length of
about 3 cm.
The vaginal canal lies in the midline and rums from the cervix to the external genitalia.
The myometrium has a homogeneous echotexture with smooth borders. The transition between
the endometrium and myometrium is delineated by an echo poor line, which is thought to represent the deeper more vascular layer
of the inner myometrium. Normal arcuate vessels may be seen in the periphery of the uterus. These vessels bifurcate into radial
branches, which supply blood throughout the uterus.
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The endometrium appears as a central line whose appearance and density are related to the phases of the menstrual cycle. After
menstruation, when the majority of the decidual inner layer of the endometrium has been shed, only a fine cavitatory line present.
As the endometrium thickens in the proliferative phase of the cycle, it becomes more prominent but remains echo poor.
The endometrium continues to thicken and become more reflective as it enters the secretory phase presumable due to the glands
filling with mucin and becoming tortuous. Towards the end of the cycle the endometriual shadow (which includes both the anterior
and posterior endometrium) may reach 10 mm.
Pre-menarchal uterus
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Secretory phase
Internal os is the fibromuscular junction between the corpus uteri and the cervix. Sonographically they have a similar appearance and
cannot be reliable differentiated. It can be localized by its interface with the lower amniotic cavity on longitudinal scans. The
amniotic fluid typically is funnel shaped (apex of funnel forms an acute angle at the internal os).
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Normal Length.
Transabdominal scan = 3.5-5cm. Variation due to compression from a full bladder.
Transvaginal scan = 4.0-4.5cm.
Uterine vasculature.
The future uteroplacental arteries, the spiral arteries have a peculiar shape, hence the term "curling arteries" (coined by their
discoverer, William Hunter, 1774).
They are involved with extensive changes during the menstrual cycle they are one of the most labile vascular systems in the human
body.
They arise from the radial arteries at the inner third of the myometrium, while the radials themselves branch from the arcuatesystem.
Small basal arteries arise from the radials and nourish the basal layer of the endometrium, facilitating tissue regeneration after
shedding at menstruation or delivery.
The endometrial segments of the spiral arteries minor sides branches arise, which are the same caliber as the basal arteries, but seem
to supply more superficial tissue layers.
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Retroflexion
Retroversion + Retroflexion
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