Speert H Gabriele Fallopio and the fallopian tubes. Obstet Gynecol — Fallopius G De Morbo Gallico. Patavii: apud C. Gabrielis Fallopii medici Mutinensis Observationes Anatomicae. Venetiis: apud MA Ulmum. Andreae Vesalii. Thiery M. Houtzager H Der Vrouwen Vrouwlijcheit. Rotterdam: Erasmus Publ. Download references. You can also search for this author in PubMed Google Scholar. This article was originally published in Tijdschrift voor Geneeskunde ;—3.
The English version is printed by permission of Prof. Lauweryns, Editor-in-Chief. Life Leuven is acknowledged for the translation. Reprints and Permissions. Thiery, M. Gabriele Fallopio — and the Fallopian tube. Gynecol Surg 6, 93—95 Download citation. Published : 06 December Issue Date : February These folds have been called the arbor vitae uteri or plicae palmatae. It was formerly thought that tubular glands descend vertically from the surface and divide into many branches forming compound racemose glands; however, secondary changes caused by the intense growth activity of the columnar cells result in the formation of tunnels, secondary clefts, and exophytic processes.
Photomicrograph low power of the epithelial lining at the junction of the cervix and vagina in the human. The glands of the cervix are definitely evident. There are no glands underlying the squamous epithelium of the vagina.
After R. The endometrial cavity lies above the internal cervical os. It is roughly triangular in shape and measures approximately 3. Ordinarily, the anterior and posterior walls of the uterus lie in apposition so that little if any actual cavity is present. At each cornu or horn of the uterus, the cavity of the uterus becomes continuous with the lumen of a fallopian tube.
Peritoneum covers most of the corpus of the uterus and the posterior cervix and is known as the serosa. Laterally, the broad ligament, a double layer of peritoneum covering the neurovascular supply to the uterus, inserts into the cervix and corpus. Anteriorly, the bladder lies over the isthmic and cervical region of the uterus. The most common position of the uterus in a nulligravid female is in moderate anteflexion or bent slightly anteriorly, and the uterus as a whole is inclined toward the symphysis in ante version against the bladder, adapting its position as the latter organ distends or empties Fig.
In a variable number of women, the uterus is retroverted or inclined posteriorly or retroflexed toward the sacrum. Many normal uteri are in mid position, with the axis of uterus being almost parallel to the spine. Dissection showing the cephalic aspect of the female genitalia and their relationships.
Transverse section of the abdomen above the crests of the ilia. This section is 1 inch above the pubis and extends through the disk between the sacrum and the last lumbar vertebra. The peritoneum covers the uterus and is separated from the uterine musculature by a thin layer of periuterine fascia, which is a continuation and extension of the transversalis fascia. This mobile fascial layer is areolar tissue and is easily separated except for a midline seam or raphe between the uterus and bladder anteriorly and between uterus and peritoneum posteriorly at the level of the isthmus.
Posteriorly it sweeps down over the posterior vaginal wall and the cul-de-sac. The blood supply of the uterus is derived chiefly from the uterine arteries Fig. These arise from the hypogastric artery and swing toward the uterus, which they reach at approximately the level of the internal os Fig.
Here the uterine arteries divide, the descending limb coursing downward along the cervix and lateral wall of the vagina. The ascending limb passes upward alongside the uterus and continues below the fallopian tube. Frequent anterior and posterior branches go to vagina, cervix, and uterus.
Arterial blood supply of the normal tube, ovary, and uterus. Courtesy of Dr John A. From Norris: Gonorrhoea in Women. Philadelphia: Saunders. Ventral view of a deep dissection of the urinary bladder and the blood supply to the left side of the internal genitalia, showing the relation of the uterine vessels to the ureter.
Blood supply of the reproductive organs with relation to the ureter and trigone of the urinary bladder. The ovarian artery, which ordinarily arises from the aorta, passes along the ovary, dividing into a number of branches. At several places in the broad ligament there are anastomotic connections between the tubal branch of the uterine artery and the ovarian artery. A branch of the uterine artery nourishes the round ligament. The veins generally accompany the arteries.
Using injection and microradiographic and histologic techniques to study the vascular anatomy of the uterus, Farrer-Brown et al. In the broad ligament each uterine artery supplies lateral branches that immediately enter the uterus and give off tortuous anterior and posterior arcuate divisions, which run circumferentially in the myometrium approximately at the junction of its outer and middle thirds.
In the midline the terminal branches of both arcuate arteries anastomose with those of the contralateral side. Each arcuate artery throughout its course gives off numerous branches running both centrifugally towards the serosa and centripetally towards the endometrium. The arteries to the serosa at first are directed radially and then frequently became more circumferential.
There is a plexus of small arterial radicals with a radial distribution located immediately below the serosa. The inner two-thirds of the myometrium is supplied by tortuous radial branches of the arcuate arteries. They provide numerous branches terminating in a capillary network which surrounds groups of muscle fibers.
An abrupt change in the density of the arterial pattern occurs at the junction of the basal layer of the endometrium with the subjacent myometrium. The endometrial vessels are relatively sparse in comparison with those of the myometrium at all stages of the menstrual cycle. The uterus is partially supported by three pairs of ligaments. The paired round ligaments extend from the anterosuperior surface of the uterus through the internal inguinal rings and through the inguinal canals to end in the labia majors.
They are composed of muscle fibers, connective tissue, blood vessels, nerves, and lymphatics. The round ligaments stretch with relative ease, particularly in pregnancy. The uterosacral ligaments are condensations of endopelvic fascia that arise from the posterior wall of the uterus at the level of the internal cervical os. They fan out in the retroperitoneal layer and attach broadly at the second, third, and fourth segments of the sacrum. They are predominately composed of smooth muscle but also contain connective tissue, blood vessels, lymphatics, and parasympathetic nerve fibers.
The cardinal ligaments form the base of the broad ligament. They are composed of perivascular connective tissue and nerves that surround the uterine artery and veins.
The cardinal and uterosacral ligament complex is collectively called the parametrium. The broad ligament is formed by folds of peritoneum covering the fallopian tubes, the infundibulopelvic vessels, and the hilus of the ovary. It contains a number of structures: fallopian tube, round ligament, ovarian ligament, uterine and ovarian blood vessels, nerves, lymphatics, and mesonephric remnants.
Below the infundibulopelvic structures, the anterior and posterior leaves of peritoneum lie in apposition, leaving a clear space below the tube with its tubal branch of the uterine artery. This avascular area is useful to the surgeon in isolating the adnexal structures and in avoiding blood vessels while performing tubal ligations. The endometrium lines the uterine cavity and is considered to have three layers: the pars basalis, the zona spongiosa, and the superficial zona compacta.
The straight branches of the radial arteries of the uterus terminate in capillaries in the basal layer, while the spiral or coiled branches penetrate to the surface epithelium, where they give rise to superficial capillaries. The endometrium varies greatly depending on the phase of the menstrual cycle. Proliferation of the endometrium occurs under the influence of estrogen; maturation occurs under the influence of progesterone. The uterine endometrial cycle can be divided into three phases: the follicular or proliferative phase, the luteal or secretory phase, and the menstrual phase.
The follicular, or proliferative phase, spans from the end of the menstruation until ovulation. Increasing levels of estrogen induce proliferation of the functionalis from stem cells of the basalis, proliferation of endometrial glands, and proliferation of stromal connective tissue. Endometrial glands are elongated with narrow lumens and their epithelial cells contain some glycogen. Glycogen, however, is not secreted during the follicular phase.
Spiral arteries elongate and span the length of the endometrium. After formation of the corpus luteum, the endometrial glands grow, become tortuous, and secrete.
The luteal, or secretory, phase begins at ovulation and lasts until the menstrual phase of the next cycle Fig. At the beginning of the luteal phase, progesterone induces the endometrial glands to secrete glycogen, mucus, and other substances. These glands become tortuous and have large lumens due to increased secretory activity.
The spiral arteries extend into the superficial layer of the endometrium. The spiral capillaries develop a terminal network of superficial capillaries. These changes result in the formation of a predeciduum prepared for the arrival of the trophoblast. Luteal phase endometrium. In the absence of fertilization by day 23 of the menstrual cycle, the corpus luteum begins to degenerate and ovarian hormone levels decrease.
As estrogen and progesterone levels decrease, the endometrium undergoes involution. During days 25—26 of the menstrual cycle, endothelin and thromboxin begin to mediate vasoconstriction of the spiral arteries.
The resulting ischemia may cause menstrual cramps. By day 28 of the menstrual cycle, intense vasoconstriction and subsequent ischemia cause mass apoptosis of the functionalis, with associated bleeding. The menstrual phase begins as the spiral arteries rupture secondary to ischemia, releasing blood into the uterus, and the apoptosed endometrium is sloughed off Fig. During this period, the functionalis is completely shed. Arterial and venous blood, remnants of endometrial stroma and glands, leukocytes, and red blood cells are all present in the menstrual flow.
Menstrual phase endometrium. Data on the lymphatic vessels of the uterus have been coordinated by Reynolds. Procedures to block the fallopian tubes can be used as a form of permanent contraception, or sterilization. The fallopian tubes are also known as oviducts or uterine tubes. They are important parts of the female reproductive system. Fertilization normally happens in the fallopian tubes. If a pregnancy implants in the fallopian tubes, or elsewhere outside of the uterus, it's referred to as an ectopic pregnancy.
Ectopic pregnancy can be very dangerous, with a risk of rupture and even death. There are two tubes, one on each side, that extend from near the top of the uterus , run laterally and then curve over and around the ovaries. Their shape is similar to an extended J. The open ends of the fallopian tubes lie very near the ovaries but they are not directly attached.
Instead, the fimbriae Latin for fringe of the fallopian tubes sweep ovulated eggs into the tubes and towards the uterus. Contrary to many drawings, while the ovaries and fallopian tubes are both attached to the uterus, they are not attached to each other.
In an adult, the fallopian tubes are around 10 to 12 centimeters cm long, although this can vary substantially from person to person. They are generally considered to consist of four sections. The short interstitial section connects through the wall of the uterus to the interior of the uterus. The isthmus is next, a narrow section that is about one-third of the length of the tube. This is followed by the ampulla, which is thin-walled like the isthmus but broader in circumference.
It makes up about half the length of the tube. Finally, there is the infundibulum, where the tube broadens into a fringed funnel that lies near the ovary. The fringes are known as the fimbriae, and they are sometimes considered a fifth segment. The longest fimbria, and the one that lies closest to the ovary, is the ovarian fimbria,. The fallopian tubes are made up of several layers. The outer layer is a type of membrane known as the serosa. Inside this are layers of muscle, known as the myosalpinx myo- is a prefix referring to muscle.
The number of layers depends on the portion of the tube. Finally, inside of the fallopian tubes is a deeply folded mucosal surface.
This layer also contains cilia. Cilia are hair-like structures. They move to propel the ovulated egg from the ovary towards the uterus. They also help distribute tubal fluid throughout the tube. The cilia of the fallopian tubes are most numerous at the ovarian end. They also change throughout the menstrual cycle. The beating movement of the cilia increases near the time of ovulation.
Interestingly, some women with a condition known as Kartagener's syndrome remain fertile even though their cilia movement is impaired. In rare cases, an accessory fallopian tube can form during development, which can affect fertility. This extra tube generally has an end that is near the ovary but does not extend into the uterus.
Therefore, if an egg is picked up by the accessory fallopian tube, it can not be fertilized and implanted. There is also a risk of an ectopic pregnancy in such an accessory tube, which can be dangerous. Other variations include extra openings, closed sacs, and functional changes to the fimbria.
The primary function of the fallopian tubes is to transport eggs from the ovary to the uterus. The eggs are picked up by the fimbriae and then swept towards the uterus. This movement is directed both by the beating of the cilia and by peristalsis , which is rhythmic contractions of the muscles of the tubes. When fertilization occurs, it is generally in the fallopian tubes. The sperm travel out from the uterus into the tubes, where they may encounter and fertilize an egg.
The fertilized egg then continues its movement towards the uterus. If a fertilized egg implants in the uterus, and continues to develop, it becomes a uterine pregnancy. Successful transport of eggs through the fallopian tubes is necessary for someone to get pregnant without medical intervention. This is why tubal sterilization , which interrupts the function of the tubes, is an effective form of permanent contraception.
This is sometimes referred to as getting one's "tubes tied. Ectopic pregnancy is the condition most commonly associated with the fallopian tubes. It occurs when there is a delay in the transport of the fertilized egg towards the uterus.
In such cases, the fertilized egg may implant and cause an ectopic pregnancy inside the tube.
0コメント