THE UTERUS.
The uterus or womb, is the organ in which the fertilized ovule is de veloped, and which expels the foetus when the term of pregnancy arrives. The uterus is a single median and symmetrical viscus.
Form, Position, and Size of the Uterus.
Form.—It is shaped, from before backwards, like a flattened cone with base upward. Immediately below its centre is a circular depression that divides the organ into two parts: the superior part is the larger—the body; the inferior part is narrower—the cervix. The depression which separates them is the isthmus of the uterus.
Position.—The uterus (Fig. 32) is placed in the cavity of the pelvis, between the rectum behind, the vagina below, to which it is firmly united, the bladder in front, and laterally, the broad ligaments which hold it.
In the foetus its fundus is at the level of the fifth lumbar vertebra, then it seems to be forced down into the true pelvis from birth; but in the adult, the fundus of the uterus is on a level with the superior strait, and, in a majority of cases, it is seen to be on the level, or even below this strait.
size of the uterus is extremely variable, depending not only on age, but on the time when it is examined.
Before puberty the cervix is almost as large as the body, but from that period on the body acquires a preponderance which it never loses, even in old women. Later, there are modifications in the size of the uterus, some temporary, others permanent.
Thus, menstruation increases very perceptibly and momentarily the size of the uterus, whereas the sexual relation and repeated pregnancy cause a permanent modification.
These measurements agree, as we will shortly see.
In nulliparm the body is a little more than half of the total length.
In women who have had one or more children the body lengthens from .31 to .39 of an inch.
The average weight of the uterus is about 630 grains. For a short time it varies in weight from 22 to 24 ounces.
to ancient authors, the uterus follows the direc tion of the inferior strait, and the cervix is then directly under the body of the organ, its mobility allowing it to move as a whole forward, back ward, and laterally. The names Ante-, Retro- and Latero-version have
been given to these excesses in movements, which are considered patho logical.
The cervix and fundus do not have an equal mobility. The cervix, being better placed than the body, can move forward, backward and even sideways. Of these movements, anteflexion appears so common that it might be considered a normal condition. Richet differs from this, showing that anteflexions are always accompanied by a morbid state of the organ. He gives us the following: 1st. In the foetus and child, the uterus can have no exact and deter mined position. Situated in the abdomen, not in the pelvis, it is affected by any pressure without the least resistance, particularly that of the in testines, which are strong enough to move and hold it forward.
2d. In adults and nulliparre the uterus is slightly curved forward, and its axis seems to follow the direction of the pelvic canal.
3d. Displacements are frequent, principally anteflexion and anteversion, which result from the pressure of the intestines.
4th. When the deviation of the uterus, version or flexion, is complete, it is accompanied by changes in the uterine tissue.
According to Sappey, the direction of the axis of the uterus is governed by the condition of the bladder. If the bladder is partly filled, its direc tion is from above downward and from before backward, and is parallel to the axis of the superior strait. If the bladder is empty, it bends for ward, the uterus forming a right angle with the vagina. If the bladder is full, the fundus of the uterus is pushed backward toward the rectum, its axis inclining from above downward and from behind forward, ap proaching that of the vagina.
While Sappey agrees with Richet on the little influence due to the presence of the rectum, it is easily seen that it is far different with the bladder. For him it is this organ that, more than any other, influences the direction of the axis of the uterus, according to its state of plenitude or vacuity.