Deep vaults in gynecology. External genitalia, perineum. Normal and pathological appearance of the cervix after a test with acetic acid

Uterus, uterus (metra), is an unpaired hollow smooth muscle organ located in the cavity of the small, at the same distance from the pubic symphysis and at such a height that its uppermost section - the fundus of the uterus - does not protrude beyond the level of the upper aperture of the pelvis. The uterus is pear-shaped, flattened in the anteroposterior direction. The wide part of it faces upward and anteriorly, the narrow part faces downwards. The shape and size of the uterus change significantly at different periods of life and mainly in connection with pregnancy. The length of the uterus in a nulliparous woman is 7-8 cm, in a woman who has given birth - 8-9.5 cm, width at the bottom level is 4-5.5 cm; weight ranges from 30 to 100 g.

The uterus is divided into the cervix, body and fundus.

Cervix, cervix uteri, sometimes gradually passes into the body, sometimes sharply demarcated from it; its length reaches 3-4 cm; it is divided into two parts: supravaginal and vaginal. The upper two-thirds of the cervix are located above and constitute its supravaginal part (cervix), portio supravaginalis (cervicis). The lower part of the cervix is, as it were, pressed into the vagina and forms its vaginal part, portio vaginalis (cervicis). At its lower end there is a round or oval opening of the uterus, ostium uteri, the edges of which form the anterior lip, labium anterius, and the posterior lip, labium posterius. In women who have given birth, the opening of the uterus looks like a transverse slit, in women who have not given birth, it is round. The hind lip is somewhat longer and less thick, located above the anterior one. The opening of the uterus is directed towards the posterior wall of the vagina.

In the area of ​​the cervix there is the cervical canal, canalis cervicalis uteri, the width of which is unequal throughout: the middle sections of the canal are wider than the area of ​​the external and internal openings, as a result of which the canal cavity is spindle-shaped.

The body of the uterus, corpus uteri, has the shape of a triangle with a truncated lower angle that continues into the cervix. The body is separated from the cervix by a narrowed part - the isthmus of the uterus, isthmus uteri, which corresponds to the position of the internal opening of the uterus. In the body of the uterus, there is an anterior vesical surface, facies vesicalis, a posterior intestinal surface, facies intestinalis, and lateral, right and left, edges of the uterus, margines uteri (dexter et sinister), where the anterior and posterior surfaces pass into one another. The upper part of the uterus, which rises in the form of a vault above the openings of the fallopian tubes, represents the fundus of the uterus, fundus uteri. With the lateral edges of the uterus, the fundus of the uterus forms angles into which the fallopian tubes enter. The area of ​​the uterine body corresponding to the place where the tubes enter is called the horns of the uterus, cornua uteri.

The uterine cavity, cavitas uteri, 6-7 cm long, in the frontal section has the shape of a triangle, in the upper corners of which the mouths of the fallopian tubes open, in the lower corner there is the internal opening of the uterus, which leads into the cervical canal. The size of the cavity in nulliparous women is different from that in women who have given birth: in the former side walls more sharply concave into the cavity. The anterior wall of the uterine body is adjacent to the posterior wall, due to which the cavity on a sagittal section has the shape of a slit. The lower narrow part of the cavity communicates with the cervical canal, canalis cervicis uteri.

The wall of the uterus consists of three layers: the outer layer - the serous membrane, tunica serosa (perimetrium), the subserosal base, tela subserosa, the middle layer - the muscular layer, tunica muscularis (myometrium), and the inner layer - the mucosa, tunica mucosa (endometrium).

The serous membrane (perimetrium), tunica serosa (perimetrium), is a direct continuation of the serous cover Bladder. Over a large area of ​​the front and back surfaces and the fundus of the uterus, through the subserosal base, tela subserosa, is tightly fused with the myometrium; At the border of the isthmus, the peritoneal cover is attached loosely.

Muscular lining of the uterus(myometrium), tunica muscularis (myometrium), is the most powerful layer of the uterine wall, consists of three layers of smooth muscle fibers with an admixture of loose fibrous connective tissue. All three layers are intertwined with their muscle fibers in various directions, as a result of which the division into layers is not well defined. The thin outer layer (subserosal), consisting of longitudinally located fibers and a small number of circular (circular) fibers, is tightly fused with the serous cover. The middle layer, circular, is the most developed. It consists of muscle bundles forming rings, which are located in the area of ​​the tube angles perpendicular to their axis, in the area of ​​the body of the uterus - in circular and oblique directions. This layer contains a large number of vessels, mainly venous, which is why it is also called the vascular layer, stratum vasculosum. The inner layer (submucosal) is the thinnest, with longitudinally running fibers.

Uterine mucosa(endometrium), tunica mucosa (endometrium), fused with the muscular layer, lines the uterine cavity without a submucosa and passes to the openings of the fallopian tubes; in the area of ​​the fundus and body of the uterus it has a smooth surface. On the front and back walls The mucous membrane of the cervical canal, endocervix, forms longitudinally running palm-shaped folds, plicae palmatae. The mucous membrane of the uterus is covered with single-layer prismatic epithelium; it contains simple tubular uterine glands, glandulae uterinae, which in the cervical area are called cervical glands (cervix), glandulae cervicales (uteri).

The uterus occupies a central position in the pelvic cavity. Anterior to it, in contact with its anterior surface, is the bladder, behind it is the rectum and loops. small intestine. The peritoneum covers the anterior and posterior surfaces of the uterus and extends to neighboring organs: the bladder, the anterior wall of the rectum. On the sides, at the place of transition into the broad ligaments, the peritoneum is loosely connected to the uterus. At the base of the broad ligaments, at the level of the cervix, between the layers of the peritoneum there is peri-uterine tissue, or parametrium, parametrium, which passes into the paracervix in the area of ​​the cervix.

The lower half of the anterior surface of the cervix is ​​devoid of serous cover and is separated from upper section the posterior wall of the bladder is a connective tissue septum that secures both organs to each other. The lower part of the uterus - the cervix - is fixed to the vagina starting from it.

The uterus occupies in the pelvic cavity not a vertical, but an anteriorly curved position, anteversio, as a result of which its body is tilted above the anterior surface of the bladder. Along the axis, the body of the uterus forms an anteriorly open angle of 70-100° relative to its cervix - anterior bending, anteflexio. In addition, the uterus can be deviated from the midline to one side, right or left, laterpositio dextra or laterpositio sinistra. Depending on the filling of the bladder or rectum, the inclination of the uterus changes.

The uterus is held in its position by a number of ligaments: the paired round ligament of the uterus, the right and left broad ligaments of the uterus, the paired rectal uterine and sacrouterine ligaments.

Round ligament of the uterus, lig. teres uteri, is a cord of connective tissue and smooth muscle fibers 10-15 cm long. It starts from the edge of the uterus immediately below and anterior to the fallopian tube.

The round ligament is located in the peritoneal fold, at the beginning of the broad ligament of the uterus, and is directed to the lateral wall of the small pelvis, then upward and forward to the deep inguinal ring. On its way, it crosses the obturator vessels and obturator nerve, the lateral umbilical fold, the external iliac vein, v. iliaca externa, lower epigastric vessels. Having passed through the inguinal canal, it exits through its superficial ring and scatters in the subcutaneous tissue of the pubic eminence and labia majora.

In the inguinal canal, the round ligament of the uterus is accompanied by the arteries of the round ligament of the uterus, a. ligamenti teretis uteri, sexual branch, r. genitalis from n. genitofemoralis, and bundles of muscle fibers from m. obliquus internus abdominis and m. transversus abdominis.

Broad ligament of the uterus, lig. latum uteri, consists of two - anterior and posterior - layers of the peritoneum; follows from the uterus to the sides, to the side walls of the small pelvis. The base of the ligament approaches the floor of the pelvis, and the leaves of the broad ligament pass into the parietal peritoneum of the small pelvis. The lower part of the broad ligament of the uterus, associated with its edges, is called the mesentery of the uterus, mesometrium. Between the leaves of the broad ligament of the uterus, at its base, there are connective tissue cords with smooth muscle bundles, forming the main ligament on both sides of the uterus, which plays a significant role in fixing the uterus and vagina. Medially and downwards, the tissue of this ligament passes into the peri-uterine tissue - parametrium, parametrium. The periuterine tissue contains the ureter, uterine artery, a. uterina, and the uterovaginal nerve plexus, plexus uterovaginalis.

Between the leaves of the upper edge of the broad ligament lies the fallopian tube. From the posterior layer of the lateral section of the broad ligament, below the ampulla of the fallopian tube, the mesentery of the ovary, mesovarium, extends. Below the medial part of the tube on the posterior surface of the broad ligament is the proper ligament
ovary, lig. ovarii proprium.

The area of ​​the broad ligament between the tube and the mesentery of the testicle is called the mesentery of the fallopian tube, mesosalpinx. In this mesentery, closer to its lateral sections, fimbria ovarica, epoophoron and paraoophoron are located. The superolateral edge of the broad ligament forms the ligament that suspends the ovary, lig. suspensorium ovarii.

On the anterior surface of the initial part of the broad ligament, the round ligament of the uterus, lig. teres uteri.

The fixing apparatus of the uterus includes the rectal-uterine and sacro-uterine ligaments, which lie in the right and left rectal-uterine folds. Both of them contain connective tissue cords, bundles of the rectouterine muscle, m. rectouterinus, and follow from the cervix to the lateral surfaces of the rectum and to the pelvic surface of the sacrum.

Innervation: plexus hypogastricus inferior (sympathetic innervation), plexus uterovaginalis.

Blood supply: a. uterina and a. ovarica (partially). Deoxygenated blood flows into the plexus venosus uterinus and then along vv. uterinae and vv. ovaricae in vv. iliacae internae. Lymphatic vessels drain lymph to the nodi lymphatici lumbales (from the fundus of the uterus) and inguinalis (from the body and cervix).

You might be interested in this read:

Parametritis – inflammation of the parametrium or accumulation purulent infiltrate in the surrounding uterine cells.

The organs adjacent to the uterus, the appendix and the rectum become inflamed during parametritis due to:

• abortions, childbirth leading to complications;
• complications after flu, sore throat;
• surgical intervention to expand the cervical canal to install an intrauterine device or after removing purulent tumors on the peritoneal walls of the internal genitalia.

Basically, the development of parametritis leads to damage to the appendages and the development of an inflammatory process in the tissue. Possible spread of inflammation to the veins, lymphatic vessels.

How to recognize parametritis?

The main symptom of parametritis is radiating to the lower back and sacral area. As the disease progresses:

• getting worse general state women;
• temperature rises to 39 degrees, shivering;
• there is a feeling of thirst, weakness, headache;
• pulse and heart rate increase;
• defecation and urination become difficult, pain and discomfort are possible, feces are discharged with pus and an unpleasant odor;
• When examining the vagina, the walls on the side of the uterus are compacted, motionless, the infiltrate is painful on palpation, and irritated.

The tissues around the uterus begin to swell. When the rectum or bladder is involved in the infiltrate, the urge to urinate is painful, frequent, and painful. Clinically, the same signs are observed with purulent parametritis. When passing it to chronic form the symptoms are less pronounced, the compaction of the fiber in the genital area is uneven, when palpated, the nodes near the vagina begin to hurt, and when shifted to the side, the cervix is ​​also painful, especially during sexual intercourse. Nervous, vegetative and vascular system fail.

Inflammation leads to menstrual irregularities. When the inflammatory process spreads to the periuterine tissue and endometrium, with the formation of pus, the fascia melts and pelviocellulitis develops. The inflammation spreads to the entire pelvic area.

It is worth noting that most often parametritis develops precisely in postpartum period due to the penetration of microbes into the fiber in a variety of ways:

• through the lymphatic vessels, venous system, respiratory tract against the background of influenza, sore throat. The causative agents of parametritis - streptococcus and staphylococcus, lead to the development of infiltration first near the uterus, then spread to the peri-vesical tissue, melt the posterior septum, spread to the rectum, tubes and ovaries, ringing the uterus and walling it up in the infiltrate.

What are the different stages of parametritis?

The form of the disease can be lateral, anterior, or posterior.

1. With anterior parametritis, infectious inflammation covers the anterior part of the uterus. When the infiltrate thickens, its anterior fornix is ​​smoothed out; the pathology often spreads to the bladder and the anterior wall of the peritoneum.
2. With posterior parametritis, the inflammatory infiltrate is localized to the posterior part of the uterus. It may spread to the rectum, narrowing the lumen in it.
3. With lateral parametritis, the arch is smoothed to the left or right of the vagina.

This disease goes through several stages as it progresses:

• exudation, initial period development of the disease;
• infiltration, exudate thickens, fibrin falls out. With treatment at this stage, the infiltrate gradually subsides, suppuration does not form;
• suppuration, the structure of the infiltrate is saturated with microbes, and the parametric fiber in the abscess begins to melt. Purulent parametritis develops.

How is diagnosis carried out?

The uterus (uterus (metra)) is an unpaired hollow smooth muscle organ located in the pelvic cavity, at the same distance from the pubic symphysis and sacrum, at such a height that its uppermost section, the fundus of the uterus, does not protrude beyond the level of the upper pelvic aperture.

A woman's uterus is pear-shaped, flattened in the anteroposterior direction. The wide part of it faces upward and anteriorly, the narrow part - downward and anteriorly. The shape and size of the uterus change significantly at different periods of life and mainly in connection with pregnancy.

STRUCTURE OF THE UTERUS

The uterus is divided into the cervix, body and fundus. The neck sometimes gradually merges into the body, sometimes it is sharply demarcated from it; its length reaches 3 cm; it is divided into two parts: supravaginal and vaginal. The upper two-thirds of the cervix are located above the vagina and constitute its supravaginal part. The lower third of the cervix is, as it were, pressed into the vagina and forms its vaginal part. At its lower end there is a round or oval opening of the uterus, the edges of which form the anterior lip and posterior lip. In women who have given birth, the opening of the uterus has the appearance of a transverse slit, in women who have not given birth, it has a rounded shape. The hind lip is somewhat longer and less thick, located above the anterior one. The opening of the uterus is directed towards the posterior wall of the vagina.

In the cervix of the uterus there is a canal, the width of which is not the same along its length: the middle sections of the canal are wider than the area of ​​​​the external and internal openings, due to which the canal cavity has a spindle-shaped shape.

The size norm for the cervix is ​​approximately 30% of the length of the entire uterus. Average size of the cervix in women reproductive age the following:

• Length from 2.8-3.7 cm;
• Width 2.9-5.3 cm;
• Thickness 2.6-3.3 cm.

The body of the uterus is triangular in shape with a truncated lower angle that continues into the cervix. The body is separated from the cervix by a narrowed part - the isthmus of the uterus, which corresponds to the position of the internal opening of the uterus. The body is distinguished by the anterior cystic surface, the posterior intestinal surface, and the lateral, right and left, edges of the uterus, where the anterior and posterior surfaces pass into one another. The upper part, which rises in the form of a vault above the openings of the fallopian tubes, is called the fundus. It represents a convexity and forms angles with the lateral edges of the uterus into which the fallopian tubes enter. The area of ​​the body corresponding to the confluence of the tubes is called the horns of the uterus.

The uterine cavity is 6-7 cm long, in the frontal section it has the shape of a triangle, in the upper corners of which the mouths of the fallopian tubes open, in the lower corner there is the internal opening of the uterus, which leads into the cervical canal; The size of the cavity in nulliparous women is different than in those who have given birth. In the former, the side walls are more sharply concave into the cavity. The anterior wall of the body is adjacent to the posterior wall, due to which the cavity in the sagittal section has the shape of a slit. The lower narrow part of the cavity communicates with the cervical canal, which has a spindle shape. The canal opens into the vagina through the opening of the uterus.

STRUCTURE AND ANATOMY OF THE UTERUS

The wall consists of three layers: the outer - serous membrane, the subserosal base, the middle - muscular layer and the inner - mucous membrane.

1. Serosa (perimetry) It is a direct continuation of the serous covering of the bladder. Over a large area of ​​the anterior and posterior surfaces and fundus of the uterus, it is tightly fused with the myometrium; At the border of the isthmus, the peritoneal cover is attached loosely.
2. Muscular membrane (myometrium) the most powerful layer of the uterine wall, consists of three layers of smooth muscle fibers with an admixture of fibrous connective tissue and elastic fibers. All three layers are intertwined with their muscle fibers in a variety of directions, due to which the division into layers is not well defined. The thin outer layer (subserosal) with longitudinally arranged fibers and a small amount of circular ones, as was said, is tightly fused with the serous cover. The middle layer is circular, the most developed. It consists of rings located in the area of ​​the tube angles perpendicular to their axis, in the area of ​​the uterine body in a circular and oblique direction. This layer contains a large number of vessels, mainly venous, which is why it is also called the vascular layer. The inner layer (submucosal) is the thinnest, with longitudinally running fibers. The muscles of the uterus are elastic, which allows it to stretch throughout the entire pregnancy, and at the same time very strong - this is necessary for pushing the formed fetus through the birth canal.
3. Mucosa (endometrium), merging with the muscular layer, lining its cavity without a submucosal layer. In the area of ​​the uterine openings of the tubes, it passes into their mucous membrane; in the area of ​​the bottom and body, it has a smooth surface. On the anterior and posterior walls of the cervical canal, the mucous membrane forms longitudinally running palm-shaped folds.

So: what size is the normal uterus?
The length of the uterus in a nulliparous woman is 7-8 cm, in a woman who has given birth - 8-9.5 cm, width at the bottom level is 4-5.5 cm; weight ranges from 30 to 100g. The permissible deviation in measurements during ultrasound scanning is no more than 3 mm in length, 6 mm in width. The deviation of the anteroposterior size is no more than 2 mm.

Table 1. "Normal uterine size"

The small size of the uterus (hypoplasia) is considered a developmental disorder of this pelvic organ. Because of this, deviations in the functioning of the uterus occur. Hypoplasia can at least cause various menstrual cycle disorders (cycle disruptions, pain critical days etc.), in the worst cases - lead to infertility, spontaneous miscarriages, up to complete inability to bear a fetus.

The most common cause of uterine enlargement is pregnancy. It is also worth considering that with age, the size of the uterus also becomes larger. If the process of change is observed within acceptable limits, then this is normal, but in most cases in a woman this is a sign of a pathological process.

During pregnancy, the parameters of this organ undergo significant changes. On average, the height of the upper part of the uterus (the so-called “fundament”) corresponds to the obstetric week, that is, approximately comparable to the gestational age; differences in size are possible by 1-3 cm (see table of values ​​below). Any significant deviation in the size of the pregnant uterus from the norm becomes the reason for additional studies, ultrasound, and determination of the state of amniotic fluid.

Table 2. "Uterine size by week of pregnancy"

WHAT IS USEFUL FOR THE UTERUS, ITS TREATMENT AND RESTORATION

Women who have had acute or chronic processes endometrium, abortion, gynecological surgery, require measures to restore the uterine mucosa, treatment and maintenance hormonal function ovaries. This justified need may be caused by the following unfavorable factors:

1. Functional failure in the production of hormones by the pituitary gland, ovaries and hypothalamus. This usually occurs after ovarian surgery, surgical or mini-abortion, and to a lesser extent after medical abortion.
2. Mechanical damage endometrium or cervix. Trauma to the mucous membrane in the uterine cavity leads to the formation of intrauterine synechiae and adhesions in the pelvis.

The course of treatment of the uterus to restore its normal functioning after gynecological operations and any abortions includes a set of measures aimed at preventing complications and their long-term consequences. At the following link you can find out what procedures our clinic offers for the rehabilitation of women’s health after peri- and intrauterine interventions that are beneficial for the uterus.

Find out about the good prophylactic- how to restore the health of the uterus, strengthen and support the female reproductive system as a whole, without taking medications and hormones:
"MASSAGE OF THE UTERUS AND OVARIES"

HOW TO CURE THE UTERUS

The clinic offers a program early diagnosis uterine pathology and various sets of tests. The choice of one method or another is made based on the identified cause, the degree of neglect of the process, the age of the patient and the presence of contraindications. This individual approach makes it possible to cure the uterus and restore its reproductive function.

It is well known that the prevention or treatment of a disease identified on early stage, always more efficient. If you want to undergo an examination, take tests, do an ultrasound, make an appointment with a doctor, call our helpline and ask your questions. Qualified specialists will help you solve many problems that concern you.

Today the clinic is hosting:

The information under the picture above is intended for those who want to learn how to improve the work of restoring the uterus and preparing the endometrium for conception and pregnancy.

Severance of the uterus from the vaginal vault is a type of uterine rupture. It was first described by the domestic author F. G. Gutenberg (1875).

Uterine rupture most often occurs in the lower segment of the uterus, either along the anterior or posterior wall. Much less frequently, another form of separation of the uterus from the vaginal vaults is observed - not within the lower segment, but slightly below it, at the level of the vaginal vaults.

Rupture of the vaginal vault threatens a woman’s life due to the possibility of fatal bleeding or infection of the wound.

Usually, the separation of the vaults occurs in the thinnest place of the vagina, near the cervix. Severance of the vagina creates a gaping wound through which intestinal loops, omentum, mesentery and other organs can fall out. Fortunately, this complication is very rare.

Vault ruptures can be spontaneous or violent. In case of violent breaks, there is always a rough, excessive use of physical force during obstetric surgery, be it tamponation, metreiriz, obstetric turn, manual release placenta, application of forceps. In spontaneous ruptures, the main role is played by pathological changes tissues of the vaginal vaults due to trauma during previous childbirth, inflammatory and degenerative processes associated mostly with childbirth, in some cases occurring independently of the latter.

Changes in the tissues of the vaults are reduced to hyaline degeneration, sclerosis, depletion of muscle and elastic fibers due to the development of connective tissue, edema, extravasation and the development of venous vessels.

The microscopic picture of the tissue taken from the site of the vault rupture, according to Poroshin, is as follows: “Immediately under the peritoneum, there is an enormous development of blood vessels: the walls of the arteries appear very thick, and the veins are thin, and the latter are very stretched, which gives the tissues a cavernous appearance. Muscle tissue almost invisible; instead, bundles of connective tissue fibers rich in old spindle-shaped cells predominate; in some places the clusters of fibers are separated by hemorrhages and are penetrated by a huge number of round cells; elastic tissue is not visible in these places; traces of it are found only in the walls of the arteries, and the fibers appear short, knotty with irregular thickenings at the ends.” The consequences of this are:
1) thinning of the arches due to their stretching;
2) scarring of tissue in places of abrasions, cracks and tears;
3) colpitis, paracolpitis, parametritis, etc.

Under these conditions, prolonged labor or excessive force used in cases of operative delivery causes overstretching of the altered tissue and its rupture. Considering these changes, we must not forget that the predisposing causes of ruptures are a narrow pelvis, tumors of the uterus, cervix and tumors in the pelvis.

The mechanism of separation of the vaginal vault from the uterus can be presented as follows. The fully opened neck (pharynx) has gone up behind the head, it can no longer be pinched between the head and the walls of the pelvis. The uterus, continuously contracting, pulls the vaults, which are connected to the pelvic floor and cannot freely follow the movement of the lower segment of the uterus. There comes a moment when the tension reaches highest limit and tissues tear (especially if they are morphologically inferior). Most often, the posterior fornix is ​​torn off, the walls of which are much thinner and more strengthened by the uterosacral ligaments.

Severances of the vaginal vaults are more common in multiparous women, since in them the elastic tissue in the area of ​​​​the junction of the cervix and vaults is gradually replaced by connective tissue.

The type of wounds with colpoporrhexis varies depending on the underlying causes. In the presence of prolonged pressure, the edges of the rupture appear cut, crushed and dead over a greater or lesser extent; in cases resulting from obstetric surgery, the edges are clean and smooth. The direction of spontaneous ruptures of the arches is always transverse, while violent ones are longitudinal, and the neck is often damaged.

Recognizing “non-penetrating” vault ruptures is not difficult, but “penetrating” ones can easily be confused with uterine rupture, since their signs are very similar, especially if the fetus (or part of it) has entered the abdominal cavity.

The rupture of the vault is usually preceded by an unusually strong labor activity, which quickly gives way to a complete cessation of contractions; there is a clearly defined contraction ring; Blood flows from the genital parts. Many authors point out that patients do not notice the rupture of the vaults, while they feel the rupture of the uterus quite clearly. The patient's pulse quickens; vomiting appears due to irritation of the peritoneum, and often hiccups.

The choice of surgical intervention is made depending on the nature of the rupture.

Only with minor (non-penetrating) ruptures is there no need for surgery. For penetrating ruptures, the choice of benefit is dictated by the characteristics of the case. Both vaginal and abdominal wall methods are appropriate here. When there is an increasing danger to a woman’s life, transsection is more appropriate.

Transsection should be started immediately upon detection of a rupture, which is usually determined after childbirth. If the rupture is detected before childbirth, the woman should be delivered quickly. As for the manipulations themselves during transection, they should be adjusted to the degree of separation and the condition of the tissue. In some cases, suturing the gap is applicable, in others - complete removal uterus using in some cases drainage (presence of infection).

Prevention should be aimed at eliminating the causes predisposing to severe stretching of the arches and their separation. Hence, any attempt to correct the neglected transverse position of the fetus (even a living one) should not take place, just as surgical aids should not be abused in cases of obvious discrepancy between the sizes of the head and pelvis.

The cervix is ​​a hollow smooth muscle formation that connects the uterus and vagina. The length of the entire cervix is ​​approximately 3 cm.

At the site of attachment of the vaginal vault, the cervix is ​​divided into two parts:

• supravaginal (located in the abdominal cavity)
• and vaginal (available for inspection in speculums)

If you insert a suppository into the vagina, you can use your finger to reach the vaginal part of the cervix. As you advance the suppository into the vagina, you place it posterior to the cervix, as your doctor recommends. That is, you place the candle in the posterior vaginal fornix (and there are 4 of them in total: anterior, posterior and two lateral). This vault is a partition between the vagina and abdominal cavity, and if you run your finger around the neck, you will find all the arches. They are the same in depth, unless you have inflammation in the pelvis.

In the center of the cervix there is a canal called the cervical canal (from Latin word cervix - neck, relating to the neck). This canal opens into the uterine cavity with its internal part, and with its external part it opens into the vagina.

The place where the canal opens into the cavity is called the pharynx (internal or external, respectively).

We do not see the internal os in mirrors.

External os of the cervix
in a nulliparous woman

External os of the cervix
in a woman who has given birth

When examined, the external pharynx has different shape: round (in women who have not given birth and who have not had abortions) or slit-like. The slit-like shape of the external pharynx is formed during small (or not very small) ruptures of the cervix, which are observed during childbirth or during medical abortion.

• around the external os of the cervix is ​​called the exocervix or the mucous membrane of the vaginal part of the cervix
• inside the cervical canal is called the endocervix or cervical mucosa

These two areas are of interest to the colposcopist.

So, we have two areas for study: external and internal - exocervix and endocervix. You have already decided where they are located. Now let's determine how they are structured, i.e. Let's consider their structure, structure.

Exocervix– covered with stratified squamous epithelium.

In the multilayered squamous epithelium of the exocervix, there are 4 layers of cells (that’s why it is called multilayered): basal, parabasal, intermediate and superficial.

• I - basal layer (lowest). The cells of the basal layer lie on a basement membrane formed by stromal elements. The membrane contains specific protein receptors that are sensitive to the concentration of sex hormones in the blood, under the influence of which changes occur in all layers of the epithelium.
• II - parabasal layer. The cells of this layer have high mitotic activity and ensure the growth and regeneration of multilayered squamous epithelium, participate in its differentiation and maturation.
• III - intermediate layer. It contains cells, so to speak, that are in “adolescence”, but are already preparing for “old age”.
• IV - surface layer. The cells of this layer are the “oldest”, most mature, “grandmothers and grandfathers”, which will soon have to retire, which consists in the exfoliation of these cells into the vaginal secretion with their subsequent removal from the body, which occurs as much as possible during menstruation.

  Superficial cells predominate in smears from the cervix in phase I of the menstrual cycle, their maximum number is observed during ovulation, in phase II the upper rows desquamate on their own.

  Cells, like you and me, are born, live and die. In the course of their lives, they must eat, just like you and me. This nutrition is provided to them by the vessels circulatory system that deliver nutrients to the cells. Vessels from the muscular layer pass through the stroma along all cell layers and end with terminal loops of capillaries on the neck.

Endocervix– covered with cylindrical epithelium, which consists of (imagine cylinders placed next to each other vertically and these cylinders are all of different sizes) cracks and depressions, which are called cervical glands (pseudoglands). And the glands must produce something. So they produce mucus, which fills the cervical canal, and which in different phases of the menstrual cycle is either very liquid or very thick and viscous.

The state of mucus (its quality and physicochemical characteristics) also depends on sex hormones produced by the ovary. Mucus plays an important role in fertilization and is a barrier to infection. Remember, the instructions for hormonal contraceptives say that they “promote thickening of cervical mucus, which prevents the penetration of sperm from the vagina into the uterine cavity.” In the same way, mucus partially prevents the penetration of infection.

Before menstruation, this mucus leaves the cervical canal, opening a passage for menstrual blood, on the one hand, and on the other hand, it opens a passage for any microorganisms that can penetrate the uterine cavity, which has a huge bleeding surface during menstruation. Therefore, it is advisable to completely avoid sexual intercourse during menstruation.

Reserve cells are located under the columnar epithelium. They also “sit” on the basement membrane, like the basal cells of stratified squamous epithelium.

Reserve cells ensure the process of regeneration of columnar epithelium (that is, they can turn into columnar epithelial cells) and, under the influence of hormonal changes or inflammation, can turn into squamous epithelial cells. These reserve cells are so cunning. Remember this moment.

So, we figured it out: exocervix - endocervix; stratified squamous epithelium - columnar epithelium. Well, somewhere they must touch. That is, there must be a border - the junction of these epithelia. And there is such a place. This is the external os.

In the area of ​​the external pharynx, the stratified squamous epithelium and columnar epithelium are in contact with each other. And this place is called the transition zone. Well, it’s clear why: because one epithelium passes into another.

This transition zone is also called the zone of transformation of reserve cells: in one direction into columnar epithelium, in the other into multilayered squamous epithelium. This area is where cancer is most often located.

When the transition zone is located in the area of ​​the external pharynx, this is an ideal option. But you understand that nothing is ideal in the world. So it is here. Under the influence of various factors, the transition zone moves either inward from the external pharynx or outward from it. The age of a woman and the state of her reproductive system plays an important role here.

In young women this zone is located outward, and in older and older women it is located inward (inside the cervical canal).

And if this zone is located outward, then we see it and can easily get a scraping from it for cytology, but if it is located inward, then getting a scraping from it is much more difficult, and in order not to miss the degeneration of cells in this zone, where cancer is most often localized, and all those brushes and spatulas that are mentioned are needed