Courtesy by Prof. Dr.

Amir Gilani

THE UTERUS
Syeda Khadija
PhD*, MSDU(Ultrasound)
Assistant Professor Department (UIRSMIT) FAHS
University of Lahore www.uol.edu.pk
E-mail:syyedakhadija55@gmail.com
Courtesy by Prof. Dr. Amir Gilani

Growth
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Uterine Ratios Change With Age

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Uterine Ratios Change With Age

2/3

1/2
Int os 1/3

2/3 1/2 1/3

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Neonatal Uterus
• Neonatal uterus is prominent and measures
3.5 cm in length
• Cervix is dominant and fundus:cervix
length ratio is 1:2
• Has a bright endometrial lining
 Courtesy by Prof. Dr. Amir Gilani

Neonatal Uterus
• Neonatal uterus is prominent and measures
3.5 cm in length
• Cervix is dominant then fundus
cervix length ratio is 1:2
• Has a bright endometrial lining
Courtesy by Prof. Dr. Amir Gilani

Infant Uterus
• By 3 months uterus regresses, becomes
tubular
• Length is 2.5 – 3cm, fundus:cervix ratio 1:1
• Endometrial echoes not visible
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Prepubertal Uterus
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Pubertal Uterus
• Length increases to 5-7cm
• Adult shape, fundus to cervix ratio is 2:1
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Adult Uterus
• 8 (L) x 4 (W) x 5 (D) cm, multiparity
increases all measurements by 1 cm
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Adult Uterus
• 8 (L) x 4 (W) x 5 (D) cm, multiparity
increases all measurements by 1 cm
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Menopausal Uterus
• Atrophy, the corpus atrophies more than the
cervix
• 3.5 – 6.5 cm (L) x 1.2 – 1.8cm (D)
• Endometrium becomes thin (< 8mm)
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Uterus

• Neonatal 3.5 cm
• Infant 2.5 – 3.0 cm
• 2 – 7 years 3.3 – 4.0 cm
• 10 years 4.0 – 5.2 cm
• 13 years 5.4 – 7.6 cm
• Nullparous adult 8.0 – 9.0 cm
• Multiparous adult 11.0 - 12.0 cm
• Post menopausal 5.0 – 12.0 cm
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Examining the Uterus

• Trans-abdominally
• Trans-vaginally
• Trans-perinially
• Trans-rectally
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Things to See ?????

• Size, shape and position
• Myometrium
• Endometrium
• Vascular structures
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How to measure ???

• Take two measurements in sagittal plane
and one measurement in transverse plane
• Longitudinal plane = L X W
• Transverse plane= D
Sagittal plane
Sagittal plane
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Transverse plane
Transverse plane
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Common Uterine Position

• Anteverted and anteflexed
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Common Uterine Position

• Anteverted and anteflexed

Version is the angle between the cervix and

the vagina. Flexion is the angle between the
cervix and the body of the uterus. Seen
trans-abdominally with an
empty bladder.
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Anteverted, Anteflexed Uterus

Flexion
Version
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Anteverted, Retroflexed
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Uterine Positions
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Uterine Shapes

Straight uterus

Cochleate
Anteverted uterus
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Retroverted
uterus
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Myometrium
Three layers of myometrium recognizable on
US
• Inner hypoechoic zone, subendometrial halo
• Intermediate myometrial layer
• Subserosal layer (variable echogenicity)
• Arcuate vessels run
between intermediate
and subserosal layers
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Subendometrial Halo
(Retroverted Uterus)
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Subserosal Layer
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Subserosal Layer

Subserosal
layer

Halo
Endometrium
Arcuate vessels © Latha Nataranjan, Bangalore