The normal endometrium
T. Yee Khong, Annie N. Y. Cheung, Wenxin Zheng, Richard Wing-Cheuk Wong, Hao Chen in Diagnostic Endometrial Pathology, 2019
The uterine artery reaches the uterus at the level of the upper cervix where the ascending branch runs lateral to the uterus and a descending branch anastomoses with the vaginal artery. The ascending branch of the uterine artery anastomoses with branches of the ovarian artery at the lateral upper part of the uterus below the isthmic part of the fallopian tube. These paired uterine arteries that run lateral to the uterus, with anastomotic contributions from the ovarian arteries, supply the uterus predominantly. Branches from this utero-ovarian anastomosis penetrate the serosa and form a circular arcuate system in the outer myometrium. Arteries from the arcuate arterial system radiate into the inner myometrium. These radial arteries terminate, just proximal to the junction of the endometrium and myometrium as the basal arteries and the spiral arteries. The basal or straight arteries ramify in the innermost layers of the myometrium and terminate in the basal endometrium, which they supply. The spiral or coiled arteries, that are destined to become the uteroplacental arteries during pregnancy, traverse the endometrium in their course towards the uterine lumen. The spiral arteries give off anastomosing branches to the glands and stroma of the functional layer, and they terminate in a complex anastomotic network in the superficial layer of the endometrium (Figure 2.12). The venous drainage from the endometrium, in general, follows the arterial supply. The human endometrium also contains lymphatic vessels that are predominantly seen in the basal layer but sometimes also in the functional layer.
Specific Management of PPH
Gowri Dorairajan in Management of Normal and High Risk Labour During Childbirth, 2022
Uterine artery ligature: It is done at the level of the internal os at the lateral wall of the uterus. The uterine vessels start ascending at that level. A deep bite, including the lower lateral wall to occlude the uterine artery, is the safest and quickest procedure. One need not necessarily skeletonise the uterine artery to ligate it. Either absorbable sutures like catgut or delayed absorbable polyglactin are used for uterine artery ligation. The uterine branch of the ovarian artery is ligated at the cornual end below the fallopian tube, with a suture passed to include a part of the adjoining uterine wall. This O’Leary ligature occludes the uterine branch coming down from the ovarian vessels via the mesosalpinx.
The development and anatomy of the female sexual organs and pelvis
Helen Bickerstaff, Louise C Kenny in Gynaecology, 2017
Because the ovary develops on the posterior abdominal wall and later migrates down into the pelvis, it carries its blood supply with it directly from the abdominal aorta. The ovarian artery arises from the aorta just below the renal artery and runs downwards on the surface of the psoas muscle to the pelvic brim, where it crosses in front of the ureter and then passes into the infundibulopelvic fold of the broad ligament. The artery divides into branches that supply the ovary and tube and then run on to reach the uterus, where they anastamose with the terminal branches of the uterine artery.
Angiography and transcatheter arterial embolization for non-variceal gastrointestinal bleeding
Published in Scandinavian Journal of Gastroenterology, 2020
Hai-Yang Lai, Ke-Tong Wu, Yang Liu, Zhao-Fei Zeng, Bo Zhang
With the patient in the supine position, celiac trunk, superior mesenteric, inferior mesenteric, and internal iliac angiography were performed with standard percutaneous transfemoral catheterization using 5 Fr RH (Cook Medical, Bloomington, IN) or Cobra (Terumo, Tokyo, Japan) catheters under local infiltration anesthesia or sedation. Selective angiography was performed in the branches depending on what was known about the localization of the bleeding. For one special case, angiography for an ovarian artery was also performed. Once the causative arteries were confirmed, then superselective catheterization was usually performed as close to the bleeding site as possible using a 2.7 Fr microcatheter (Progreat, Terumo, Tokyo, Japan) or 2.6 Fr microcatheter (ASAHI Corsair), which is inserted coaxially through the macrocatheter.
The reproductive endocrine feature and conception outcome of women with unknown etiological menstrual cycle (36–45 days) with long follicular phase
Published in Gynecological Endocrinology, 2022
Zhewei Wang, Jiongjiong Yan, Huifen Chen, Laman He, Shaohua Xu
Under normal circumstances, the estrogen level synthesized by the ovary increases with follicular development in the follicular stage. Meanwhile, the blood flow of ovarian artery in the diastolic phase increases gradually and RI decreases. Follicular size and blood perfusion reflect the serum estrogen level [18,19]. Insufficient perfusion of ovarian blood flow on the ovulation side during ovulation may be related to LUFS [20,21]. Generally, only one ovary ovulates in the menstruation cycle, and the level of local estrogen on its side gradually increases but the ovarian artery’s RI decreases and statistically lower than that of the opposite side on ovulation. However, this does not occur in women with follicular dysplasia [22]. Our study found that the rate of ‘RI of the ovarian artery on ovulation side greater than that of the opposite side’ on the day when B-ultrasound indicated the follicle was mature in the LMC group was higher. This result supported another conclusion that these women had higher risk of poor ovulation quality. From the view of theoretical base of TCM, follicle quality and ovarian blood perfusion may interact as both the cause and effect [23]. That is to say, insufficient ovarian blood flow would further hamper the development of follicles. In the study, the outcome of 3 participants who received TCM later indicated one possible solution to long follicular phases, which invites further study.
Laparoscopic surgeries for uterine fibroids and ovarian cysts reduce ovarian reserve via age- and surgical type-manner
Published in Gynecological Endocrinology, 2022
Xiaolong Shi, Shuo Chen, Yunling Yang, Limin Liu, Linlin Huang
The influence of hysterectomy in ovarian reserve is contradicted. A prospective study showed that both laparoscopic and non-laparoscopic hysterectomy caused permanent serum AMH reduction [22], whereas other studies showed no significant difference in ovarian reserve in 2-3 months after laparoscopic hysterectomy or myomectomy [23,24]. Fluctuation of ovarian artery by hysterectomy was considered as the cause of serum AMH reduction [24,25]. However, Abdelazim et al. showed no significant difference in the ovary volume and ovarian-related hormone content between pre- and post-hysterectomy [26]. Accordingly, the reduction of serum AMH concentration after hysterectomy might be also transient. Considering that patients received hysterectomy had higher healthy-related quality of life than those received myomectomy [27], hysterectomy is more recommended than myomectomy if the patient has no plan to get pregnancy.
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