Relations

• Anteriorly — the base of the bladder and the urethra (which is embedded in the anterior vaginal wall).

•◊◊Posteriorly — from below upwards, the anal canal (separated by the

Peritoneum

Sacral promontory

Bladder

Symphysis pubis

Ovary and tube

Urethra

Peritoneum

Sacral promontory

Bladder

Symphysis pubis

Ovary and tube

Urethra

Uterus Relations

Rectum Vagina

Uterus

Fig. 101 Sagittal section of the uterus and its relations.

perineal body), the rectum and then the peritoneum of the pouch of Douglas which covers the upper quarter of the posterior vaginal wall.

• Laterally — levator ani, pelvic fascia and the ureters, which lie immediately above the lateral fornices.

The amateur abortionist (or inexperienced gynaecologist) without a knowledge of anatomy fails to realize that the uterus passes upwards and forwards from the vagina; he pushes the instrument or IUCD (intra-uterine contraceptive device), which he intends to enter the cervix, directly backwards through the posterior fornix. To make matters worse, this is the only part of the vagina which is intraperitoneal; the peritoneal cavity is thus entered and peritonitis follows.

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