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TABLE 11-6 ■ Abnormalities and Positions of the Uterus

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position

Vascularity Image Ovary Nodule
Myomas

Myomas of the Uterus (Fibroids)

Myomas are very common benign uterine tumors. They may be single or multiple and vary greatly in size, occasionally reaching massive proportions. They feel like firm, irregular nodules in continuity with the uterine surface. Occasionally, a myoma projecting laterally can be confused with an ovarian mass; a nodule projecting posteriorly can be mistaken for a retroflexed uterus. Submucous myomas project toward the endometrial cavity and are not themselves palpable, although they may be suspected because of an enlarged uterus.

position

Prolapse of the Uterus

Prolapse of the uterus results from weakness of the supporting structures of the pelvic floor, and is often associated with a cystocele and rectocele. In progressive stages, the uterus becomes retroverted and descends down the vaginal canal to the outside. In first-degree prolapse, the cervix is still well within the vagina. In second-degree prolapse, it is at the introitus. In third-degree prolapse (procidentia), the cervix and vagina are outside the introitus.

Palpable through rectum

Normal angle maintained

Cervix faces forward

Body of the uterus may not be palpable

Body of the uterus may not be palpable

Palpable through rectum

Normal angle maintained

Cervix faces forward

Angled back

May be palpable through rectum

Matriz Retroversoflexion

Angled back

May be palpable through rectum

Retroversion of the Uterus

Retroversion of the uterus refers to a tilting backward of the entire uterus, including both body and cervix. It is a common variant occurring in about 1 out of 5 women. Early clues on pelvic examination are a cervix that faces forward and a uterine body that cannot be felt by the abdominal hand. In moderate retroversion, shown on the left, the body may not be palpable with either hand. In marked retroversion, shown on the right, the body can be felt posteriorly, either through the posterior fornix or through the rectum. A retroverted uterus is usually both mobile and asymptomatic. Occasionally, such a uterus is fixed and immobile, held in place by conditions such as endometriosis or pelvic inflammatory disease.

Retroflexion of the Uterus

Retroflexion of the uterus refers to a backward angulation of the body of the uterus in relation to the cervix. The cervix maintains its usual position. The body of the uterus is often palpable through the posterior fornix or through the rectum.

Both retroversion and retroflexion are usually normal variants.

TABLE 11-7 ■ Adnexal Masses

Adnexal masses most commonly result from disorders of the fallopian tubes or ovaries. Three examples—often hard to differentiate—are described. In addition, inflammatory disease of the bowel (such as diverticulitis), carcinoma of the colon, and a pedunculated myoma of the uterus may simulate an adnexal mass.

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