long the pelvic sidewall, each ovary usually rests in the ovarian fossa ofWaldeyer, which is a slight depression between the external and internal iliac vessels. During childbearing years, ovaries variably measure 2.5 to 5 cm in length, 1.5 to 3 cm in width, and 0.6 to 1.5 cm in thickness.
he ovarian ligament, also called the uteroovarian ligament, originates from the upper posterolateral portion of the uterus, just beneath the tubal insertion level, and extends to the uterine pole of the ovary (see Fig. 2-10). Measuring a few centimeters long and 3 to 4 mm in diameter, this ligament is made up of muscle and connective tissue and is covered by peritoneum-the mesovarium. Blood supply reaches the ovary through this double-layered mesovarium to enter the ovarian hilum.
The ovary consists of an outer cortex and inner medulla. In young women, the cortex is smooth, has a dull white surface, and is lined by single layer of cuboidal epithelium, the germinal epithelium ofWaldeyer. his epithelium is supported by a connective tissue condensation, the tunica albuginea. Beneath this, the ovarian cortex contains oocytes and developing follicles. The medulla is composed of loose connective tissue, numerous arteries and veins, and a small amount of smooth muscle ibers.
The ovaries are supplied with both sympathetic and parasympathetic nerves. he sympathetic nerves are derived primarily from the ovarian plexus that accompanies the ovarian vessels and originates in the renal plexus. Others are derived from the plexus that surrounds the ovarian branch of the uterine artery. Parasympathetic input is from the vagus nerve. Sensory aferents follow the ovarian artery and enter at T]o spinal cord level.
Also called oviducts, these serpentine tubes extend laterlly 8 to 14 cm from the uterine cornua. hey are anatomically classified along their length s an interstitial portion, isthmus, ampulla, and inundibulum (Fig. 2-14). vIost proximal, the interstitial portion is embodied within the uterine muscular wall. Next, the narrow 2-to 3-mm wide isthmus widens gradually into the 5-to 8-mm wide ampulla. Last, the inundibulum is the unnel-shaped fimbriated distal extremity of the tube, which opens into the abdominal cavity. These latter three extrauterine portions are covered by the mesosalpinx at the superior margin of the broad ligament.
In cross section, the extrauterine fallopian tube contains a mesosalpinx, myosalpinx, and endosalpinx. he outer of these, the mesosalpinx, is a single-cell mesothelial layer unctioning as visceral peritoneum. In the myosalpinx, smooth muscle is arranged in an inner circular and an outer longitudinal layer. The tubal musculature undergoes rhythmic contractions constantly, the rate of which varies with cyclical ovarian hormonal changes.
The tubal mucosa or endosalpinx is a single layer of columnar epithelium composed of ciliated, secretory, and intercalary cells resting on a sparse lamina propria. Clinically, its close proximity to the underlying myosalpinx contributes to easy invasion by ectopic trophoblast. The tubal mucosa is arranged in longitudinal folds that become progressively more complex toward the fimbria. In the ampulla, the lumen is occupied almost completely by the arborescent mucosa. The current produced by the tubal cilia is such that the direction of flow is toward the uterine cavity. Tubal peristalsis created by cilia and muscular layer contraction is believed to be an important factor in ovum transport (Croxatto, 2002).