Course

The uterine artery (Fig. 32.1) arises from the internal iliac artery and travels caudally and anteriorly to reach the uterus a little above the uterine cervical junction.

Fig. 32.1 Uterine artery.

It ascends the border of the uterus, where its branches anastomose with the ovarian artery. The twists and turns of the uterine vessels allow them to adapt to manifold uterine movements.

Keep in mind the following:

Collaterals

Among the numerous arterioles arising from the uterine artery, we cite branches for the:

Terminal branches

Near the cephalad part of the uterus, the uterine artery anastomoses with the ovarian artery, which descends from the abdominal aorta.

Position

A bilateral technique, the patient is in either left or right lateral decubitus, legs slightly flexed. Position yourself behind the patient (Fig. 32.2).

Fig. 32.2 Manipulation of the uterine artery in lateral decubitus.

Technique

Glide the fingers of both hands along the iliac fascia in the direction of the pubic symphysis. Try to sink as deeply and posteriorly as possible before gliding in the direction of the symphysis.

Once you feel the body of the uterus, first stretch it cephalad and then medially. The uterine arteries run along a cephalocaudal longitudinal main axis, but also divide into innumerable arterioles that run perpendicular to its main axis. To stretch the small ramifications, glide the uterus bilaterally. Repeat on the other side.

Position

The patient has a soft pillow under the lumbar region, with both hands resting on the belly, legs flexed (see Fig. 32.3). Position yourself to the side of the patient, with your hands against the medial aspect of the iliac bone.

Fig. 32.3 Manipulation of the uterine artery in decubitus.

Technique

Following the same principle as in decubitus, endeavor to go posterior first, then medially and finally caudad.

Surround the vesicouterine unit with both hands and draw it cephalad several times. Maintain the traction for about 20 s and follow the Listening with induction.

Some patients feel an immediate benefit from this manipulation. ‘It is as if a weight has been lifted from my belly,’ they tell us.