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Am J Obstet Gynecol. 2019 Dec 2. pii: S0002-9378(19)32682-1. doi: 10.1016/j.ajog.2019.11.1262. [Epub ahead of print]

Standardized Terminology of Apical Structures in the Female Pelvis Based on a Structured Medical Literature Review.

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University of Texas Southwestern Medical Center, Dallas, TX. Electronic address:
University of New Mexico, Albuquerque, NM.
University of South Carolina School of Medicine, Greenville.
University of Utah, Salt Lake City, UT.
Stanford University, Palo Alto, CA.
Holy Cross Hospital, Silver Springs, MD.
Boston University School of Medicine, Boston, MA.
Cooper Medical School of Rowan University, Camden, NJ.
Northwestern, Chicago, IL.
Center for Evidence Synthesis in Health, Brown University School of Public Health, Providence, Rhode Island.
University of Michigan Department of Obstetrics and Gynecology, Ann Arbor, Michigan.
University of Texas Southwestern Medical Center, Dallas, TX.



To review the published literature and selected textbooks, compare existing usage to Terminologia Anatomica, and compile standardized anatomic nomenclature for the apical structures of the female pelvis.


MEDLINE was searched from inception until May 30, 2017 based on 33 search terms generated by group consensus. Resulting abstracts were screened by eleven reviewers to identify pertinent studies reporting on apical female pelvic anatomy. Following additional focused screening for rarer terms and selective representative random sampling of the literature for common terms, accepted full text manuscripts and relevant textbook chapters were extracted for anatomic terms related to apical structures.


From an initial total of 55,448 abstracts, 193 eligible studies were identified for extraction, to which 14 chapters from 9 textbooks were added. In all, 293 separate structural terms were identified of which 184 had Terminologia Anatomica accepted terms. Inclusion of several widely-used regional terms (vaginal apex, adnexa, cervico-vaginal junction, uretero-vesical junction, and apical segment), structural terms (vesicouterine ligament, paracolpium, mesoteres, mesoureter, ovarian venous plexus, and artery to the round ligament) and spaces (vesicocervical, vesicovaginal, and presacral) not included in Terminologia Anatomica is proposed. Further, two controversial terms (lower uterine segment and supravaginal septum) were identified that require additional research to support or refute continued use in medical communication.


This study confirms and identifies inconsistencies and gaps in the nomenclature of apical structures of the female pelvis. Standardized terminology should be used when describing apical female pelvic structures to facilitate communication and promote consistency among multiple academic, clinical, and surgical disciplines.


Apex support; Apical compartment; Apical segment; Female pelvic anatomy; Gynecology; Nomenclature; Terminology

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