The Uterine And Cervical Ligaments

Original Editor - Khloud Shreif

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Description[edit | edit source]

Uterus and nearby organs.jpeg

The structures of the internal genitalia/ female reproductive system is supported by the pelvic floor musculature, pelvic fascia, and ligaments on both sides of the uterus. These ligaments divided into, uterine ligaments that are soft and lax, having a limited role in supporting the uterus and internal genitalia, unlike the cervical ligaments which are tough, non-extensible, and condensed thickening of pelvic tissue.

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Uterine Ligaments[edit | edit source]

Broad Ligament

Description: The broad ligament is a double flat peritoneum sheet. Its upper outer border form a ligament where ovarian vessels pass. It contains the round ligament, the fallopian tube, arteries, veins, lymphatics, nerve fibers, loose connective tissue, and remnants of Wolffian duct.

Attachments: It extends from the uterus and fans out to the lateral pelvic wall.

Function: The broad has three subdivisions, all three subdivisions help to maintain the uterus in its place in the pelvis, but it is not the main support.

  1. Mesometrium: the largest part of the ligaments surround the uterus.
  2. Mesovarium: projects from the posterior surface of the broad ligament and enclose the ovary vascular supply not covering the ovary itself.
  3. Mesosalpinx: traps the fallopian tube and originates from the mesovarium[1].

Clinical Relevance: Gartner's cyst, it develops in response to the dilatation of Wolffian duct, persists in the anterolateral wall of the vagina. Need surgical intervention only in patients with severe symptoms or if it causes obstetrical complications[2][3].

Assessment: For investigation, urinary tract ultrasound or magnetic resonance image MRI. For confirmation, vaginal diagnostic ultrasound will be one.

Round Ligament

Round Ligament

Description: A fibromuscular band of connective tissue, runs forward and downward between the two sheets of the broad ligament. It runs down deep in the inguinal canal to enter the labia majora [4]. It is about 10-12 cm in length.

Attachment: It attaches proximally at the superior and lateral side of the uterus at the cornu, its fiber blend with that of the labia majora and mons pubis and inserts at mons pubis below the skin.

Function: It pulls the uterus forward, helping to maintain the uterus anteverted.

Clinical Relevance:

  • Endometriosis may extend to involve the round ligament, and in severe cases, the surgical approach is the choice if conservative treatment fails
  • Round ligament pain, during the second trimester of pregnancy, due to the physiological changes the round ligament is stretched and may cause pain, and cramping this pain usually disappears after a period of rest. After postpartum recovery, it may cause pain again
  • Round Ligament Varices (RLV) are conditions where veins become tortuous during pregnancy.[5]

Assessment: Magnetic resonance image is the choice for the diagnosis of the round ligament.

Ovarian Ligament

Description: It is a short fibromuscular structure that lies with the broad ligament,

Attachment: It attaches the ovary to the posterolateral aspect of the uterus

Function: It connects the ovary with the uterus at the cornu.

Cervical Ligaments[edit | edit source]

Ligaments of the cervix, connect the lateral side of the cervix and vagina to the lat pelvic wall and provide support to the uterus and vagina.

Cardinal Ligaments/ Mackenrodt’s Ligaments

Description: It is one of the most important ligaments in supporting the pelvic organs, it is described as transverse cervical ligament.

Cervical ligaments

Attachment: It attaches from the lateral side of the cervix and vagina to the lateral pelvic wall.

Function: This ligament with uterosacral ligament and other pelvic musculature collaborate to support the pelvic organs and prevent prolapse.

Clinical Relevance

  • During hysterectomy due to cervical cancer, the cardinal ligaments are involved and they may be removed as they are a common site for cancerous cells to ensure the disease is free.
  • Ureter and uterine vessels are related and near to the cardinal/ Mackenrodt’s ligaments and may be injured during surgeries if the ligaments are manipulated[6].

Uterosacral Ligaments

Description: Known as Sacro-cervical ligaments or recto-uterine ligaments

Attachment: They extend from the posterior aspect of the cervix and vagina and directed backward to surround the rectum and insert in the base of the third sacral vertebrae.

Function: Support the uterus and pelvic organs.

Clinical Relevance: Uterosacral ligaments are major sites that developed endometriosis.

Pubocervical Ligaments

Attachment: Extend from the anterior of the cervix and vagina and directed forward to surround the urethra below the bladder and insert in the posterior aspect of the symphysis pubis.

Function: Support the uterus and pelvic organs.

[7]

References[edit | edit source]

  1. https://teachmeanatomy.info/pelvis/female-reproductive-tract/ligaments/
  2. Bala R, Nagpal M, Kaur M, Kaur H. Posterior vaginal wall Gartner's duct cyst. Journal of mid-life health. 2015 Oct;6(4):187.
  3. Rios SS, Pereira LC, Santos CB, Chen AC, Chen JR, Maria de Fátima BV. Conservative treatment and follow-up of vaginal Gartner’s duct cysts: a case series. Journal of medical case reports. 2016 Dec;10(1):147.
  4. Gossman W, Fagan SE, Sosa-Stanley JN, Peterson DC. Anatomy, abdomen and pelvis, uterus. InStatPearls [Internet] 2019 Jul 11. StatPearls Publishing.
  5. Ameer MA, Fagan SE, Sosa-Stanley JN, Peterson DC. Anatomy, Abdomen and Pelvis, Uterus. StatPearls. 2020 Jan.
  6. Eid S, Iwanaga J, Oskouian RJ, Loukas M, Tubbs RS. Comprehensive Review of the Cardinal Ligament. Cureus. 2018 Jun;10(6).
  7. AnatomyZone. Introduction to Female Reproductive Anatomy Part 2 - Ligaments - 3D Anatomy Tutorial. Available from: http://www.youtube.com/watch?v=Bf_sr2qRRWs[last accessed 14/6/2020]