The Uterine And Cervical Ligaments

Original Editor - Khloud Shreif

Top Contributors - Khloud Shreif

Description

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 thinking of pelvic tissue.

Uterine Ligaments

Broad Ligament

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.

Mesometrium: the largest part of the ligaments surround the uterus.

Mesovarium: projects from the posterior surface of the broad ligament and enclose the ovary vascular supply not covering the ovary itself.

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.

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

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[5].

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.

[6]

References

  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. Eid S, Iwanaga J, Oskouian RJ, Loukas M, Tubbs RS. Comprehensive Review of the Cardinal Ligament. Cureus. 2018 Jun;10(6).
  6. 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]