Exxcellence pearls: broad ligament extension and hematoma

Question 1

What is the broad ligament?

What are its boundaries?

Answer 1

Anterior and posterior leaflets of peritoneum which cover the lateral uterine corpus and upper cervix and extend to the pelvic sidewalls.

Superiorly the round ligament, inferiorly the cardinal and uterosacral ligaments, laterally the IP ligament where it blends with the pelvic sidewall.

Question 1

Along which planes can broad ligament hematomas extend?

Answer 1

Presacral space or retroperitoneal spaces.

Question 2

What is the primary blood supply of the uterus?

What is the venous outflow within the broad ligament called?

Answer 2

Uterine and ovarian arteries.

Pampiniform plexus.

Question 4

What color are arterial hematomas typically?

Venous hematomas?

Answer 4

Bright or dark red.

Dark red or bluish in color.

Question 5

How should a stable hematoma be treated?

How should an expanding hematoma be initially treated?

Answer 5

Monitoring alone.

Direct pressure and evaluate for further expansion. Obvious bleeding sites maybe suture ligated.

Question 6

If hematoma expansion persists despite pressure and suture ligation, what steps should be considered?

Answer 6

Uterine and/or ovarian artery ligation or vascular embolization by interventional radiology.

Question 7

Where does the ureter cross under the uterine artery?

Answer 7

1 to 2 cm lateral to the uterus at the level of the internal cervical os.