FRS - Supporting Ligaments

Question 1

The ligaments of the female reproductive system can be divided into three categories. These are the…

Answer 1

1) Broad ligament
2) Uterine ligaments
3) Ovarian ligaments

Question 2

Broad ligament

Sub-divisions?

Anatomical relations?

Answer 2

Anatomically, it can be divided into three regions:

1) Mesometrium -surrounds the uterus. It runs laterally to cover the external iliac vessels, forming a distinct fold over them. The mesometrium also encloses the proximal part of the round ligament of the uterus.
2) Mesovarium - projects from the posterior surface of the broad ligament and attaches to the hilum of the ovaries, enclosing its neurovascular supply. It does not cover the ovary itself.
3) Mesosalpinx - originates superior to the mesovarium and covers the fallopian tubes.

Anatomical relations

It is attaches to the uterus, fallopian tubes and ovaries. These organs are supplied by the ovarian and the uterine arteries which are also enclosed in the broad ligament.

Other ligaments are also enclosed within the broad ligament:
1) Ovarian ligament

2) Round ligament of the uterus
3) Suspensory ligament of ovary

Question 3

Ligaments associated with the ovary?

Answer 3

There are two ligaments that attach to the ovary:

1) Ovarian ligament - is attached to the ovary inferiorly and connects the ovary to the side of the uterus. It is a fibrous band that lies within the broad ligament.
2) Suspensory ligament of ovary - extends outwards from the ovary to the lateral abdominal wall. It consists of a fold of peritoneum, and thus some consider it to be apart of the broad ligament. It contains the ovarian vessels and nerves (ovarian artery, vein, nerve plexus and lymphatic vessels).

Question 4

Ligaments associated with the uterus?

Round and cardinal?

Answer 4

Superior aspect - broad ligament and the round ligament

Inferior aspect - cardinal, pubocervical, and uterosacral ligaments.

The inferior aspect is also supported by the structures in the pelvic floor - levator ani, perinal membrane and the perineal body.

Round ligament

A remnant of the embryonic gubernaculum. It originates at the uterine hornes and attaches to the labia majora, passing through the inguinal canal. This ligament can be a source of pain during pregnancy, due to the increased force placed on the ligament by the expanding uterus.

Cardinal ligaments

It houses the uterine artery and veins and the lower border of the broad ligament. These arise from the side of the cervix and the lateral fornix of the vagina. They provide and extensive attachment of the lateral pelvic wall at the level of the ischial spines. When a hysterectomy is performed due to malignancy, the cardinal ligaments are often removed as they are common resevoir of cancerous cells.

Question 5

Ligaments associated with the uterus - part 2?

Pubocervical and uterosacral?

Answer 5

Pubocervical

These are bilateral structures, which attach the cervix to the posterior surface of the pubic symphysis. They function to support the uterus within the pelvic cavity.

Uterosacral ligaments

These ligaments are also bilateral fibrous bands which atach the cervic to the sacrum. They are also known as the recto-uterine ligaments or sacrocervical ligaments. This supports the uterus and holds it in place.