Ligaments or Folds and Pouches of the Pelvis

Gross Anatomy - Ligaments or Folds and Pouches of the Pelvis

A. Broad ligament of the uterus

• Consists of two layers of peritoneum , extends from the lateral margin of the uterus to the lateral pelvic wall, and serves to hold the uterus in position.
• Contains the uterine tube, uterine vessels, round ligament of the uterus, ovarian ligament, ureter (lower part), uterovaginal nerve plexus, and lymphatic vessels.
• Does not contain the ovary but gives attachment to the ovary through the mesovarium.
• Has a posterior layer that curves from the isthmus of the uterus (the rectouterine fold ) to the posterior wall of the pelvis alongside the rectum.

1. Mesovarium

• Is a fold of peritoneum that connects the anterior surface of the ovary with the posterior layer of the broad ligament.

2. Mesosalpinx

• Is a fold of the broad ligament that suspends the uterine tube.

3. Mesometrium

• Is a major part of the broad ligament below the mesosalpinx and mesovarium.

B. Round ligament of the uterus

• Is attached to the uterus in front of and below the attachment of the uterine tube and represents the remains of the lower part of the gubernaculum.
• Runs within the layers of the broad ligament, contains smooth muscle fibers, and holds the fundus of the uterus forward, keeping the uterus anteverted and anteflexed.
• Enters the inguinal canal at the deep inguinal ring, emerges from the superficial inguinal ring, and becomes lost in the subcutaneous tissue of the labium majus.

C. Ovarian ligament

• Is a fibromuscular cord that extends from the ovary to the uterus below the uterine tube, running within the layers of the broad ligament.

D. Suspensory ligament of the ovary

• Is a band of peritoneum that extends upward from the ovary to the pelvic wall and transmits the ovarian vessels, nerves, and lymphatics.

E. Lateral or transverse cervical (cardinal or Mackenrodt's) ligaments of the uterus

• Are fibromuscular condensations of pelvic fascia from the cervix and the vagina to the pelvic walls, extend laterally below the base of the broad ligament, and support the uterus.

F. Pubocervical ligaments

• Are firm bands of connective tissue that extend from the posterior surface of the pubis to the cervix of the uterus.

G. Pubovesical (female) or puboprostatic (male) ligaments

• Are condensations of the pelvic fascia that extend from the neck of the bladder (or the prostate gland in the male) to the pelvic bone.

H. Sacrocervical ligaments

• Are firm fibromuscular bands of pelvic fascia that extend from the lower end of the sacrum to the cervix and the upper end of the vagina.

I. Inferior pubic (arcuate pubic) ligament

• Arches across the inferior aspect of the pubic symphysis and attaches to the medial borders of the inferior pubic rami.

J. Rectouterine (sacrouterine) ligaments

• Hold the cervix back and upward and sometimes elevate a shelf-like fold of peritoneum (rectouterine fold) , which passes from the isthmus of the uterus to the posterior wall of the pelvis lateral to the rectum. It corresponds to the sacrogenital (rectoprostatic) fold in the male.

K. Rectouterine pouch (cul-de-sac of Douglas)

• Is a sac or recess formed by a fold of the peritoneum dipping down between the rectum and the uterus.
• Lies behind the posterior fornix of the vagina and contains peritoneal fluid and some of the small intestine.

L. Rectovesical pouch

• Is a peritoneal recess between the bladder and the rectum in males, and the vesicouterine pouch is a peritoneal sac between the bladder and the uterus in females.

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