Reproductive Anatomy: Section Two

Overview

• Focus on ligaments surrounding female pelvic organs and other key structures.

Major Ligaments and Structures

Infundibulum Pelvic Ligament (Suspensory Ligament)

• Function: Connects ovary to lateral pelvic wall, suspends the ovary.
• Contents: Ovarian artery and vein travel through it.
• Clinical Relevance:
  • Ovarian Torsion: Ovary twists around the ligament, disrupting blood flow, causing ischemia.
  • Surgical Caution: Ureter passes posteriorly and inferiorly; risk of damaging ureter during oophorectomy.

Uterus Sacral Ligaments

• Function: Connect uterus to sacrum, support uterus.
• Importance: Damage can lead to pelvic organ prolapse.
• Pelvic Organ Prolapse:
  • Occurs when supporting structures are weakened.
  • Common in older women with multiple or prolonged deliveries.
  • Other supporting structures: Transverse cervical ligaments, levator ani muscles.

Round Ligament

• Function: Connects uterine horn to the labia majora.
• Pathway: Travels through the inguinal canal.
• Clinical Note: Inguinal hernias in females may involve round ligament.

Ovarian Ligament

• Function: Connects ovary to the uterus.
• Note: Often confused with suspensory ligament.

Transverse Cervical (Cardinal) Ligament

• Function: Conducts uterine artery and vein.
• Attachments: Lateral side of uterus at cervix level to lateral pelvic wall.
• Clinical Importance:
  • Risk of ureter damage during ligation in hysterectomy.
  • Supports uterus; weakness can lead to prolapse.

Broad Ligament

• Structure: Fold of the peritoneum, mesentery.
• Components:
  • Mesosalpinx: Involves fallopian tubes.
  • Mesovarium: Involves ovaries.
  • Mesometrium: Involves uterine body.
• Surgical Note: Often transected during hysterectomy.

Clinical Case Application

Case 1: Pelvic Organ Prolapse

• Patient: 67-year-old female with posterior vaginal wall bulge.
• Diagnosis: Pelvic organ prolapse due to damaged uterus sacral ligaments.

Case 2: Oophorectomy

• Patient: 49-year-old female with ovarian cancer.
• Complication: Hemorrhage post-ovary removal due to transecting suspensory ligament (ovarian artery/vein).

Case 3: Hysterectomy

• Patient: 33-year-old female with endometriosis undergoing hysterectomy.
• Complication: Ureter damage during uterine artery ligation in transverse cervical ligament; transected too posteriorly.

Key Takeaways

• Ligaments and their contents are crucial for both structural support and clinical implications in surgeries.
• Understanding ligament pathways and their associated vessels is essential for preventing surgical complications.