LIGAMENTS OF THE UTERUS.
The uterus is held in the pelvis by eight ligaments: Laterally the broad ligaments; antero-laterally, the round ligaments; posteriorly, the utero sacral ligaments; anteriorly, the vesico•uterine ligaments.
I. The Vesico-uterine Ligaments.
These are of so little importance that Sappey scarcely describes them. They are formed by a fold of peritoneum where it passes from the uterus to the bladder. A few muscular fibres, going from the uterus to the bladder, and holding these folds of the peritoneum to the lateral por tions, constitute these ligaments.
IL The Utero-sacral Ligaments.
These are much larger than the preceding, but like them are formed by muscular fibres, which leave the posterior surface of the uterus, while holding the peritoneum at the point where it is reflected from the pos terior surface of the uterus, to the anterior surface of the rectum. Lat erally, they embrace this organ, and are inserted on the lateral and an terior portions of the third and fourth sacral vertebrae. Some of the fibres are lost directly in the walls of the rectum.
III. The Round .Ligaments.
They leave the superior and anterior part of the uterus below the tube; then occupy the anterior fold of the broad ligaments, whence they pass towards the abdominal orifice of the inguinal canal, and are terminated by fibres, some of which are attached to the inferior wall of the inguinal canal, others to the spine of the pubes, and others still, passing out of the external inguinal ring, are lost in the labia majors.
They consist of a peritoneal envelope, striated muscular fibres, and smooth muscular fibres, an artery, veins, fibres of elastic tissue, and fibres of connective tissue.
The peritoneal envelope; after having covered their anterior portion, furnishes them a complete envelope, which leaves them at the superior orifice of the inguinal canal, to form, at this point, a depression called the external inguinal ring. The terminal parts of the round ligaments are, in the adult, unprovided with peritoneum.
In the foetus, on the contrary, the peritoneum accompanies the round ligaments to their extremity, and thus penetrates with them the inguinal canal, and forms a diverticulum called Nuck's canal. The smooth fibres proceed directly from the uterus; the striated fibres are furnished, accord ing to Rouget, by the transversalis abdominis.
The artery of the round ligament sometimes comes directly from the epigastric, more frequently from the cremasteric artery. It occupies the centre of the round ligament, and is prolonged to the uterus, for which it is principally designed.
Several veins accompany this artery. All communicate, and form a plexus, very marked even in the fcetus. During pregnancy they develope considerably, and in certain cases may even become varicose.
The nerves emanate from the genital branch of the genito-crural nerve.
The function of the round ligaments is, to bring the womb forward after emptying of the bladder (Sappey). We will see, further on, that Thevenot makes them play an important part in the accommodation of the foetus.
IV. Broad Ligaments.
Placed vertically in the pelvic cavity, the broad ligaments are the prin cipal ligaments of the uterus, the lateral borders of which they clasp by their internal extremity, while they are attached to the wall of the pelvis by their external extremity. They are quadrilateral in shape, having four sides; a superior free end floating in the pelvis, an inferior facing the side of the perineum, and two lateral, one of which is attached to the uterus, the other to the wall of the pelvis. They divide the true pelvis into two cavities, one, the anterior, designed for the bladder, the other, the posterior, for the rectum. They therefore present for consideration an anterior surface, a posterior surface, aril four borders. (Figs. 32 and 33.) The anterior surface touches the bladder.
The posterior is in contact with the rectum, the convolutions of the ilium, and often of the sigmoid flexure.