Broad Ligament

The broad ligament of the uterus is a broad, double-layered fold of peritoneum extending from the lateral sides of the uterus toward the lateral walls and floor of the pelvis. It is associated with the uterus, uterine tubes, ovaries, and several important vessels, nerves, connective tissue structures, and embryological remnants.

Despite its name, the broad ligament is not a dense fibrous ligament comparable to the major stabilizing ligaments of a synovial joint. It is primarily a peritoneal fold. Its two layers are continuous with the peritoneal covering of the uterus and with the parietal peritoneum of the pelvic walls and floor.

The broad ligament is conventionally divided into three parts according to the structures with which each portion is associated: the mesometrium, mesosalpinx, and mesovarium.

Location

The broad ligament lies within the female pelvis on either side of the uterus. It extends laterally from the uterus toward the pelvic wall and creates a peritoneal partition associated with the internal reproductive organs.

The uterus occupies a central position between the right and left broad ligaments. The uterine tube is associated with the superior free margin of the ligament, while the ovary is attached to its posterior aspect through the mesovarium.

General Structure

The broad ligament consists of two layers of peritoneum, an anterior layer and a posterior layer. Between these layers lies connective tissue containing vessels, nerves, smooth muscle fibers, lymphatics, and structures related to the reproductive organs.

The amount and organization of tissue between the two peritoneal layers vary according to the region of the broad ligament.

Parts of the Broad Ligament

The broad ligament is divided anatomically into three principal parts:

• Mesometrium
• Mesosalpinx
• Mesovarium

These subdivisions are continuous with one another rather than completely separate anatomical structures.

Mesometrium

The mesometrium is the largest portion of the broad ligament. It extends laterally from the uterus and lies inferior to the mesosalpinx.

It is associated particularly with the body and cervix of the uterus and contains connective tissue through which important uterine vessels, nerves, lymphatics, and supporting structures pass.

Mesosalpinx

The mesosalpinx is the portion of the broad ligament associated with the uterine tube. It lies between the uterine tube superiorly and the region of the ovary and mesovarium inferiorly.

The uterine tube occupies the superior free margin of the broad ligament, and the mesosalpinx forms a peritoneal fold supporting its relationship to the remainder of the broad ligament.

Mesovarium

The mesovarium is a short peritoneal fold connecting the anterior border of the ovary to the posterior layer of the broad ligament.

Unlike a typical mesentery, it does not cover the entire surface of the ovary. The ovary therefore projects from the posterior aspect of the broad ligament.

Relationship to the Uterus

The two layers of the broad ligament are continuous medially with the peritoneal covering of the uterus. From the lateral uterine margins, these layers extend outward toward the pelvic walls.

The broad ligament therefore helps maintain the anatomical relationship between the centrally located uterus and structures positioned laterally within the pelvis.

Relationship to the Uterine Tube

The uterine tube runs along the superior margin of the broad ligament. The portion of the broad ligament immediately associated with the tube is the mesosalpinx.

The uterine tube extends laterally from the uterine horn toward the ovary, terminating in the infundibulum and fimbriae near the lateral end of the broad ligament.

Relationship to the Ovary

The ovary is associated with the posterior aspect of the broad ligament and is connected to it through the mesovarium.

The ovary itself is not enclosed within the broad ligament. Instead, it projects posteriorly from the ligament, with the mesovarium attaching at the ovarian hilum.

Anterior and Posterior Layers

The broad ligament has anterior and posterior peritoneal layers. These layers become separated by vessels, connective tissue, and reproductive structures as they extend laterally from the uterus.

The posterior layer gives rise to the mesovarium and is closely related to the ovary and ovarian ligament.

Superior Border

The superior portion of the broad ligament forms a free margin containing the uterine tube. This relationship makes the uterine tube one of the most important landmarks for identifying the ligament.

Laterally, the peritoneal folds associated with the broad ligament become continuous with structures extending toward the lateral pelvic wall.

Inferior Region

Inferiorly, the two peritoneal layers diverge and become continuous with the peritoneum covering the pelvic floor and adjacent pelvic structures.

Connective tissue at the base of the broad ligament is continuous with the connective tissue of the parametrium and contains important neurovascular structures.

Contents and Associated Structures

The broad ligament and the connective tissue between or immediately associated with its layers contain numerous structures. Important examples include:

• Uterine tubes
• Round ligaments of the uterus
• Ovarian ligaments
• Uterine and ovarian vessels and their branches
• Lymphatic vessels
• Autonomic nerves
• Connective tissue
• Smooth muscle fibers
• Embryological remnants

The exact relationship of each structure differs within the various portions of the broad ligament.

Round Ligament of the Uterus

The round ligament of the uterus begins near the uterine horn, inferior and anterior to the origin of the uterine tube. It passes laterally within the broad ligament toward the deep inguinal ring.

It then travels through the inguinal canal and terminates within connective tissues associated with the labium majus.

Ovarian Ligament

The ovarian ligament, also called the proper ligament of the ovary, connects the medial pole of the ovary to the lateral aspect of the uterus near the uterine horn.

It lies within or immediately related to the posterior layers of the broad ligament and represents a remnant of the embryonic gubernaculum.

Suspensory Ligament of the Ovary

The suspensory ligament of the ovary, also called the infundibulopelvic ligament, is a peritoneal fold extending from the ovary toward the lateral pelvic wall.

It is continuous with the lateral region of the broad ligament and transmits the ovarian vessels, lymphatics, and nerves.

Uterine Artery

The uterine artery typically arises from the anterior division of the internal iliac artery and travels medially through connective tissue at the base of the broad ligament toward the uterus.

Near the cervix, the uterine artery crosses superior to the ureter before ascending along the lateral margin of the uterus.

Uterine Artery and Ureter

The relationship between the uterine artery and ureter is an important surgical landmark. Near the lateral aspect of the cervix, the uterine artery passes superior to the ureter.

This relationship is often remembered by the anatomical principle that the ureter passes beneath the uterine artery. The close proximity of these structures is clinically important during hysterectomy and other pelvic procedures.

Ovarian Artery

The ovarian artery arises directly from the abdominal aorta and descends into the pelvis within the suspensory ligament of the ovary.

Its branches supply the ovary and uterine tube and anastomose with branches of the uterine artery.

Venous Drainage

Venous channels accompanying the uterine and ovarian arteries contribute to extensive venous plexuses within the female pelvis.

Uterine veins ultimately drain toward the internal iliac veins. Ovarian veins accompany the ovarian arteries superiorly, with the right ovarian vein generally draining into the inferior vena cava and the left ovarian vein into the left renal vein.

Lymphatics

Lymphatic vessels associated with the uterus, uterine tubes, and ovaries travel through or near the broad ligament along vascular pathways.

Their destinations differ according to the organ and region. Ovarian lymphatics primarily follow the ovarian vessels toward lumbar lymph nodes, while uterine lymphatic drainage follows several routes toward pelvic and other regional lymph node groups.

Nerve Supply

Autonomic nerve fibers pass through connective tissues associated with the broad ligament to reach the uterus, uterine tubes, ovaries, and adjacent pelvic structures.

These fibers arise from pelvic autonomic plexuses and accompany vascular pathways toward their target organs.

Parametrium

The parametrium is connective tissue surrounding the uterus, particularly adjacent to the cervix and between layers at the base of the broad ligament.

It contains vessels, nerves, lymphatics, and connective tissue structures and is clinically important in pelvic surgery and the spread of disease from the cervix and uterus.

Broad Ligament and Uterine Support

The broad ligament contributes to maintaining the anatomical relationships of the uterus, uterine tubes, and ovaries, but it is not considered the principal mechanical support of the uterus.

Major uterine support is provided by the pelvic floor and condensations of endopelvic fascia, particularly the cardinal and uterosacral ligament complexes.

Cardinal Ligament

The cardinal ligament, also called the transverse cervical ligament, is a condensation of connective tissue extending from the cervix and upper vagina toward the lateral pelvic wall.

It lies at the base of the broad ligament and provides important support to the cervix and uterus. The uterine vessels travel within this region.

Uterosacral Ligaments

The uterosacral ligaments extend from the cervix toward the sacrum and provide important posterior support to the uterus and upper vagina.

They are functionally more important for uterine support than the broad ligament itself.

Relationship to the Pelvic Peritoneum

The broad ligament is formed by reflections of the pelvic peritoneum around the internal reproductive organs. These reflections create several clinically important peritoneal recesses.

Anteriorly, peritoneum reflects between the uterus and urinary bladder. Posteriorly, it extends between the uterus and rectum.

Vesicouterine Pouch

The vesicouterine pouch is the peritoneal recess between the urinary bladder and the anterior surface of the uterus.

It is created by the reflection of peritoneum from the bladder onto the uterus.

Rectouterine Pouch

The rectouterine pouch, also called the pouch of Douglas, is the peritoneal recess between the posterior uterus and the rectum.

It is the most inferior portion of the peritoneal cavity in the upright female and is clinically important because fluid, blood, or pus may accumulate there.

Embryological Development

The broad ligament develops as the paramesonephric ducts descend and fuse during development. Their movement and fusion draw peritoneal folds medially, producing the broad ligament and contributing to the organization of the female pelvic peritoneum.

The fused caudal portions of the paramesonephric ducts contribute to formation of the uterus and upper vagina, while the unfused cranial portions form the uterine tubes.

Gubernaculum and Broad Ligament

The developing broad ligament influences the relationship of the embryonic gubernaculum to the uterus. As the uterus develops, the gubernaculum becomes attached to it and is divided functionally into two adult structures.

The portion between the ovary and uterus becomes the ovarian ligament, while the portion extending from the uterus toward the inguinal canal becomes the round ligament of the uterus.

Embryological Remnants

Several remnants of the embryonic mesonephric system may persist within or adjacent to the broad ligament. These structures are usually small and clinically insignificant but can occasionally give rise to cysts.

Important remnants include the epoophoron, paroophoron, and Gartner duct remnants.

Epoophoron

The epoophoron consists of remnants of mesonephric tubules located within the broad ligament, commonly in the region of the mesosalpinx near the ovary and uterine tube.

It is homologous to portions of the male reproductive duct system derived from mesonephric structures.

Paroophoron

The paroophoron is another group of vestigial mesonephric tubules that may be found within the broad ligament, generally closer to the uterus than the epoophoron.

These remnants are usually microscopic or inconspicuous.

Paratubal and Paraovarian Cysts

Paratubal and paraovarian cysts may develop within the broad ligament or mesosalpinx from embryological remnants or other epithelial structures.

These cysts are located adjacent to, rather than within, the ovary and may sometimes become large enough to cause pelvic symptoms or complicate adnexal torsion.

Broad Ligament Cysts

Cystic lesions can develop between the layers of the broad ligament. Their origins vary and may include mesonephric remnants, paramesonephric remnants, or other epithelial inclusions.

Large cysts can distort the normal relationships of the uterus, ovary, uterine tube, ureter, and pelvic vessels.

Broad Ligament Leiomyoma

A broad ligament leiomyoma is a smooth muscle tumor arising within or extending into the broad ligament. Some represent uterine leiomyomas growing laterally between the layers of the ligament, while others may arise from smooth muscle elements within the ligament itself.

Large lesions can displace the uterus, ureter, urinary bladder, and pelvic vessels, making surgical anatomy more complex.

Broad Ligament Hematoma

A broad ligament hematoma is an accumulation of blood within connective tissue associated with the broad ligament. It may occur following trauma, childbirth, vascular injury, or pelvic surgery.

Because the broad ligament contains and borders important pelvic vessels, bleeding can dissect through tissue planes and produce a substantial concealed hematoma.

Broad Ligament and Hysterectomy

The broad ligament is an important surgical landmark during hysterectomy. Surgical dissection requires identification and management of vessels and supporting structures associated with its layers and base.

Particular attention is required near the uterine artery because of its close relationship to the ureter.

Broad Ligament and Oophorectomy

During removal of an ovary, the surgeon must consider the relationships among the ovary, mesovarium, ovarian ligament, and suspensory ligament of the ovary.

The ovarian vessels within the suspensory ligament must be controlled while protecting nearby structures, particularly the ureter.

Broad Ligament and Salpingectomy

During removal of a uterine tube, the relationship between the tube and the mesosalpinx is surgically important.

Vascular branches traveling within the mesosalpinx must be controlled while preserving adjacent structures when appropriate.

Relationship to the Ureter

The ureter descends along the lateral pelvic wall and then courses anteromedially toward the urinary bladder. Near the cervix, it passes inferior to the uterine artery within connective tissue associated with the base of the broad ligament.

This makes the ureter particularly vulnerable during procedures involving the uterine vessels, cervix, and lateral uterus.

Relationship to the Ovary and Ovarian Fossa

The ovary lies posterior to the broad ligament and is attached to its posterior surface by the mesovarium. Its lateral pole is connected toward the pelvic wall by the suspensory ligament of the ovary.

This arrangement permits the ovarian vessels to reach the ovary while maintaining its relationship to the uterus and uterine tube.

Relationship to the Round Ligament

The round ligament lies between the layers of the broad ligament as it travels from the uterine horn toward the deep inguinal ring.

Its position is generally anterior and inferior to the uterine tube and anterior to the ovarian ligament.

Relationship to the Ovarian Ligament

The ovarian ligament extends from the medial pole of the ovary toward the uterus immediately inferior to the uterine tube.

Together with the round ligament, it represents the adult derivatives of the embryonic gubernaculum.

Broad Ligament versus Mesentery

The broad ligament resembles a mesentery because it is composed of peritoneal layers associated with organs and neurovascular structures. However, its anatomy is more complex than that of a simple intestinal mesentery.

It forms part of the pelvic peritoneal arrangement around several reproductive organs rather than suspending a single organ from the posterior abdominal wall.

Broad Ligament versus Cardinal Ligament

Feature	Broad Ligament	Cardinal Ligament
Primary composition	Double layer of peritoneum	Condensed connective tissue and fascia
Relationship	Extends from uterus toward pelvic walls	Extends from cervix and upper vagina toward lateral pelvic wall
Main role	Maintains relationships and transmits associated structures	Important mechanical support of cervix and uterus
Major vessels	Associated with uterine and ovarian vascular pathways	Uterine vessels traverse its region

Broad Ligament versus Suspensory Ligament of the Ovary

Feature	Broad Ligament	Suspensory Ligament of Ovary
Structure	Large double peritoneal fold	Peritoneal fold extending toward lateral pelvic wall
Main association	Uterus, tube, and ovary	Ovary
Important contents	Multiple reproductive neurovascular structures	Ovarian vessels, nerves, and lymphatics
Location	Between uterus and pelvic wall	Between ovary and lateral pelvic wall

Broad Ligament versus Ovarian Ligament

Feature	Broad Ligament	Ovarian Ligament
Composition	Peritoneal fold	Fibromuscular cord
Attachment	Uterus toward pelvic wall	Ovary to uterus
Embryological basis	Related to development of paramesonephric ducts and pelvic peritoneal folds	Derived from gubernaculum

Anatomical Organization

Part	Main Relationship
Mesometrium	Largest portion associated with uterus
Mesosalpinx	Associated with uterine tube
Mesovarium	Connects ovary to posterior broad ligament

Key Anatomical Relationships

• The broad ligament is a double layer of pelvic peritoneum.
• It extends from the lateral uterus toward the lateral pelvic walls and floor.
• Its three principal subdivisions are the mesometrium, mesosalpinx, and mesovarium.
• The uterine tube lies along its superior margin.
• The ovary is attached to its posterior aspect by the mesovarium rather than enclosed within the ligament.
• The round ligament travels within the broad ligament toward the deep inguinal ring.
• The ovarian ligament connects the ovary to the uterus.
• The uterine artery travels through connective tissue at the base of the broad ligament and crosses superior to the ureter near the cervix.
• The suspensory ligament of the ovary transmits the ovarian vessels toward the ovary.
• The broad ligament contributes to organ relationships but is not the principal mechanical support of the uterus.

Clinical Importance

The broad ligament is an important anatomical landmark in gynecological surgery because major reproductive structures and neurovascular pathways are closely associated with it. Procedures involving the uterus, uterine tubes, or ovaries require an understanding of the relationships between its peritoneal layers, uterine vessels, ovarian vessels, ureters, and supporting connective tissues.

The relationship between the uterine artery and ureter is particularly important. Injury to the ureter can occur during procedures involving the cervix and uterine vessels if this anatomical relationship is not recognized.

The broad ligament can also be involved in pathological processes including cysts, leiomyomas, hematomas, endometriosis, inflammatory disease, and the spread of pelvic malignancy. Because lesions may grow between its layers, they can displace adjacent organs and vessels and alter normal pelvic anatomy.

Functional Importance

The broad ligament helps organize the internal female reproductive organs within the pelvis. Its peritoneal folds maintain relationships among the uterus, uterine tubes, and ovaries while providing pathways through which vessels, lymphatics, nerves, and connective tissue structures reach these organs.

Its subdivisions reflect these anatomical relationships. The mesometrium is associated predominantly with the uterus, the mesosalpinx with the uterine tube, and the mesovarium with the ovary. Together they form an important component of the female pelvic peritoneal architecture.

Understanding the broad ligament provides a foundation for studying uterine anatomy, ovarian anatomy, uterine tubes, pelvic peritoneum, uterine vessels, ovarian vessels, the ureter, uterine support, hysterectomy, adnexal surgery, and the embryological development of the female reproductive tract.