UTERUS (LIGAMENTS OF). 



705 



the (perhaps effused) fibrine. The centre of 

 these coagula may be found softened, and 

 containing the creamy pus-like fluid which 

 results from the molecular disintegration and 

 liquefaction so commonly observed in fibrin ous 

 clots. Frequently the clots are of a less 

 consistent texture, being of a dark brown or 

 chocolate colour, or reduced to the con- 

 sistence of a soft pulp. The coats of the 

 veins may be thickened and adherent to the 

 contained coagula, or covered by fibrinous 

 laminas or merely blood-stained, or pre- 

 senting no deviation from the natural state. 



LIGAMENTS OF THE UTERUS. 



These terms are applied to several dupli- 

 catures of peritoneum, containing variable 

 quantities of fibrous and muscular tissue, 

 which serve to connect together the uterus 

 and its appendages and to limit the motions of 

 these parts within the pelvis. They are dis- 

 tinguished as the broad, the round, the utero- 

 sacral, and the utero-vesical ligaments. 



The broad ligament. The fold of perito- 

 neum in which the uterus is contained, after 

 investing the fundus and anterior and posterior 

 walls of the organ, passes off laterally in the 

 form of a double lamina that extends from 

 each uterine border horizontally outwards as 

 far as the sides and base of the pelvis, to which 

 it is attached. Thus a vertical septum is 

 formed, which divides the cavity of the pelvis 

 transversely into two chambers ; the anterior 

 and shallower one containing the bladder, the 

 posterior and deeper holding the rectum and a 

 portion of the small intestines. The uterus 

 occupies the middle of the septum, while the 

 lateral extensions of it form the broad liga- 

 ment of either side. Figs. 368. and 404. /.. 



Attached to the upper border of the broad 

 ligament are three folds, termed lesser wings. 

 The central and superior of these, which is the 

 largest, contains in its free falciform edge the 

 Fallopian tube, and at its base a portion of the 

 parovarium. It has been already described as 

 the mesentery of the tube. The smaller pos- 

 terior fold invests the ovary together with its 

 proper ligament ; while the third or anterior 

 fold is inclined obliquely towards the body of 

 the uterus, and constitutes the covering of the 

 round ligament. Between the laminae which 

 form the principal or lower portion of the broad 

 ligament, as well as within the alaj, are found 

 the blood-vessels, lymphatics,and nerves which 

 supply the uterus and its appendages, together 

 with a variable amount of fibrous and un- 

 striated muscular tissue that serves to connect 

 the alminas together. 



This structure should be regarded as a me- 

 sentery rather than a ligament of the uterus. 

 It serves to invest the uterus and its appen- 

 dages with a common peritoneal covering, and 

 to protect these parts and attach them to the 

 pelvis, as the mesentery attaches the intestines 

 to the spine ; while the interspace of the folds 

 suffices for the conveyance of vessels and 

 nerves. The resemblance to a mesentery is 

 more obvious in the bicorned and intestiniform 

 uterus of the mammalia generally, as well as 

 Supp. 



of many other vertebrata in which it forms 

 the mesometrium. 



The utero-sacral ligaments. From the pos- 

 terior wall of the uterine neck two falciform 

 folds of peritoneum proceed towards the 

 rectum. These are most easily seen when the 

 parts are stretched. Between them lies the 

 depression of variable depth known as the 

 retro-uterine pouch, or space of Douglas. 

 When the peritoneum is removed, these folds 

 are seen to be occasioned by two correspond- 

 ing bands of fibrous tissue, extending from the 

 substance of the cervix backwards towards the 

 sacrum, to which they are attached. Their 

 strength varies considerably in different sub- 

 jects 7 so that when not much developed they 

 may be overlooked. The importance of these 

 ligaments, or rather fibrous bands, has perhaps 

 not been generally sufficiently appreciated. 

 From their position and connections it cannot 

 admit of doubt that they are intended to re- 

 strain the motions of the uterus, to prevent 

 it from being forced upwards in the act of con- 

 junction, and especially to limit the descent 

 of the organ in erect postures of the body. 



The utero-vesical ligaments. Opposite to 

 the point of junction of the body and neck of 

 the uterus, where the peritoneum is reflected 

 forwards on to the bladder, are commonly 

 observed two slighter lateral folds, containing 

 bundles of fibrous tissue. These constitute 

 the anterior or utero-vesical ligaments. 



The round or siib-pubic ligament: ligamen- 

 tum rotundum, ligamentum uteri teres. This 

 ligament consists of a flattened chord or band 

 of muscular and fibrous tissue, which, traced 

 from below upwards, proceeds from the in- 

 ternal inguinal ring in a curved direction to- 

 wards the superior angle of the uterus on 

 either side, where it is inserted in front of and 

 a little below the commencement of the 

 Fallopian tube. (Figs. 404. and 418.) The 

 ligament of the right side is commonly 

 shorter than that of the left : hence it hap- 

 pens that in pregnancy the uterus more 

 often inclines to that side. According to Mr. 

 Rainey*, the round ligament arises by three 

 fasciculi of tendinous fibres : the inner one 

 from the tendons of the internal oblique and 

 transversalis muscles near the symphysis pu- 

 bis ; the middle one, from the superior column 

 of the external abdominal ring, near its upper 

 part ; and the external fasciculus, from the 

 inferior column of the ring, just above Gim- 

 bernat's ligament. From these attachments 

 the fibres pass backwards and outwards, soon 

 becoming fleshy : they then unite into a 

 rounded chord, which crosses in front of the 

 epigastric artery, and behind the lower border of 

 the internal oblique and transversalis muscles-, 

 from which it is separated by a thin layer of 

 fascia continuous with the fascia transversali? : 

 it then gets between the layers of peritoneum 

 forming the broad ligament, along which it 

 passes backwards, downwards, and inwards 

 to the point of insertion already described. 



* On the Structure and Use of the Ligamentum 

 Rotundum Uteri, Phil. Trans, p. 515. pt. ii. 1850. 

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