![]() ![]() In the standing position, the cardinal ligament has a vertical orientation while the uterosacral ligaments are dorsally oriented, and together they provide apical support for the uterus and vagina. Altered connective tissue distribution in the cardinal ligaments with fewer and thinner collagen fibers have been reported in women with prolapse of the pelvic organ. They determined that it was not a ligament in the sense of a separate thickening of connective tissue. The cardinal ligaments of women with a prolapsed uterus showed a higher expression of collagen III and tenascin and lower quantities of elastin. It contains a network of collagen fibers and few isolated elastic fibers with numerous cellular elements, particularly fibroblasts. Īccording to Range et al., microscopically, the cardinal ligament is chiefly made up of blood vessels (mainly veins), nerves originating from the inferior hypogastric plexus, lymphatic vessels, and the surrounding loose areolar connective tissue. It contains autonomous nerve fibers, hypogastric nerve, extensions of inferior hypogastric plexus (pelvic plexus), and Vessels. ![]() (b) Neural part (the caudal portion of cardinal ligament, paracervix): the neural section is an extension of the inferior hypogastric plexus. (a) Vascular part (the cranial portion of cardinal ligament, parametrium): It is an extension of the perivascular sheath of internal iliac vessel branches going to the genital tract which contains - internal iliac artery, uterine artery and vein, vaginal artery, vesical artery, smooth muscle, connective tissue, lymph nodes, and adipose tissue. The former was considered to be corresponding to the cranial portion of the cardinal ligament, whereas the latter was considered to be corresponding to the caudal portion of the cardinal ligament. Tissues that are situated and cross cranially over the ureter are categorized with the parametrium, and the tissues that are situated and cross underneath to the ureter categorize along with the paracervix. The passage of the ureter in the intermediate section divides cardinal ligament into two parts. ![]() The cardinal ligament is divisible into two parts: (a) the cranial or superficial vascular part which chiefly contains vessels, and the (b) the caudal or deep neural part which contains inferior hypogastric plexus nerves. One branch which is composed of nerve fibers and the veins returning from the post-lateral wall of the bladder is the vesical branch of the cardinal ligament, and the other branch which is composed of nerve fibers and the veins returning from the uterine cervix is the cervical branch of the cardinal ligament). Īccording to Tauchi, the cardinal ligament divides in a Y-shaped manner at about the middle of the proximal and distal attachments into two parts (branches). Its average length is 4.6 cm, and the maximum average width is 2.1 cm. It is attached to the pelvic sidewall with an apex at the first branch of the internal iliac artery. Proximal (pelvic) section: This is the lateral most and thickest section, which is triangular on a cross-section. These are uterovesical fold (anterior ligament) anteriorly, rectouterine fold (posterior ligament) posteriorly, and broad ligament laterally. Peritoneal folds related to the uterus form less important secondary support of uterus in the form of peritoneal ligaments. As per Terminologia Anatomica, the cardinal ligament has the name parametrium or paracervix however, Mackenrodt ligament, transverse cervical ligament, lateral cervical ligament, paracervical ligament, retinaculum uteri sustentaculum of Bonny or the web are the other terms also used for it. It is composed of loose areolar connective tissue surrounded by blood vessels, nerves, and lymphatics. The cardinal ligament is a paired thickening of the parametrium and pelvic fascia at the base of the broad ligament, which extends between the cervix and vaginal fornix medially to the sidewall of pelvis laterally. Cardinal ligament and the uterosacral ligaments provide apical support for the uterus and upper vagina. These are pubocervical ligament anteriorly, cardinal ligament laterally, uterosacral ligament posteriorly, and round ligament. The visceral layer of pelvic fascia and parametrium becomes condensed around the uterus to form primary support of uterus in the form of true ligaments. The muscles of the pelvic floor and the connective tissue of pelvis, including pelvic fascia, provide stability to the pelvic floor and are essential for the support of pelvic viscera. ![]()
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