Obstetrics and Gynecology - A.M. Hromova 2000

Anatomical and physiological characteristics of the female body
Anatomy of the female reproductive organs
Ligamentous apparatus of the uterus. Pelvic floor

The proper position of the Internal Organs is maintained by the suspending, fixing, and supporting ligamentous apparatus of the Uterus.

The suspending apparatus of the uterus includes (Fig. 3):

- the broad ligament of the uterus, which is a peritoneal fold covering the uterus;

- the round ligament of the uterus (lig. teres uteri), composed of interwoven smooth Muscle fibers and a significant amount of Connective Tissue fibers, forming a cord 10-12 cm long and 3-5 mm wide. From the uterine angle, it extends bilaterally toward the Inguinal Canal, passes through the superficial inguinal ring, and anchors in the connective tissue of the pubic tubercle;

- the suspensory ligament of the Ovary (lig. suspensorium ovarii), which is the most mobile part of the broad ligament of the uterus. It holds the ovary and part of the Uterine tube in a suspended state and transmits the a. et v. ovarica;

- the proper ovarian ligament (lig. ovarii proprium), consisting primarily of smooth muscle fibers and connecting the uterine end of the ovary to the uterus. Through this ligament, the ovarian Branches of the uterine artery enter the mesovarium.

The fixing apparatus of the uterus comprises the following structures:

- the rectouterine muscle (m. rectouterinus), extending from the posterior surface of the cervix to the lateral surface of the rectum;

- the cardinal ligament (lig. cardinale), representing a Condensation of connective tissue strands and bundles of unstripped muscle fibers at the Base of the broad ligament of the uterus. Medially, the tissue of the ligament merges into the parametrium surrounding the cervix and the upper part of the Vagina;

- the pubovesical muscle (m. pubovesicalis), consisting of connective tissue strands with interwoven smooth muscle fibers that run from the inferior angle of the uterus to the Pubic Symphysis and Urinary Bladder.

The supporting apparatus is formed by the Muscles AND FASCIAE of the pelvic floor, which consists of three musculo-fascial layers.

The anterior (superficial) layer of the pelvic floor muscles comprises the following muscles:

- the ischiocavernosus muscle (m. ischiocavernosus), originating from the ischial tuberosity and inserting into the Tissues of the Clitoris;

- the bulbospongiosus muscle (m. bulbospongiosus), originating from the perineal body (centrum tendineum perinei) and attaching to the vaginal walls;

- the external anal sphincter (m. sphincter ani externus), originating in the region of the coccygeal apex, encircling the anal opening with its fibers, and inserting into the perineal body. Together with the m. bulbospongiosus, it forms a figure-eight configuration in the area of the Perineum and the vaginal vestibule;

- the superficial transverse perineal muscle (m. transversus perinei superficialis), originating from the ischial tuberosity and terminating in the perineal body.

The Middle layer of the pelvic floor muscles is formed by the urogenital Diaphragm (diaphragma urogenitale), which has a triangular shape and is located between the symphysis, pubic bones, and ischial bones. It is formed by the muscle

that compresses the Urethra (m. sphincter urethrae) and the deep transverse perineal muscle (m. transversus perinei profundus).

The inner layer of the pelvic floor muscles (diaphragma pelvis) is a robust paired muscle, the levator ani (m. levator ani). Its muscle fibers originate from various pelvic bones, run in three directions, and attach to the coccyx. The m. levator ani is formed by the pubococcygeus (m. pubococcygeus) and iliococcygeus (m. iliococcygeus) muscles. The muscles and Fasciae of the pelvic floor perform the following vital Functions:

- the pelvic floor serves as a support for the internal genital organs, helping to maintain their normal anatomical position;

- the pelvic floor provides support not only for the internal reproductive organs but also for other abdominal viscera;

- during childbirth, as the fetus is expelled, all three layers of the pelvic floor muscles stretch to form a wide canal that serves as a continuation of the bony birth canal.