The broad ligament is a double fold of peritoneum draping over the uterus, fallopian tubes, and ovaries, creating the parametrium. It contains the round ligament anteriorly, the ovarian ligament posteriorly, and the fallopian tubes at its superior border, as well as the uterine artery and ureter in its inferior base. The ureter runs through the base of the broad ligament under the uterine artery — the relationship memorised as water under the bridge.
| Origin | Lateral uterine walls |
|---|---|
| Insertion | Pelvic side walls and floor |
| Actions | Suspends the uterus; contains the round ligament, ovarian ligament, fallopian tubes, uterine and ovarian vessels; creates the peritoneal pouch around the uterus |
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The uterine artery crosses over the ureter in the broad ligament base 2 cm lateral to the cervix — the most clinically important relationship in gynaecological surgery. Ureteral injury during hysterectomy most commonly occurs at this location. Total hysterectomy requires careful identification of this crossing point to avoid ureteral ligation or division when tying the uterine artery pedicles.
Ureter transection or ligation at the broad ligament base where the ureter crosses under the uterine artery 2 cm lateral to the cervix, avoided by careful anatomical dissection.
