The uterine artery arises from the anterior division of the internal iliac artery and runs medially across the pelvic floor in the base of the broad ligament to reach the lateral wall of the uterus at the level of the cervix. It crosses superior to the ureter (water passes under the bridge) before ascending along the lateral uterus in a tortuous course, giving branches to the cervix, body, and fundus, and anastomosing with the ovarian artery at the fundus.
The relationship of the uterine artery to the ureter is one of the most clinically important in pelvic surgery: the artery crosses 2 cm lateral to the cervix, superior to the ureter. During hysterectomy, the ureter is at risk when the uterine artery is clamped and ligated. Uterine artery embolisation (UAE) is a minimally invasive treatment for symptomatic uterine fibroids, performed by interventional radiologists via femoral artery access. The uterine artery dilates dramatically during pregnancy to meet the demands of the gravid uterus and placenta.
The uterine artery is the primary haemorrhage risk in hysterectomy; inadvertent avulsion or incomplete ligation causes torrential pelvic bleeding requiring vascular clamp control and re-ligation, always confirmed to be away from the ureter.
Uterine atony, placental site bleeding, or uterine artery disruption after delivery produces postpartum haemorrhage exceeding 500 mL, managed progressively from uterotonic drugs to uterine massage, tamponade balloons, surgical ligation, UAE, and hysterectomy as a last resort.
