Overview

Length≈10–12 cm

The round ligament attaches to the uterus just below and in front of the entry of the uterine tube, runs anterolaterally between the layers of the broad ligament, crosses the external iliac vessels, hooks around the inferior epigastric artery to enter the deep inguinal ring, traverses the inguinal canal (accompanied by the genital branch of the genitofemoral nerve and the ilioinguinal nerve), and ends in the subcutaneous tissue of the labium majus. It contains smooth muscle, a small artery (from the uterine artery and a branch of the inferior epigastric) and lymphatics that drain part of the uterine fundus/cornua to the superficial inguinal nodes. It helps keep the uterus anteverted.

Location: From the lateral angle of the uterus below the tube, within the broad ligament, through the inguinal canal to the labium majus.

Anatomy

Development: Distal part of the gubernaculum (the proximal part becomes the ovarian ligament).

Function

Helps maintain anteversion of the uterus.
Carries lymphatics from the uterine fundus to the inguinal nodes.

Clinical significance

Round ligament pain

Sharp groin or lower abdominal pain in the second trimester as the ligament stretches with the enlarging uterus; varicosities of its veins in pregnancy can mimic an inguinal hernia.

Canal of Nuck

A patent processus vaginalis accompanying the round ligament in females can cause an inguinal hernia or hydrocele of the canal of Nuck.

Test yourself

The round ligament of the uterus ends in the:

Sacrum
Labium majus, after passing through the inguinal canal
Lateral pelvic wall over the external iliac vessels
Ovary

Answer: Labium majus, after passing through the inguinal canal

The round ligament runs from the uterotubal junction through the deep inguinal ring and inguinal canal to the subcutaneous tissue of the labium majus. Like the ovarian ligament, it is a remnant of the gubernaculum.