ovarian ligament

**Anatomy** - Also called the utero-ovarian ligament or proper ovarian ligament. It is a round fibromuscular band of connective tissue and smooth muscle. - It attaches the medial (uterine) pole of the ovary to the lateral wall of the uterus, posteroinferior to the uterine tube (fallopian tube) attachment. - It lies within the posterior layer of the broad ligament (mesovarium region). - Continuity: it is continuous with the round ligament of the uterus. Both are derived from the embryonic gubernaculum.

**Embryology** - The ovarian ligament and the round ligament of the uterus both come from the gubernaculum, a fibrous cord attached to the gonad and the labioscrotal swellings. - The part of the gubernaculum between the ovary and uterus becomes the ovarian ligament. - The part between the uterus and labia majora becomes the round ligament of the uterus. It passes through the inguinal canal. - In males, the gubernaculum becomes the gubernaculum testis, which guides testicular descent. Its remnant is the scrotal ligament.

**Key comparisons (high-yield)** - **Ovarian ligament**: ovary to uterus. Remnant of the gubernaculum. It carries no major vessels. - **Suspensory ligament of the ovary (infundibulopelvic ligament)**: ovary to the lateral pelvic wall. It contains the ovarian artery, vein, and nerves. The ureter lies close to it. - **Round ligament of the uterus**: uterine fundus to the labia majora via the inguinal canal. It is a gubernacular remnant. - **Broad ligament**: peritoneal fold that contains the uterine tubes, ovarian ligament, round ligament, and uterine vessels. It is made up of the mesosalpinx, mesovarium, and mesometrium. - **Cardinal (transverse cervical, Mackenrodt) ligament**: cervix and vagina to the lateral pelvic wall. It carries the uterine artery and vein, and the ureter runs beneath it ("water under the bridge"). It is the main support of the uterus.

**Clinical significance** - **Ovarian torsion**: the ovary twists on its ligamentous pedicle, which includes the suspensory and ovarian ligaments. This compromises the blood supply, causing sudden unilateral pelvic pain, nausea, and vomiting. It is often associated with an ovarian mass or cyst, such as a mature cystic teratoma. Doppler ultrasound may show decreased or absent flow, though normal flow does not exclude torsion. Treatment is emergent laparoscopic detorsion, with oophorectomy reserved for non-salvageable tissue. - **Oophorectomy**: surgeons clamp and ligate the infundibulopelvic (suspensory) ligament to control the ovarian vessels. They must identify the ureter to avoid injuring it. The ovarian ligament is divided to free the ovary from the uterus. - **Laxity**: an elongated or lax ovarian ligament may be a risk factor for torsion. - **Blood supply**: ovarian vessels reach the ovary through the suspensory ligament. The ovary also has an anastomotic supply from the uterine artery ovarian branch, which runs along the ovarian ligament and mesovarium. This explains why ovarian blood supply is dual.

**Memory aid** - "Ovary to Uterus": the ovarian ligament connects these two. "Ovary to pelvic wall": suspensory ligament. Both the ovarian and round ligaments arise from the gubernaculum.