Question

G2L2 woman delivered at home by a trained dai presents with uterine prolapse. Which structure is weak?

• A. Round ligament
• B. Broad ligament
• C. Cardinal ligament
• D. Uterosacral ligament

Hint:

For uterine prolapse, remember the key support: cardinal ligament.

Answer 1

The Correct Option is C

Step 1: Understanding the Question:
The patient has Pelvic Organ Prolapse (uterine prolapse) following multiple deliveries. We need to identify the primary anatomical support of the uterus that has failed.
Step 2: Detailed Explanation:

Pelvic Supports: The uterus is held in place by a combination of pelvic floor muscles (the levator ani) and several ligaments.

Cardinal Ligament (Mackenrodt's): These are the transverse cervical ligaments. They extend from the side of the cervix and lateral vaginal vault to the lateral pelvic wall. They provide the primary lateral support and are considered the most important ligaments for preventing the uterus from descending into the vagina.

Uterosacral Ligaments (D): These provide posterior support, pulling the cervix backward and keeping the uterus in an anteverted position. Their weakness also contributes to prolapse.

Ligaments with minimal support:
- Round Ligament (A): Keeps the uterus anteverted but provides almost no structural support against gravity.
- Broad Ligament (B): A fold of peritoneum that carries vessels but does not provide significant mechanical support.

Clinical Correlation: In women with multiple vaginal deliveries (G2L2), especially those with poor obstetric care (delivered by "dai" without proper perineal support), the cardinal and uterosacral ligaments can become stretched and weakened, leading to prolapse.

Step 3: Final Answer:
The Cardinal ligament is the principal structural support of the uterus, and its weakness is the main factor in uterine descent.