During a hysterectomy, the surgeon isolates the uterine artery at the level of the cervix and must ligate it safely. The uterine artery is a branch of which trunk, and what structure must be identified before clamping?

• A Posterior division of internal iliac; obturator nerve
• B Internal pudendal artery; pelvic splanchnic nerves
• C Anterior division of external iliac; bladder base
• D Anterior division of internal iliac; ureter ✓

Explanation

The uterine artery arises from the anterior division of the internal iliac artery and crosses the floor of the pelvis in the root of the broad ligament. Roughly 2 cm lateral to the cervix it passes superior to the ureter, giving the teaching phrase water flows under the bridge. The ureter is therefore at direct risk during ligation. The posterior division of the internal iliac supplies the body wall and gluteal region, not the uterus.

Reference: Moore's Clinically Oriented Anatomy, 9th ed.

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Written and medically reviewed by the StethoPrep medical team.