How is the puncture performed?
After treatment and anesthesia, the cervix is fixed with bullet forceps and retracted anteriorly, the posterior fornix is stretched, and the needle on a syringe is inserted 1–2 cm strictly along the midline into the retrouterine space; the contents are aspirated. Dark non-coagulable blood is a sign of intra-abdominal bleeding, pus is an abscess (sent for culture), serous fluid is sent for cytology. When puncturing an ovarian cyst, the needle is inserted under the control of a vaginal ultrasound probe, and the contents are examined cytologically. The result is assessed immediately and determines further tactics: emergency laparoscopy, drainage, antibiotics or observation.
Indications
- suspicion of a disturbed ectopic pregnancy, ovarian apoplexy with an unclear ultrasound picture - detection of blood in the pelvis;
- suspicion of a purulent process (pyosalpinx, abscess of the pouch of Douglas) - obtaining pus for culture and drainage;
- fluid in the retrouterine space of unknown origin - cytology;
- aspiration of the contents of a functional ovarian cyst under ultrasound (according to indications), collection of eggs during IVF (transvaginal puncture).
The role of the method today
With the advent of accurate ultrasound and laparoscopy, posterior fornix puncture is used less frequently, but remains a quick and accessible way to confirm intra-abdominal bleeding or pus when ultrasound is equivocal and laparoscopy is not immediately available: obtaining dark, non-coagulable blood confirms a ruptured tube or ovary and determines urgent surgery. The method also allows you to drain the pelvic abscess and evacuate the contents of the cyst. It is performed by an experienced gynecologist in conditions that allow, if necessary, to proceed to surgery.
