Puncture of the posterior vaginal fornix: indications, procedure, evaluation of the result

In modern medicine, there are many different diagnostic methods that can quickly and accurately confirm or disprove the alleged diagnosis. Some techniques are simple and do not require patients to special preparations. In this case, the procedures themselves are carried out quickly, without any effort. Other methods can cause discomfort, but you can not do without them. One such manipulation is puncture of the posterior vaginal fornix.

Features of the procedure

The function of the posterior vaginal fornix has its own characteristics. It is performed with a diagnostic purpose to detect the contents of the rectum-uterine cavity. Less often this procedure is performed as an auxiliary one.

Puncture of the posterior vaginal vault requires anesthesia. Patients are given short-term anesthesia or local conductive anesthesia is performed.

In order for the diagnosis to be effective, the patient should lie down so that her pelvis is located downwards. This position helps drain even a small amount of liquid located in the rectum-uterine zone. This at times increases the effectiveness of the manipulation.

Indications

Puncture of the posterior vaginal fornix is ​​used when suspicion of rupture of the uterus and other internal organs, as well as:

• when suspected of having any type of liquid in the small pelvis;
• if necessary, administer medications;
• for suspected ovarian cancer;
• at break of purulent pathologies into the abdominal cavity.

Puncture through the posterior vaginal fornix allows you to accurately determine the presence of fluid and its appearance without surgical intervention.

Where is the procedure performed?

Manipulation is carried out only in a hospital, as it is a surgical kind of intervention. During the procedure, all the rules of antiseptics and asepsis are observed. Before the puncture, the patient should empty the bladder and intestine. For these purposes, a cleansing enema may be prescribed.

Most often, nitrous oxide or any other mask anesthesia is used for anesthesia. Less common is general intravenous anesthesia and local anesthesia in the form of a solution of novocaine.

How is it conducted?

Puncture of the abdominal cavity through the posterior vaginal vault is performed by a long thick needle. Its size is more than ten centimeters. The needle is put on a 10- or 20-gram syringe.

The patient is located in the gynecological chair. After placement, the doctors carry out the treatment of the female genitalia. Usually, a solution of iodonate is used for this. Then a mirror and a lift are introduced into the vagina, which helps to determine the location of the cervix. The doctor performs the seizure of the organ by the back lip with forceps. After that, the lift is removed, and the mirror is transferred to the assistant.

Under the cervix, the doctor makes a puncture with a needle. It is carried out, retreating a few centimeters from the place where the vagina passes into the cervix. At the selected site, the needle is inserted into the abdominal cavity. During the puncture, the specialist feels how the instrument for puncturing the posterior vaginal vault fell into the void. Then the doctor pulls the piston toward him. If there is liquid in the cavity, then it begins to enter the syringe.

Fluid and its value

The punctate is inspected, determining its character. As a result of the procedure, blood, pus, serous fluid can be detected. According to the indications, a bacteriological, cytological or other type of analysis of the obtained fluid is carried out.

When the purulent contents appear, the doctor may suggest a rupture of the abscess, peritonitis. The presence of pathological contents may indicate an abscess of the uterine appendages.

If there is blood in the cavity, then this indicates bleeding. It can be caused by rupture of the uterine tube in ectopic pregnancy. In this case, the blood has a dark color with an admixture of clots. Also, it can get into the cavity because of the rupture of the inner vessel. In this case, it quickly collapses.

There are times when the doctor can not get the liquid, although it is in the cavity. This procedure is due to the fact that the needle is clogged with a blood clot. To the doctor was able to get the result, he must remove the needle and push the clot out of it with air. Usually it is done on a napkin so that you can determine the presence of blood. If the clot is extracted, and there is no blood in the syringe's cylinder, then even this will be enough to suggest an ectopic pregnancy.

It happens that it is not possible to suck the liquid out of the recess due to too high a density. In this situation, a sterile sodium chloride solution is introduced into the cavity to dilute the liquid. In this more liquid state, the solution is easily collected and transferred to the laboratory for analysis.

After manipulation of

At the end of the procedure, the set used to puncture the posterior vaginal vault is decontaminated. If a disposable tool is used, it is recycled.

After the operation, the patients can go home. Complications after puncture occur extremely rarely.

Blood can be detected not only with ectopic pregnancy, but also in other pathological conditions. For example, it appears with apoplexy of the ovary, with a rupture of the spleen, the ingress of menstrual blood into the arch and in other types of pathologies.

If a purulent infection is detected during the puncture, the doctor sucks it off, and injects an antibiotic into the depression.

Puncture is an informative procedure conducted not only with a diagnostic, but also with a therapeutic purpose. Through the puncture, the doctor can quickly inject the medication exactly into the affected area.