In modern medicine, there are many different diagnostic methods that can quickly and accurately confirm or refute the alleged diagnosis. Some methods are simple and do not require any special preparations from patients. In this case, the procedures themselves are carried out quickly, without any effort. Other methods can cause discomfort, but without them it is impossible to do. One of these manipulations is the puncture of the posterior vaginal fornix.
Features of the procedure
Puncture of the posterior vaginal fornix has its own characteristics. It is carried out for diagnostic purposes to identify the contents of the rectal uterine cavity. Less commonly, this procedure is performed as an auxiliary.
Puncture of the posterior vaginal fornix requires anesthesia. Patients undergo short-term anesthesia or local conduction anesthesia is performed.
For the diagnosis to be effective, the patient should lie down so that her pelvis is down. This situation helps to drain even a small amount of fluid located in the rectal uterine zone. This significantly increases the effectiveness of the manipulation.
Indications
Puncture of the posterior vaginal fornix is used for suspected rupture of the uterus and other internal organs, as well as:
- if you suspect the presence of any type of fluid in the pelvis;
- if necessary, introduce drugs;
- with suspected ovarian cancer;
- with a breakthrough 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, since it is a surgical type of intervention. During the procedure, all the rules of antiseptic and aseptic are followed. Before the puncture is performed, the patient must empty the bladder and intestines. For these purposes, a cleansing enema may be prescribed.
Most often, nitrous oxide or any other mask anesthesia is used for anesthesia. Less commonly used are general intravenous anesthesia and local anesthesia in the form of a solution of novocaine.
How is it carried out?
Puncture of the abdominal cavity through the posterior vaginal fornix is performed with 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, doctors conduct treatment of the external genitalia of a woman. Usually, a solution of iodonate is used for this. Then, a mirror and a lift are inserted into the vagina, which helps determine the location of the cervix. The doctor grabs the organ behind the back lip with forceps. After that, the lift is removed, and the mirror is transferred to the assistant.
Under the cervix, the doctor punctures the needle. It is performed by stepping back a few centimeters from the place where the vagina passes into the neck. At the selected location, the needle is inserted into the abdominal cavity. During the puncture, the specialist feels how the instrument for puncture of the posterior vaginal fornix got into the void. Then the doctor pulls the piston towards himself. If there is fluid in the recess, then it begins to flow into the syringe.
Liquid and its meaning
Punctate is examined, determining its nature. As a result of the procedure, blood, pus, serous fluid can be detected . According to indications, bacteriological, cytological or other type of analysis of the obtained fluid is carried out.
With the appearance of purulent contents, the doctor may suggest a rupture of the abscess, peritonitis. The presence of pathological contents may indicate an abscess of the uterus.
If there is blood in the recess, then this indicates bleeding. It can be caused by a rupture of the fallopian tube during an ectopic pregnancy. In this case, the blood has a dark color with an admixture of clots. It can also fall into the recess due to rupture of the inner vessel. In this case, it quickly collapses.
There are times when the doctor is unable to get the liquid, although it is in the cavity. This version of the procedure is due to the fact that the needle is clogged with a blood clot. In order for the doctor to get the result, he must remove the needle and push the clot out of it with air. This is usually done on a napkin so that the presence of blood can be determined. If a clot is obtained and there is no blood in the syringe barrel, even this will be enough to suggest an ectopic pregnancy.
It happens that it is not possible to suck out the liquid from the recess due to too high 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
At the end of the procedure, the used kit for puncture of the posterior vaginal fornix is subjected to disinfection. If a disposable tool was used, then it is disposed of.
After surgery, patients can go home. Complications after a puncture are extremely rare.
Blood can be detected not only during ectopic pregnancy, but also in other pathological conditions. For example, it appears with ovarian apoplexy, with rupture of the spleen, ingestion of menstrual blood and other types of pathologies.
If purulent contents are detected during a puncture, the doctor sucks it off and introduces an antibiotic into the cavity.
Puncture is an informative procedure carried out not only for diagnostic, but also for therapeutic purposes. Through a puncture, the doctor can quickly inject the drug exactly into the affected area.