Culdocentesis

Kuldotsentez is an invasive method of diagnosis, in which the puncture of the posterior fornix of the vagina for diagnostic or therapeutic purposes is performed. Given the low availability of minimally invasive and non-invasive diagnostic methods at the primary and secondary level of medical care, with acute gynecological pathology, which requires immediate action, this method is a priority and most informative. Although the culture cen- thesis has its own shortcomings, it is necessary to know the basic principles and purposes of such diagnostics.

Indications for the procedure

Kuldotsentez is an invasive intervention that can only be performed by a doctor obstetrician-gynecologist who has the appropriate qualifications for such methods. It should be carried out taking into account all the rules of aseptic and antiseptic, therefore it is considered mandatory to conduct in an operating or clean dressing. This method is invasive, which increases the risk of possible complications, so its use is limited to cases where it is difficult to establish a true diagnosis or differentiate similar pathologies. Often, acute gynecological pathologies can be diagnosed by ultrasound. In this case, you can determine the free fluid in the zatocechnom space, rupture of the cyst or other pathology. If there is no possibility to conduct ultrasound of pelvic organs, which can be in emergency situations when calling home or at night, then the culture is a method of choice. Therefore, indications for the conduct of a culture-centhesis are:

  1. suspicion of an interrupted ectopic pregnancy and bleeding into the extrauterine space;
  2. suspicion of rupture of the ovarian cyst;
  3. apoplexy of the ovary with bleeding;
  4. Ovarian cancer - to clarify the diagnosis and definition of atypia;
  5. any suspicion of the presence of fluid in the extrauterine space (Douglas) with the clinic of the acute abdomen.

In any case, the condition for the puncture of the posterior vaginal vault is the overhanging of the posterior for manual palpation and examination in mirrors, as well as a positive symptom of fluctuations or "floating uterus." At the same time, it is possible to perform ultrasound or laparoscopy, which is a less invasive method, but if there is no time for this and the possibilities, then this is an indication for the culdocentesis.

Preparation

Preparation for this procedure does not take much time, because the minutes played play a role. As a rule, the procedure is performed under local anesthesia.

First, external genitalia are treated with alcohol and antiseptic. Then the mirror is inserted into the vagina, which allows you to limit the field for intervention. The lower lip is removed downward, then the puncture site is indicated. This place is located in the posterior vaginal vault along the median line below the external pharynx. Using a long and thick puncture needle, a puncture is carried out until a sensation of failure occurs. Then attach the piston and draw the contents. By its nature, you can not only determine the diagnosis, but also to indicate the further tactics of treatment.

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Technique of the cultivation

In addition to determining the indications for this procedure, it is also necessary to determine the correct tactics for the intervention to be diagnostic justified.

The uterus is in the small pelvis between the bladder in front and the rectum from behind. Accordingly, there are depressions in these places, which are covered by the peritoneum. The space between the uterus and rectum is the most significant and it is located in such a way that it is below all the cavities, that is, if it gets into a small pelvis of free fluid, it flows right there. This space utero-rectum is also called Douglas. In the culture center, a puncture is performed through the posterior vaginal vault of this space, since it is here that it is possible to determine blood, free fluid, exudate or other pathological fluids.

Kuldocenthesis in the ovarian cyst can be performed if there is a suspicion of rupture of such a cyst for the purpose of differentiating an ectopic pregnancy. In this case, the contents of the punctate will be in the form of serous fluid in case of ruptured cyst, and with ectopic pregnancy or apoplexy of the ovary - spotting of different intensity and volume.

Contraindications to the procedure

Contraindications to culdocentesis are limited only by absolute ones, since this method may be necessary to establish a diagnosis. The main contraindications include:

  1. inflammatory diseases of the vagina and uterus - invasive intervention can cause not only the spread of the process into the cavity of the small pelvis, but can also significantly worsen the course of the underlying disease;
  2. cancer of the uterus - is contraindicated due to the risk of contact metastasis;
  3. suspicion of continued bleeding of small pelvic organs in large volume, which can cause hemorrhagic shock;
  4. pregnancy;

These are the contraindications that must be taken into account, but by weighing the importance and diagnostic value of the procedure in each case individually.

Advantages and disadvantages of cultivation

The advantage of a culture-cen- thesis can be considered its accessibility and speed of diagnosis in difficult situations. That is why it can be considered though outdated, but very informative method. But there are drawbacks, as it is an invasive method and further complications are possible. Inflammatory exogenous processes in the small pelvis can develop, and also the rehabilitation period is prolonged with this method. Therefore, if it is possible to verify the diagnosis with ultrasound, the latter method should be used.

The consequences of a culture-centhesis can be in the form of adhesive processes in a small pelvis, if such a puncture was not a single one. Also, attention should be paid to the condition of the uterus after such a procedure, since there may be a minor hematoma when a medium-sized vessel is injured and prolonged bleeding from it.

The rehabilitation period after culdocentesis, as a rule, corresponds to the main pathology, because of which it was carried out. That is, if the ectopic pregnancy was the cause, which was confirmed, the rehabilitation should be carried out for at least three months. For this period, you also need to give up sexual relations. The next pregnancy is recommended to be planned after a year. Care of the genitals does not require special intervention, you need a simple hygienic care with the monitoring of the condition and examination of the gynecologist one month after the procedure.

Kuldotsentez, although an invasive method of diagnosis, but it is very informative, so it can be used for diagnosis and differential diagnosis of acute gynecological pathology. It is necessary to know the basic conditions of its conduct and indications, so that the procedure has as few negative consequences as possible and was diagnostically significant.

Last update: 26.06.2018

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