Puncture of abdominal cavity through posterior vaginal vault

 The puncture of the posterior fornix is performed in a hospital with the observance of aseptic and antiseptic rules with a 10-12 cm thick needle, put on a 10 ml syringe. 

Indications for conduction

Indication for puncture through the posterior vaginal vault is the suspicion of the presence of free fluid in the cavity of the small pelvis to clarify the diagnosis of ectopic pregnancy, with an indistinct clinical picture. In the case of difficult differential diagnosis between pelvioperitonitis and impaired ectopic pregnancy, the puncture helps to recognize the inflammatory process. Puncture through the anterior abdominal wall is performed in the presence of ascites. The ascitic fluid is tested for the content of atypical cells to exclude a malignant tumor. The absence of atypical cells in the ascites fluid can indicate an association of ascites with heart disease, cirrhosis of the liver. Through the posterior arch, puncture is done with suspicion of tubal pregnancy, sometimes with acute inflammatory processes of the uterine appendages and pelvic peritoneum in order to detect blood, serous or purulent effusion in the abdominal cavity.

Puncture is used to take an aspirate in case of suspected ovarian cancer.

Preparation

Before the operation, it is necessary to empty the bladder and intestine. With puncture of the posterior fornix, inhalation, intravenous anesthesia or local anesthesia with a 0.25% solution of novocaine in an amount of 5.0-10.0 ml is used. Through the posterior vaginal vault

Technique of puncture of the inverted arch

The patient is placed on a gynecological chair. The external genitalia, vagina and cervix are disinfected with alcohol and 5% tincture of iodine. With the help of the rear mirror and the lift, the vaginal part of the cervix is exposed and the back lip is grasped with bullet forceps. The lift is removed, the rear mirror is handed over to the assistant. The cervix is tightened by bullet forceps on itself and anteriorly, while the mirror is pressed against the back wall of the vagina and thus maximally stretches the posterior fornix. Under the neck of the uterus strictly along the middle line, having retreated 1 cm from the place where the vault crosses into the vaginal part of the cervix, the needle is guided through the posterior arch. The needle penetrates to a depth of 2-3 cm. When piercing the arch, a feeling of needle dropping into the void appears. After this, pull the plunger of the syringe towards you. The liquid is drawn into the syringe. If the liquid does not go into the syringe, you can carefully push the needle inward or, alternatively, slowly remove it and simultaneously pull the syringe plunger toward you. The obtained punctate is examined, its character, color, smell determined.

According to the indications, it is produced by bacteriological, cytological or biochemical research. With an interrupted ectopic pregnancy, the punctate will be a liquid blood of a dark color. Small white blood clots are found on a white napkin.