OC10.05: Can we predict pouch of Douglas obliteration using sonovaginography in women with chronic pelvic pain?

To use sonovaginography (SVG) to predict pouch of Douglas obliteration in women with chronic pelvic pain, prior to endometriosis surgery. This is a continuing, prospective observational study, which began in June 2009. All women included in this study were of reproductive age, had history of chronic pelvic pain, and had a plan for laparoscopic endometriosis surgery. A history was obtained and an ultrasonographic evaluation with sonovaginography (SVG) was performed on all women prior to laparoscopy. During SVG, a transvaginal (TV) ultrasound was performed with the introduction of gel into the posterior fornix of the vagina. The gel created an acoustic window between the TV probe and the surrounding structures of the vagina, allowing for visualization of the pouch of Douglas (POD). Women then underwent laparoscopic surgery for diagnosis and, if necessary, surgical treatment of endometriosis. The correlation between SVG findings and laparoscopic findings was then analysed to assess the ability of SVG to predict obliteration of the POD prior to surgery. To date, complete SVG and laparoscopic data was available for 21 women. For predicting POD obliteration, the sensitivity and specificity of SVG were 83% and 100%, respectively. The PPV and NPV were 100% and 94%, respectively. Although the numbers are small, this ongoing study demonstrates that SVG can predict POD obliteration. This has potential implications for the selection of women for specialist advanced laparoscopic intervention.