Prediction of Pouch of Douglas Obliteration: Point-of-care Ultrasound Versus Pelvic Examination

Kristina Arion, Arion K, Tuba Aksoy, Aksoy T, Allaire C, Catherine Allaire, Heather Noga, Christina Williams, Williams C, Mohamed A. Bedaiwy, Paul J. Yong
Journal of Minimally Invasive Gynecology · 2018 · vol. 26(5) , pp. 928–934 · doi:10.1016/j.jmig.2018.09.777 · PMID:30267896 · W2892934671
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Point-of-care ultrasound was evaluated against pelvic examination for accurately predicting obliteration of the Pouch of Douglas in patients.

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Abstract

Study objectiveTo evaluate the point-of-care preoperative transvaginal ultrasound (TVUS) sliding sign in comparison with palpation of a nodule on digital pelvic examination for the prediction of pouch of Douglas (POD) obliteration.DesignAnalysis of data from a prospective data registry (Canadian Task Force classification II-2).SettingA tertiary referral center.PatientsWomen with suspected endometriosis who had preoperative pelvic examination and point-of-care TVUS followed by laparoscopic surgery between August 2015 and December 2016.InterventionsWomen were preoperatively assessed for the prediction of POD obliteration with pelvic examination for a nodule and point-of-care TVUS uterine/cervix sliding sign.Measurements and main resultsThe study included 269 women, 15.2% (41/269) of whom had POD obliteration at the time of surgery. A preoperative negative sliding sign had a sensitivity of 73.2% (95% confidence interval, 57.1%-85.8%) and a specificity of 93.9% (95% CI, 89.9%-96.6%) in the prediction of POD obliteration compared with preoperative palpation of a nodule on pelvic examination, which had a sensitivity of 24.4% (95% CI, 12.4%-40.3%) and a specificity of 93.4% (95% CI, 89.4%-96.3%). The difference in sensitivity was statistically significant (McNemar test, p <.001). A negative sliding sign was also associated with longer operating times and more difficult surgery including the need for ureterolysis.ConclusionThe point-of-care TVUS sliding sign showed significantly improved sensitivity compared with palpation of a nodule on pelvic examination for the prediction of POD obliteration. Therefore, the point-of-care TVUS sliding sign improves the preoperative assessment of POD disease and thus may lead to more optimal surgical planning in women with suspected endometriosis.

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Condition tags

endometriosis

MeSH descriptors

Douglas' Pouch Endometriosis Gynecological Examination Palpation Palpation Peritoneal Diseases Point-of-Care Systems Adult Cohort Studies Douglas' Pouch Douglas' Pouch Endometriosis Endometriosis Female Gynecological Examination Humans Middle Aged Pelvis Pelvis Pelvis

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