Definition - What does Culdocentesis mean?

Culdocentesis is a procedure that involves the withdrawal of abnormal fluid from the space just behind the uterus called as the cul de sac using a needle. The use of culdocentesis has now decreased due to the wide availability of ultrasound to detect conditions such as ectopic pregnancy, tubal rupture, and collection of blood in the peritoneal cavity (called hemoperitoneum). However, culdocentesis has a major role in relieving the symptoms of ovarian hyperstimulation syndrome (OHSS), which is a potentially serious complication of fertility medications used during in vitro fertilization (IVF). A transvaginal ultrasound (TVUS) is used to guide this procedure. The procedure can be performed in an outpatient clinic.

FertilitySmarts explains Culdocentesis

The following women are candidates for a culdocentesis:

  • Women with pelvic inflammatory disease, in which pus-filled fluid can be extracted
  • Women with ruptured ectopic pregnancies that result in hemoperitoneum
  • Women with ovarian hyperstimulation syndrome (OHSS) to tap the excess abdominal fluid that is causing abdominal enlargement

In this procedure, after sterilizing the vagina, the patient is asked to lie down with the feet positioned above or at the same level as the hips (often in stirrups). The doctor then introduces an instrument to open up the vagina. Some doctors then prefer injecting a local anesthetic to numb the area whereas most do not. An ultrasound machine with a vaginal probe that is connected to a needle guide is inserted. A needle is then passed through the central path of the needle guide and is then coursed through the walls of the vagina into the cul de sac. The needle used is similar to the needle used for an egg retrieval procedure. A vaginal ultrasound is done to determine the location of the fluid relative to the uterus. The fluid is then suctioned from the cul-de-sac.

Following culdocentesis, women with OHSS often report immediate improvement in their symptoms like abdominal distension, discomfort, and difficulty breathing. Most women can resume daily activities following culdocentesis.

Although complications with culdocentesis are rare, the following can be observed:

  • Puncture of the bowel
  • Bleeding from the puncture site due to injury to the blood vessels
  • Rupture of tubal pregnancy

Since OHSS is induced by the pregnancy hormone - human chorionic gonadotropin (hCG), its levels will continue to rise causing OHSS to become more serious and even last longer. This causes re-accumulation of the fluid mandating a repeat culdocentesis.

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