> MANUAL VACUUM ASPIRATION > DILATATION AND CURETTAGE > CULDOCENTESIS > COLPOTOMY > SALPINGECTOMY FOR ECTOPIC PREGNANCY > REPAIR OF RUPTURED UTERUS > MANUAL REPAIR OR PLACENTA > REPAIR OF CERVICAL TEARS > REPAIR OF VAGINAL AND PERINEAL TEARS > UTERINE INVERSION > UTERINE AND UTERO-OVARIAN ARTERY LIGATION > POSTPARTUM HYSTERECTOMY CULDOCENTESIS 1 Apply antiseptic solution to the vagina (especially the posterior fornix). 2 Provide emotional support and encouragement. If necessary, use local infiltration with lidocaine. 3 Gently grasp the posterior lip of the cervix with a tenaculum and gently pull to elevate the cervix and expose the posterior vagina. 4 Place a long needle (e.g. spinal needle) on a syringe and insert it through the posterior vagina, just below the posterior lip of the cervix (Figure 12.10). Figure 12.10 5 Pull back on the syringe to aspirate the pouch of Douglas (the space behind the uterus): • If non-clotting blood is obtained, suspect ectopic pregnancy • If clotting blood is obtained, a vein or artery may have been aspirated; remove the needle, re-insert it and aspirate again • If clear or yellow fluid is obtained, there is no blood in the peritoneum; the woman may, however, still have an unruptured ectopic pregnancy and further observations and tests may be needed • If no fluid is obtained, remove the needle, reinsert it and aspirate again; if no fluid is obtained, the woman may have an unruptured ectopic pregnancy • If pus is obtained, keep the needle in place and proceed to colpotomy. > MANUAL VACUUM ASPIRATION > DILATATION AND CURETTAGE > CULDOCENTESIS > COLPOTOMY > SALPINGECTOMY FOR ECTOPIC PREGNANCY > REPAIR OF RUPTURED UTERUS > MANUAL REPAIR OR PLACENTA > REPAIR OF CERVICAL TEARS > REPAIR OF VAGINAL AND PERINEAL TEARS > UTERINE INVERSION > UTERINE AND UTERO-OVARIAN ARTERY LIGATION > POSTPARTUM HYSTERECTOMY