UBC Faculty Research and Publications

Prediction of Pouch of Douglas obliteration : Point-of-care ultrasound vs. pelvic examination Arion, Kristina; Aksoy, Tuba; Allaire, Catherine; Noga, Heather; Williams, Christina; Bedaiwy, Mohamed Ali, 1968-; Yong, Paul J.


Study Objective: To evaluate point-of-care pre-operative transvaginal ultrasound (TVUS) sliding sign, in comparison to palpation of a nodule on digital pelvic examination, for the prediction of pouch of Douglas (POD) obliteration. Design: Analysis of data from a prospective data registry (Canadian Task Force Classification II-2). Setting: Tertiary referral center. Patients: Women with suspected endometriosis who had pre-operative pelvic examination and point-of-care TVUS, followed by laparoscopic surgery between August 2015 and December 2016. Intervention: Women were pre-operatively assessed for prediction of POD obliteration with pelvic examination for a nodule and point-of-care TVUS uterine-cervix sliding sign. Measurements and Main Results: The study included 269 women, of which 15.2% (41/269) had POD obliteration at the time of surgery. A pre-operative negative sliding sign had a sensitivity of 73.2% (95% CI: 57.1-85.8%) and specificity of 93.9% (95% CI: 89.9-96.6%) in prediction of POD obliteration, compared to pre-operative palpation of a nodule on pelvic examination which had a sensitivity of 24.4% (95% CI: 12.4-40.3%) and 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 need for ureterolysis. Conclusion: Point-of-care TVUS sliding sign demonstrated significantly improved sensitivity compared to palpation of a nodule on pelvic examination for prediction of POD obliteration. Therefore, point-of-care TVUS sliding sign improves the pre-operative assessment of POD disease, and thus may lead to more optimal surgical planning in women with suspected endometriosis

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