A female patient is found to have an ectopic pregnancy. In order to gain access to the peritoneal cavity endoscopically to remove the embryo, the instrument can be passed into the vagina and through the?
In females, the rectouterine pouch is a peritoneal fold reflecting from the rectum to the posterior fornix of the vagina. This means that an incision made through the posterior fornix of the vagina will allow a surgeon to enter the rectouterine pouch of the peritoneal cavity and remove the embryo. Entering the anterior fornix of the vagina would not allow a surgeon to enter the peritoneal cavity. In fact, one might pierce through into the bladder. The cervix is the inferior poion of the uterus which connects the uterus to the vagina. Passing through the cervix would allow the surgeon to enter the uterus, but not the peritoneal cavity. Ref:Cunningham F.G., Leveno K.J., Bloom S.L., Hauth J.C., Rouse D.J., Spong C.Y. (2010). Chapter 2. Maternal Anatomy. In F.G. Cunningham, K.J. Leveno, S.L. Bloom, J.C. Hauth, D.J. Rouse, C.Y. Spong (Eds), Williams Obstetrics, 23e.
Anterior fornix
Cervix
Posterior fornix
Retropubic space