The American Society for Reproductive Medicine (ASRM) revised classification of endometriosis (r-ASRM) assigns scores based on lesion characteristics. Which anatomical feature, when present, contributes the HIGHEST single-lesion score in the r-ASRM system?
- A Right ovarian endometrioma >3 cm
- B Posterior cul-de-sac complete obliteration ✓
- C Left fallopian tube filmy adhesion enclosing <1/3 tube
- D Bilateral peritoneal deep endometriosis lesions >3 cm each
Explanation
In the r-ASRM endometriosis classification (1996 revision), complete posterior cul-de-sac (pouch of Douglas) obliteration scores 40 points alone — the maximum single-feature score. This reflects the severe functional impact of complete obliteration with fixation of uterus to rectum. Stage IV (severe) requires only ≥40 points total, meaning complete cul-de-sac obliteration alone places a patient in Stage IV. By comparison, an ovarian endometrioma >3 cm (A) scores 20 points; filmy tubal adhesions (C) score 1–4 points; and bilateral peritoneal lesions >3 cm (D) score 6 points each. Posterior cul-de-sac obliteration is therefore the highest-weighted single item in r-ASRM.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
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Written and medically reviewed by the StethoPrep medical team.