A 29-year-old woman with Stage III endometriosis has her endometriosis scored using the rASRM classification. She scores 48 points. The rASRM Stage IV threshold is >40 points. Which finding in the classification contributes MOST points?
- A Superficial peritoneal endometriosis lesion >3 cm
- B Left ovarian endometrioma >3 cm
- C Complete posterior cul-de-sac obliteration ✓
- D Partial left adnexal adhesion, filmy type
Correct answer: C. Complete posterior cul-de-sac obliteration
Explanation
In the rASRM (revised American Society for Reproductive Medicine) scoring system, complete obliteration of the posterior cul-de-sac (pouch of Douglas) is awarded 40 points — the single highest-weighted individual item in the classification. This reflects the severe anatomical distortion and adhesion formation associated with complete POD obliteration. An ovarian endometrioma >3 cm scores 16 points (ovary deep ≥3 cm), and superficial peritoneal lesion >3 cm scores only 4 points.
Reference: Shaw's Textbook of Gynaecology, 17th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.