Hematometer

Hematometra is a disease characterized by the accumulation of blood in the uterine cavity, which disrupts its contractility with possible further infection. This condition develops for many reasons, but in most cases it is a consequence of invasive intervention. Complications and consequences of this condition are very serious, so it is necessary to diagnose and treat this pathology in time.

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Epidemiology

The epidemiology of this problem shows that among all possible causes of the development of such a condition, postpartum complications account for more than 88% of cases. Invasive interventions – abortions and surgeries – are in second place in terms of prevalence. More than 65% of cases of hematometra are diagnosed already at the stage of complications, that is, during infection, which confirms the enormous role of preventive diagnostics.

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Causes hematometers

Hematometra develops due to the accumulation of blood between the layers of the endometrium, and several conditions are necessary for this. Normally, the menstrual cycle consists of monthly blood discharge due to desquamation of the functional layer of the endometrium. This occurs despite the fact that the structure of the endometrium is not disturbed and the release of hormones contributes to this phenomenon. For blood to accumulate in the uterus, the structure of the layers of the endometrium must be disturbed and there must be an obstacle to the outflow of blood from the uterus. Therefore, the reasons for the development of hematometra are surgical or other invasive interventions that can disturb the structure of the endometrium.

Most often, hematometra develops after childbirth, against the background of a cesarean section or invasive intervention during the period of birth of membranes. Pregnancy and childbirth can be considered the most common cause of hematometra development. The fetus is tightly connected to the uterus for all ten weeks, they have a common blood circulation and the fetal membranes are constantly in contact with the endometrium. After the birth of the child, a large wound surface is formed, which bleeds. Immediately after birth, the uterus contracts, which is a protective mechanism for the development of major bleeding, including hematometra. But if for certain reasons there was insufficient contraction of the uterus, then blood can accumulate in the uterine cavity. The pathogenesis of hematometra formation lies not only in the accumulation of blood, but also in the disruption of its outflow from the vagina. Therefore, another condition is the bending of the uterus or uneven contraction of its different sections. It is after childbirth that the uterus can contract very strongly and go into a position of strong bending - anteflexio or retroflexio, or the lower segment can contract and spasm, blocking the exit from the uterus. Therefore, childbirth is the most common cause of the development of such a condition. Based on this, we can identify the main risk factors for the development of hematometra. These factors include:

• childbirth complicated by bleeding in the third period - this contributes to the disruption of the structure of the endometrium and the blood that accumulates can freely pass through the layers of the endometrium;
• a large fetus or twin births are also an additional factor in trauma to the birth canal;
• ruptures of the uterus or cervix during childbirth;
• hypotension or atony of the uterus during labor does not allow the uterus to contract normally;
• concomitant fibroids can change the structure and thickness of the endometrium and disrupt the normal postpartum discharge of blood and remnants of the fetal membranes;
• Frequent abortions or miscarriages in the anamnesis lead to disruption of the normal structure of the endometrium;
• A history of inflammatory diseases of the uterus – endometritis or myometritis – disrupts the process of uterine contraction after childbirth.

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Risk factors

Taking into account these risk factors, other reasons for the development of hematometra emerge from them. One of such reasons is intervention on the uterus, which is accompanied by curettage of its cavity - abortion, miscarriage, ectopic pregnancy. All these cases are accompanied by bleeding, in which blood can pass through the damaged layers of the endometrium and accumulate there. Hematometra after curettage of a frozen pregnancy develops quite often, since in this case the fetal membranes grow together more tightly with the endometrium. In this case, the frozen fetus enhances the synthesis of connective tissue, which contributes to a strong connection with the uterus. Therefore, after removal of the fetus and curettage of the fetal place, synechiae often remain, which do not allow everything to be removed completely - and this is a high risk of developing hematometra.

Hematometra after a cesarean section can develop only if the uterine cavity has not been fully examined or if it has significantly shrunk and changed position significantly. In this case, the uterine discharge that should normally be there after childbirth cannot come out and accumulates, "saturating" the rigid uterine cavity.

Hematometra after a medical abortion can develop in case of improper behavior or following all recommendations. After all, an abortion also leaves behind a large wound surface, and for some time the remaining blood should come out with discharge. In this case, you need to stay in bed and not lift heavy objects. If there were any violations, this can cause the uterus to contract, which leads to a violation of its topic, so an obstacle may arise in the way of discharge. This will cause the development of hematometra.

Girls can also develop hematometra, and the reason for this can be a partially or completely overgrown maiden hymen. In this case, the girl's menstrual blood may not all come out, but some of it remains. It accumulates in the cavity and gradually seeps through the endometrium, which can lead to serious complications.

Women in menopause may also develop this condition. The main reason is the age-related characteristics of the woman. During this period, menstruation is irregular, often scanty and occurs every two months. At the same time, the size of the uterus itself, the cervical canal and the vagina decreases, which leads to the fact that menstruation may not come out completely. This will cause the development of hematometra.

Given the number of reasons for the development of this pathological condition, it is necessary to conduct a thorough diagnosis of any symptoms in women at risk in order to promptly determine the diagnosis and begin treatment.

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Symptoms hematometers

Hematometra after childbirth develops most often and the clinical picture is not always obvious. The first signs may appear already on the second day after childbirth, and sometimes they may appear only after a week. Under normal conditions, all the remains of the fetal membranes, the maternal part of the placenta and the remains of blood are released after childbirth with special discharge - lochia. They are cyclical and immediately after childbirth they are red, then a light shade of red, and then become white serous discharge. It is the first three days that part of the blood is released, which can be retained in the uterus with the development of hematometra. Therefore, the first and main diagnostic sign of the development of such a condition is the absence of lochia or their scanty nature. Then other symptoms may appear, which are already associated with the accumulation of blood in the cavity. Then the woman feels a pulling pain in the lower abdomen, a feeling of distension in the pelvis. The uterus can increase in size and press on neighboring organs, which can affect the appearance of other symptoms - frequent urination or a feeling of a full bladder.

If hematometra develops after menstruation, then the symptoms of pain in the lower abdomen are very pronounced and are often accompanied by nausea and headache. Hematometra in postmenopause often develops against the background of uterine fibroids. Then the increase in the size of the uterus and the change in the structure of the myometrium due to the numeral nodes leads to the fact that menstrual discharge accumulates with the development of this pathology. Simultaneously with the growth of the fibroid, the symptoms of hematometra may not appear until the moment when the blood volume becomes significant. Then abdominal pain appears and there may be vaginal discharge of an unpleasant nature. There may be purulent discharge, which already indicates the appearance of complications.

After an abortion, there may also be some bloody discharge for some time, and the absence of it or any other discharge may be a symptom of the development of hematometra, so you need to pay attention to the discharge after surgery. Discharge after hematometra is normalized against the background of treatment: at first there is a small bloody discharge, and then serous and normal milky discharge.

Moderate hematometra may not manifest itself in any way, since the small volume does not contribute to any changes. But with a long-term condition, chronic hematometra may develop. This is a condition in which a small amount of blood always accumulates in the uterine cavity, which does not affect the woman's condition. This may be the case if there is a small defect in the bottom of the uterus or the angle of the uterus after some operation, where some blood may accumulate. Over time, this blood may be released, and another one may form in its place. This corresponds to the concept of chronic hematometra.

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Complications and consequences

The consequence of hematometra can often be infection with the development of a large focus of infection. Blood is a nutrient medium for most microorganisms. In the vagina there are not only Doderlein bacilli, but also many opportunistic and pathogenic microbes, which quickly multiply when such an environment appears. Then symptoms of intoxication appear, the body temperature rises, the pain becomes very strong and pus or blood with pus is released from the vagina. This is the most common complication that occurs against the background of hematometra and is diagnosed when these complications appear.

The most serious complication of hematometra after an abortion can be considered a hydatidiform mole. This is a pathology that has a high degree of malignant degeneration. It develops if the remains of the fetal membranes are fixed on the endometrium due to an incomplete abortion. As a result, hematometra can form, which aggravates the condition due to late diagnosis. This condition requires immediate surgical intervention, which can threaten extirpation of the uterus.

Symptoms of such a condition cannot always be diagnosed at the initial stage, but later, if the nature of such discharge changes, it is necessary to suspect a health problem.

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Diagnostics hematometers

Diagnosis of hematometra after childbirth is not particularly difficult, since in the postpartum period the woman is under close medical supervision for three days. The doctor immediately after childbirth monitors the condition of the woman in labor and also evaluates the postpartum discharge. Then, during the first day and until the end of her stay in the maternity hospital, the woman is examined and her condition is assessed. Therefore, if the discharge is insufficient or its nature does not correspond to normal lochia, then there is a suspicion of the possible development of hematometra. In addition, the doctor evaluates the condition of the uterus, its tone, contraction and possible irregularities in location.

Diagnosis of hematometra, which occurs in girls after menstruation against the background of an overgrown maiden hymen, is a little complicated. Here it is necessary to find out from the girl the time of menarche, their nature and the volume of discharge. As a rule, at the beginning of the cycle the amount of discharge is abundant and lasts at least five days. If the girl indicates a scanty nature of discharge and abdominal pain regardless of menstruation, then it is necessary to examine the girl. When examining in mirrors, it is necessary to carefully assess the condition. Tension of the maiden hymen, its cloudy color and pain during palpation indicate the benefit of hematometra.

After an abortion, there should also be vaginal discharge similar to menstruation, so if a woman has come with complaints, it is necessary to clarify the nature of the discharge and whether there was any at all. It is necessary to examine the woman in mirrors and if there is hematometra, the examination will cause pain, there may be changes in the cervix in the form of spasms or discharge from the cervical canal. With bimanual palpation, it is possible to determine limited mobility of the uterus, its tension.

The tests that need to be done if there is a suspicion of hematometra should exclude complications. Therefore, it is necessary to do a general blood test, urine test, and in some cases a biochemical blood test. The changes that may occur are a decrease in hemoglobin or first-degree anemia, if there are infectious complications, then there may be leukocytosis with a shift in the formula to the left.

If hematometra is also complicated by infection with the development of endometritis, then an analysis of vaginal discharge is mandatory to determine the pathological flora and its sensitivity to antibacterial agents.

Instrumental diagnostics are necessary to clarify the diagnosis if hematometra is suspected. The main diagnostic method is ultrasound examination. This method allows diagnosing the presence of blood in the uterine cavity, and also helps to clarify its amount, the condition of the uterine wall, blood circulation, the position of the uterus and appendages. Echo signs of hematometra are a change in the signal in the uterine cavity in the form of areas of enlightenment of varying intensity. An uneven edge of the signal allows us to judge the presence of fluid, and if the blood has clots, then areas of greater signal intensity are determined. It is also possible to determine a change in the position of the uterus in relation to the midline and a violation of the topic.

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Differential diagnosis

Differential diagnostics of postpartum hematometra should be carried out with insufficient involution of the uterus, postpartum septic complications. Insufficient involution of the uterus occurs after childbirth complicated by hypotension or atony of the uterus or weakness of labor. As a result, after childbirth, the uterus does not contract sufficiently and the tone may be impaired, which during palpation may resemble hematometra due to an increase in its size. But unlike hematometra, with insufficient involution, the discharge is not impaired and there are bloody lochia in the first three days. Postpartum septic complications in the form of endometritis or parametritis are accompanied by an increase in the size of the uterus, increased tone, pain during palpation. But unlike hematometra, with inflammatory processes there is an increase in temperature to hectic numbers and symptoms of intoxication are expressed.

If hematometra develops in a woman in menopause, it is necessary to conduct differential diagnostics with uterine myoma. Both pathologies are characterized by an increase in the size of the uterus, but the main diagnostic sign of myoma is palpation of a compacted uterus, enlarged due to the myometrium. With hematometra, the uterus is enlarged due to the contents in it, and the structure itself is not changed. In addition, an ultrasound examination can accurately determine the presence of fluid in the cavity or myoma.

Correct diagnosis and management of the postpartum period, as well as timely consultations with a doctor, allow for a timely diagnosis and adequate therapy.

Treatment hematometers

Medicines that are used in the treatment of hematometra have several directions. It is necessary to eliminate the blood that is in the uterine cavity, stop the bleeding, if any, and use drugs to reduce the uterus or regulate its tone, also mandatory in this case is considered to be taking antibacterial drugs to avoid endometritis. First of all, it is necessary to eliminate the blood that is in order to avoid complications, for this purpose, drugs are used that help stop bleeding and prevent further bleeding. Etamzilat for hematometra can be used in complex therapy at the initial stage.

1. Etamzilat is a drug from the group of systemic hemostatic agents that can be used to stop bleeding if hematometra is caused by trauma to the birth canal or there is a source of bleeding. The drug has a predominant effect on platelet cells and capillaries, which helps activate the vascular-platelet link to stop bleeding. The method of using the drug to stop bleeding is intravenous, which accelerates the effect of the drug. The dosage of the drug is 10 milligrams per kilogram, on average, one ampoule is used three or four times a day. Side effects are possible in the form of jaundice, rash, itching of the skin, a feeling of facial heat and decreased pressure. Precautions - use with caution in patients with asthma and varicose veins.
2. No-shpa is used for hematometra without fail if there is a spasm of the uterus or an increase in its tone, which has led to a sharp bend. The effect of antispasmodic therapy is expressed immediately and the tone of the uterus decreases, which leads to better blood outflow. Therefore, the use of antispasmodic therapy is pathogenetically justified.

No-shpa is a myotropic antispasmodic, the active ingredient of which is drotaverine. The drug reduces the tone and motor activity of the smooth muscles of internal organs, dilates blood vessels. Due to this, an analgesic effect occurs, and it also has a good effect on the tone of the uterus. The method of application for hematometra is mainly intramuscular. Dosage - 2 milliliters of the drug must be administered, then repeated no earlier than an hour later. Side effects that may be - hyperemia of the skin, fever, chills, increased body temperature, weakness, rapid heartbeat, arterial hypotension headache, dizziness, insomnia, nausea, constipation, vomiting, local reactions at the injection site. Precautions - do not use in congenital pathologies - malabsorption and lactose intolerance.

1. Duphaston is widely used for hematometra already in the period after the active release of a certain volume of blood from the uterine cavity. When the main volume of blood that formed during hematometra came out against the background of therapy or surgery, that is, some areas of the endometrium that contain hemolyzed blood after hematometra. To transfer the endometrium to the secretion phase with further maximum cleansing of the uterus, an additional amount of progesterone is needed.

Duphaston is a monocomponent hormonal drug, the main active ingredient of which is dydrogesterone, a synthetic analogue of progesterone. The drug acts only on the endometrium, epithelium of the cervical canal and vagina, stimulating the rejection of the functional layer. Therefore, it is used in the treatment of hematometra, as an additional therapy. The method of administration of the drug is in tablets, the dosage is individual under the control of the dynamics of uterine discharge. Side effects are dizziness, drowsiness, pain in the mammary gland, itching of the skin, vomiting, fluid retention with the formation of edema. Precautions - it is important to control the dosage of the drug and the effect of this dose.

1. Macrocef is a third-generation beta-lactam antibiotic cefoperazone, especially effective against gram-positive and gram-negative flora. The drug has a bactericidal effect on possible anaerobic pathogens, so it can be used for prophylactic purposes in gynecology. The dosage of the drug is 1000 milligrams once a day, taking into account prophylactic administration, intramuscularly for five days. Side effects are possible when affecting the stomach - colitis or dysbacteriosis develops, which is manifested by bloating, stool disorders. Precautions - the drug cannot be used if you are allergic to penicillin antibiotics, as well as with congenital enzyme deficiencies.

Surgical treatment of hematometra is used in cases where antispasmodic therapy is insufficient to reduce uterine tone and evacuate blood. Surgical intervention may have different volumes. In case of overgrown maiden hymen and as a result of this formation of hematometra, only a small puncture of the hymen is performed or, if this is not enough, defloration. If hematometra formed in the postpartum period, then a manual revision of the uterus is performed or, if necessary, curettage. Hematometra after an abortion often requires curettage to avoid complications. Therefore, invasive intervention is part of the treatment of hematometra in any case, with the addition of antispasmodic, antibacterial and hormonal therapy.

Vitamins for hematometra are used for more effective rehabilitation and restoration of the female body. For this purpose, an increased amount of vitamin C, B, A is needed. If there is anemia after serious blood loss due to intervention, then adequate nutrition or even the use of iron preparations for the second degree of anemia is recommended.

Physiotherapy is very effective at the convalescence stage to restore uterine blood circulation, normalize ovarian function and epithelium. Thermal procedures and magnetic therapy can be used for treatment. In the postpartum period, it is better to refuse thermal procedures and when breastfeeding, it is possible to use spa therapy.

Folk treatment of hematometra

Traditional medicine can be used in complex therapy, both to stop bleeding and to normalize uterine discharge after recovery. For this purpose, you can use compresses, vaginal tampons or herbal infusions that affect different parts of the process. Treatment of hematometra at home should be a full course, using hemostatic and antispasmodic herbs.

1. Nettle is used for hematometra to reduce the severity of blood loss and normalize the endometrium during treatment. For a medicinal decoction, take one hundred grams of stinging nettle and steep in hot water. In the acute period, you can take half a glass of decoction every three hours. Then you can drink the decoction twice a day.
2. A warm heating pad on the lower abdomen has good antispasmodic properties, it also reduces tension and helps to relax the uterus. To do this, you need to fill the heating pad with warm water (not hot!) and put it on the lower abdomen. After that, you need to take a position on your side, which improves the outflow of the contents of the uterine cavity.
3. At home, you need to do small exercises that have a drainage effect and improve the cleansing of the uterine cavity from all secretions. To do this, you need to squat in the "plie" pose at a slow pace no more than five times. Next, you need to bend to the sides, reaching your hands to the side surfaces of your knees. Lastly, you need to lie on your side for five minutes, then change sides. Such light exercises will help to better resolve the disease, but they can only be used if there is no major bleeding and no other contraindications.

Herbal treatment of hematometra affects not only the bleeding condition, but there are also many herbs that help relax the uterus and normalize the general condition by replenishing the volume of blood loss.

1. Tincture of water pepper is used as a hemostatic agent for hematometra. To prepare the tincture, take one hundred grams of water pepper grass, pour in the same amount of alcohol and leave for two days. After that, add six tablespoons of honey and a liter of water. Drink the tincture one shot four times a day. This tincture also increases overall immunity and has a tonic effect.
2. Anise root and horseradish root infusion are especially effective in treating hematometra and further hormonal disorders. To prepare a medicinal tea, take ten grams of both ingredients, pour half a liter of water, and then, after it has steeped for twenty minutes, strain and drink.
3. Tea made from raspberry stems, viburnum berries and blueberry leaves normalizes the tone of the myometrium, improves microcirculation and blood flow in the uterus. For tea, take equal parts of all ingredients, brew and drink instead of tea.
4. Elecampane herb is a plant whose effect is to improve the tone of the uterus and reduce the severity of spasmodic pain. To prepare the medicine, three tablespoons of washed and chopped elecampane leaves should be boiled for five minutes in a liter of clean water, then add a few spoons of honey and stir. After the tea has cooled, you need to drink it three times a day, half a cup at a time.

Homeopathy is used both in the acute period and in the period of remission to restore normal menstrual function after hematometra. For this purpose, herbal preparations and inorganic drugs are used. The main approach to choosing a drug is symptomatic.

1. Agnus-plus is a plant that improves the trophism of the myometrium, reduces the severity of edema of the postpartum tract and has a number of antibacterial substances. The drug is especially effective in the treatment of hematometra in the acute period, when the tone of the uterus is most increased and the vessels are spasmodic. The method of administration of the drug is parenteral and the dosage begins with three granules every three hours on the first day, then you need to take three granules every six hours the next day, and from the third day, three granules twice a day. Side effects may be on the first day of administration in the form of increased nagging pain in the lower abdomen, which passes after a few hours.
2. Quercus-edas is a homeopathic medicine used to treat hematometra in women during menopause. The drug not only affects the accumulation of blood, but also regulates hormonal levels, which is very important for the further normalization of discharge in women of this age. The medicine is dosed four drops in the morning and evening, the method of application is to dissolve the drops in a large amount of water. Side effects can occur at a high dose - dizziness, headache, general weakness.
3. Nicomel is a homeopathic medicine used in the complex treatment of hematometra complicated by endometritis. The drug does not allow the infectious process to become chronic. The method of administration of the drug is parenteral. The granules should be chewed until completely dissolved, it is not recommended to swallow them whole. The dosage is two granules twice a day. Side effects may occur in case of combination with iodine preparations - then there may be allergic reactions.
4. Galium-hel is an inorganic homeopathic preparation. It is used to treat any type of bloody uterine discharge, including hematometra, which can be complicated by uterine discharge already in the remission period. The method of using the preparation depends on the form. The dosage for drops is one drop five times a day, and for capsules - two capsules three times a day. Side effects are possible in the form of hyperemia of the skin of the hands and feet, as well as a feeling of heat. Precautions - do not use in combination with drugs of bee origin.
5. Pionia Plus is a homeopathic remedy of plant origin that is effective for hematometra in the postoperative period during an abortion. It is used to treat patients who complain of discharge after an abortion with nagging abdominal pain and irregular menstruation. It is available in the form of drops and is used in a dosage of three drops every day. The course of treatment can be started immediately after the onset of complaints, and before planning a pregnancy or after the restoration of a normal cycle, you can stop taking the drug. Precautions - if you have a history of infertility or miscarriage, you should use the drug with caution. Side effects may manifest as intestinal dysfunction.

The use of folk and homeopathic remedies should only be in combination with other medications and only after consultation with a doctor, since the rapid possibility of infection increases the risk of complications with untimely treatment.

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Prevention

Prevention of hematometra development in the postpartum period is very important, since it is at this moment that the condition of the uterus is a risk factor for the development of pathology. Therefore, it is important to follow all the doctor's recommendations. If the birth was complicated or there was a cesarean section, then you cannot lift heavy objects, including the child, for the first two days. But at the same time, you need to get up and move soon after the operation, this tones the uterus and prevents postpartum complications.

Prevention of hematometra after an abortion is a protective regimen with careful monitoring of the condition and discharge from the uterus.

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Forecast

The prognosis for hematometra recovery is favorable in case of timely diagnosis. Rehabilitation after such a disease is not difficult, so working capacity is restored quickly.

Hematometra is a condition that often occurs in the postpartum period in women due to complicated childbirth. In this case, blood and remnants of the membranes accumulate in the uterine cavity. This condition may be asymptomatic for some time, therefore it threatens complications that are dangerous to health. To avoid such a problem, you should always carefully monitor your health and, if any symptoms appear, consult a specialist.