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Haematometra

An accumulation of blood within the uterus. The most common cause is imperforate hymen or transverse septum causing accumulation of menstrual discharge. In older women it can occur secondary to cervical pathology, e.g. carcinoma or cervical stenosis (eg after cone biopsy or therapeutic abortion).

Causes
  • May be caused by Mullerian duct anomalies.1
  • Imperforate hymen
  • In older women may be secondary to carcinoma of cervix or cervical stenosis (e.g. following cone biopsy).
  • Other cause include Listeria monocytogenes infection, laser endometrial ablation, uterine curettage and cervical cryocoagulation or electrocoagulation.2
  • May be the result of childbirth, either by normal vaginal delivery or assisted deliveries such as forceps.
  • Acute haematometra is a rare complication following induced termination of pregnancy.3
Presentation
  • Amenorrhoea, but there may be some menstrual blood flow4
  • Lower abdominal swelling and tenderness
  • May present with severe primary dysmenorrhoea
  • May be associated with pyometra, especially after TOP, when the patient may have a high fever and other evidence of infection.
  • If due to imperforate hymen and therefore associated haematocolpos develops, the hymen may bulge and exhibit a bluish discoloration.
Investigations
  • Abdominal ultrasound
  • MRI scan may be required if the ultrasound result is unclear
Management

Depends on cause, eg hymen can be incised.

Complications

Rare cause of urinary tract obstruction and urinary retention.5

Document References
  1. Dadhwal V, Mittal S, Kumar S, et al; Hematometra in postmenarchal adolescent girls: a report of two cases.; Gynecol Obstet Invest. 2000;50(1):67-9. [abstract]
  2. Gomez Arzapalo E, Perez Mendizabal A, Herrera Avalos I, et al; [Hematometra & Listeria monocytogenes]; Ginecol Obstet Mex. 2001 May;69:206-8. [abstract]
  3. Grimes DA, Creinin MD; Induced abortion: an overview for internists.; Ann Intern Med. 2004 Apr 20;140(8):620-6. [abstract]
  4. Nayci A, Avlan D, Oz U, et al; Does menstrual flow exclude hematometra? A rare case of uterine anomaly presenting with anorectal malformation.; J Pediatr Surg. 2002 Apr;37(4):666-7. [abstract]
  5. Chircop R; A case of retention of urine and haematocolpometra.; Eur J Emerg Med. 2003 Sep;10(3):244-5. [abstract]
Acknowledgements EMIS is grateful to Dr Colin Tidy for writing this article. The final copy has passed scrutiny by the independent Mentor GP reviewing team. ©EMIS 2007.
DocID: 1022
Document Version: 20
DocRef: bgp1819
Last Updated: 23 Sep 2006
Review Date: 22 Sep 2008









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PS - Health and Poverty

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See also MAKEPOVERTYHISTORY North East for details and links to campaigns against poverty.

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