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Complications after abortion - hematometer

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The hematometer is a violation of the natural mechanism of removal of blood from the uterus, with the result that it begins to accumulate there. In gynecology, this disease is quite rare. This pathological condition usually occurs after curettage of the uterus or childbirth. Difficulty in the outflow of blood from this organ is due to its insufficient contraction, as well as as a result of blockage of the cervical canal with a polyp or placenta. The pathology at first often proceeds without any symptoms, so the woman goes to the hospital if the disease is neglected.

The main causes of

Hematometer - what is it and for what reasons does it occur? We found out that it is a collection of blood in the uterus, in which her curettage, caused by abortion, non-developing pregnancy and for diagnostic purposes, is to blame. As a result of this surgical intervention, only the upper layer of the uterine mucosa is removed.

The main causes leading to a hematometer are the following factors:

  • Polyp of the cervical canal. This disease is considered quite dangerous and is usually diagnosed after forty years. But the likelihood that a polyp will cause hematometers is quite small.
  • Postpartum period. The increased risk of the formation of such a pathology after childbirth is associated with injuries and ruptures of the birth canal.
  • An abortion, after which not only parts of the mucous can remain in the uterus, but also parts of the fetus. This contributes to the appearance of such a disease.
  • Scraping of the uterus, after which the hematometer most often occurs, as the cervical canal narrows.
  • Endometrial cancer.

What is the danger of this disease?

A hematometer after curettage of a missed pregnancy or other surgical intervention in this area is very dangerous not only for health, but also for a woman’s life. If you ignore this condition and do not heal, then the likelihood of purulent inflammation, leading to the removal of the uterus and further infertility, is high.

The most dangerous complication of hematometers is sepsis (blood poisoning), which can be fatal.

The symptoms that appear after curettage or delivery of the hematometer may have characteristic symptoms, and if a woman pays attention to them in a timely manner, she can be treated in time and avoid serious complications.

The hematometer is manifested by severe pains in the lower abdomen, as blood pressure is applied to the walls of the uterus. Also, a woman should be alerted by the fact that menstrual or postpartum discharge has abruptly stopped. If they continue, they will have an unnatural color and an unpleasant smell.

As the disease progresses without untreated hematome, the symptoms may be as follows: chills and fever. If an infection begins to develop in the uterus, severe pain is felt in the tailbone and lower back. In this case, it is necessary to consult a doctor as soon as possible, since in the future the pain will only intensify. At this stage there is a feverish state, body temperature jumps up sharply. The woman is already moving with difficulty, and she should be urgently hospitalized. These are the main signs of hematometers after curettage.

Drug treatment

The hematometer that appeared after curettage is treated in several stages. First, the uterus is cleaned of accumulated blood with the help of medicines that contribute to its reduction. These drugs include "Oxytocin". This medicine quickly removes fluid from the uterine cavity, and also stops bleeding and relieves pain.

The doctor is obliged not to eliminate the symptoms, but to get rid of the main cause of such a disease as the hematometer (after curettage). Treatment involves the use of drugs such as Methylergometrine, Ergotal, Ergotamine, which also contribute to the reduction of the uterus. But it should be remembered that these medical devices should be used only under the supervision of a specialist, as they have a large number of complications and side effects.

In order to relieve the woman's condition, the following antispasmodics are prescribed: “No-shpa”, “Spazgan”, “Spazmalgon”. These drugs relax the uterine muscles and contribute to the withdrawal of accumulated blood. It is also necessary to take non-steroidal anti-inflammatory drugs, most often sulfonamides and drugs of the phenylacetic acid group.

Instrumental procedures

If with a disease such as hematometer (after curettage), medication treatment did not bring the desired result, the doctor may prescribe special procedures by which the accumulated blood is removed from the uterus.

Probing and hysteroscopy are used in case of severe obstruction of the uterus canal. However, if, after curettage, the hematometer is accompanied by the development of any infectious process, such procedures complement the complete reorganization of the uterine cavity and the prescription of antibiotics.

Vacuum aspiration of the contents of the uterine cavity is also carried out, that is, sucking accumulated blood from this organ with a special apparatus.

Many women prefer to treat such a disease as the hematometer of the uterus, folk remedies, which leads to the most adverse consequences. Homeopathy and herbal medicine can only be beneficial as a soothing and supportive therapy. Traditional treatment cannot be replaced by such methods.

Possible complications

If, after curettage, the hematometer remains untreated, this can lead to the following serious complications:

  • endometritis (infectious-inflammatory process occurring in the uterus),
  • pyometra (accumulation of pus in the uterus, accompanied by inflammation of the ovaries),
  • peritonitis and pelvioperitonitis (an infectious process in the abdominal organs),
  • sepsis (blood poisoning),
  • infertility.

Prevention

In order to avoid such a disease, it is necessary to treat the following pathologies of the pelvic organs in time:

  • endometritis,
  • vulvovaginitis
  • salpingoophoritis.

Often inflammatory diseases of the internal organs lead to adhesions, so it is important for a woman to be registered with a gynecologist. The doctor will help to keep women's health under control, to promote the correct choice of contraceptives, to prevent the possibility of abortion.

Many women are interested in the question of whether arising after hematome scraping does not become an obstacle to pregnancy. The gynecologist cannot have an answer to it, since everything depends on the complications that this pathological condition leads to.

Thus, the answer to the question became clear: "What is a hematometer?" This pathology develops due to the scraping of the uterus, and its late treatment can lead to the death of the patient. In gynecological practice, there are a lot of examples when a woman gets into intensive care several days after an abortion or childbirth. The reason for this is the hematometer, which has developed due to the remnants of the ovum or placenta left in the uterus. Therefore, it is extremely important to take care of your health.

Scraping

The ugly and frightening word "scraping" and the caressing ear foreign definition of "curettage" refer to the same procedure. It involves the removal of the upper layer of the endometrium using a special tool - curette.

The procedure belongs to the category of mini-operations and is carried out strictly according to the indications:

  1. In order to identify diseases.
  2. As a therapeutic measure.
  3. To remove parts of the embryo or the membranes of the fetus after a self-abortion, or unsuccessful medaborta.
  4. To remove residues of placental tissue after delivery.

When diagnostic scraping the resulting material is sent to the study. The results of microscopic and bacteriological studies allow us to specify the diagnosis and correctly select the treatment.

Curettage helps prevent the development of infection and inflammation in the tissues of the uterus. It is used for therapeutic purposes when:

  • Endometriosis.
  • Polyposis.
  • Fibromatosis.
  • The effects of hormonal imbalance.
  • And with the growth of malignant tumors.

The operation is carried out in a hospital and on an outpatient basis. By the time it takes only a quarter of an hour. The procedure is painful, so it is performed using anesthesia:

  • General (anesthesia).
  • Local (with anesthesia of the cervix).
  • Regional (epidural anesthesia).

Curettage in two stages. At the first stage, the cervix relaxes and instrumentation is introduced into the uterine cavity. At the second stage, the actual curettage is performed. The procedure is extremely unpleasant, but certainly useful.

When properly carried out, it leads to complications infrequently. Nevertheless, the unpleasant consequences can be felt by pain, temperature, cramps and hematometra.

Hematometer

This is a painful condition, developing because of the difficulty or impossibility of the outflow of blood from the uterine cavity. A characteristic feature of her is a sharp cessation of blood flow in the process of menstruation or in the postoperative period. This pathology is diagnosed in gynecological practice quite rarely, mainly in young girls.

The development of the pathological process is connected:

  • With functional disorders (poor contractile activity of the myometrium, hemostatic disorders).
  • With congenital organic pathology and acquired pathologies (polyps and strictures of the cervical canal and other problems).

Practice shows that in most cases, this pathology develops as a complication after childbirth. The second place is occupied by the hematometer after an abortion and surgical interventions.

This pathology is diagnosed in most cases only at the stage of bacterial infection of uterine tissues and the development of pyometra, that is, suppurative inflammation. That, in turn, complicates her treatment and significantly worsens the patient's condition.

Hematometers can flow independently or be combined with hematocolpos (accumulation of blood in the vagina) and accumulation of blood in the fallopian tubes (hematosalpinx).

The main factor that should alert a woman is the abrupt cessation of bleeding. For any bleeding, the process slowly fades away. Otherwise, it is necessary as soon as possible to contact a gynecologist. Because the strength of symptoms is directly dependent:

  1. From the volume of secretions accumulated in the uterine cavity.
  2. The duration of the formation of hematometers.
  3. The causes and factors that gave rise to it.
  4. Age of the patient.

For example, in adolescence, patients suffering from cervix stenosis develop secondary or false amenorrhea. In the menstrual period there are no vaginal discharge, the girl notes:

  • Discomfort in the lower abdomen and heaviness.
  • Periodic cramping pains.

The intensity of the pain syndrome varies from barely perceptible sensations to seizures, which can be compared in intensity with the onset of labor contractions.

With the development of pathology in women there is a worsening of the general condition provoked by internal bleeding:

  • Great weakness.
  • Tachycardia.
  • Decreased blood pressure.
  • Nausea and dizziness.
  • Visual symptoms (the appearance of "flies" in sight).
  • Fainting
  • Anemia.
  • Pressure and pain in the lower abdomen.

Blood is a fertile environment for the development of bacteria. The pyometra is a frequent companion of a hematometer not treated in time.

Hematometra also creates good conditions for other inflammatory diseases of the uterus: endometritis or combined inflammation of the myometrium and endometrium (metroendometritis). An untreated hematometer can lead to the formation of a Cuver’s uterus, sepsis or peritonitis. The consequence of late evacuation of blood accumulation often becomes infertility.

The main reason for the lack of evacuation of blood from the uterus is, as mentioned above, the appearance of obstacles in its path and the disruption of the contractile activity of the myometrium. The risk of developing this pathology doubles when both of these causes are present simultaneously.

Taking into account all possible factors, it is customary to single out 4 main groups of reasons:

  • Childbirth.
  • Interventions on the uterus.
  • Obstruction (obstruction) of the genital tract.
  • Stenosis of cervix.

Obstruction can be caused by mechanical compression from the outside or anatomical defects of the genital tract. That is, be organic or functional. Organic pathology includes:

  • Atresia (fusion of the walls) of the vagina.
  • Education intrauterine septum.
  • Asherman syndrome (intrauterine adhesions or synechiae). The formation of synechiae leads to partial and sometimes complete obliteration (overgrowth) of the vagina.

If these anomalies have not been diagnosed and corrected in childhood, then at the age of puberty and the onset of menstrual bleeding, they are the cause of hematoma.

For organic reasons can be attributed, and tumors actually in the uterus or on the path of blood flow, that is, in the cervix. They create a physical obstacle to the movement of the contents of the uterus after the medaborta, separate curettage, performed with a diagnostic purpose (RDV). Such formations include:

  • Polyposis or single large polyps.
  • Large fibroids, localized near the outer uterine throat.
  • Cancers in the uterus or her cervix.

The outflow of blood from the uterine cavity can prevent obturation (blockage) of the internal pharynx of the organ. This is possible if a rather large blood clot, part of the placenta, or a fragment of a fetus destroyed in the medaborta process is retained in the throat.

The formation of hematometers may be associated with cicatricial deformity of the uterine cervix, which caused its narrowing. Scars are formed after radiation therapy or traumatic operations.

As a functional cause, cervix spasm is considered:

  1. After artificial termination of pregnancy.
  2. After LDV (curettage, performed for diagnostic and therapeutic purposes).

The disturbance of the outflow of the bloody contents from the uterus, which develops within a few weeks after giving birth, is called lohiometers because postpartum hemorrhages are called lochia. This post-natal complication is most often triggered by:

  • Hypo-or atony myometrium.
  • Shock caused by large blood loss.
  • Inactive generic activity.
  • Manual separation of the placenta.
  • Excessive stretching of the myometrium by the fruit of large dimensions.
  • Overstretching of the uterus due to multiple pregnancy.
  • Cicatricial changes in the uterus or its cervix, resulting from tissue breaks as a result of childbirth.

Concomitant factors that may affect the contractile function of the uterus, the condition of its mucous lining, the formation of obstacles to the outflow of blood are:

  • Numerous abortions in history.
  • Inflammation of the uterus.
  • Chronic miscarriage.
  • Injuries to the birth canal, not associated with surgery or childbirth.

Most often, the hematometer after curettage develops due to spasm of the cervical canal. Although other factors are not excluded (incomplete removal of fetal membranes after an abortion, etc.).

Diagnostics

The diagnosis allows the complex of procedures, including a conversation, examination and hardware-instrumental examination of the patient. The main are:

  • Collect obstetric history.
  • Gynecological examination.
  • Ultrasound of the reproductive organs by the intravaginal method.
  • Blood tests.
  • Laboratory smear test.

A conversation with a gynecologist allows you to identify the patient's complaints, establish the cyclical nature of menstruation and the deviation of this function, and recently transferred procedures on the genitals. With palpation examination, a specialist determines the consistency and size of the uterus (it is enlarged, painful, soft consistency).

To exclude pregnancy, ultrasound diagnosis is prescribed. The vaginal sensor allows you to detect the liquid contents of the uterus and blood clots. Thanks to this procedure, it is possible to determine the cause of the violation of the evacuation of the detected fluid (polyp, fibroids, etc.).

Blood tests help confirm / deny the pregnancy and reveal anemia. A smear on pathogenic microflora gives the specialist additional information about the development of inflammatory processes in the uterus.

If the diagnosis is difficult, the patient is given a hysteroscopy. This is an endoscopic procedure that allows using the special instruments to carefully examine the uterine cavity. In addition, it makes it possible to carry out medical intrauterine manipulations in a small volume. This method involves not only the diagnosis of the disease, but also its treatment.

The main task of a specialist in healing this disease is to ensure the evacuation of hematometers and to create conditions for the free release of fluid from the uterine cavity. In some cases, it is possible to achieve uterus emptying at the diagnostic stage. But the treatment does not end there.The measures that will be taken by the doctor depend on the factors that provoked the disease:

  1. When spasming cervix, antispasmodics are prescribed (Nosh-pa, Spasmalgon and others).
  2. In case of violation of contractile activity prescribe drugs that increase the contraction of the myometrium (Oxytocin, drugs based on ergot).
  3. Treatment and measures to prevent the development of complications require the use of non-hormonal anti-inflammatory drugs and antibiotics.

After achieving the result, the treatment should be continued, eliminating the reason for the delay in evacuating the contents of the uterus: removal of polyps, repeated LDV in order to remove residual membranes or placenta.

It is desirable to treat the hematometer as early as possible, before the tissues of the organ are soaked with blood. Otherwise, an uterus amputation may be required.

Types of scraping

When choosing a medical center for gynecological cleaning, rely on the experience and qualifications of specialists. This will help, after the procedure, to avoid serious complications such as pain or hematometer after curettage. There are several types of gynecological cleaning, each of which has its own goals and objectives.

Diagnostic cleaning of the uterine cavity is assigned when diagnosing the internal organs of the pelvis of a woman. The main purpose of this scraping is to determine the causes of a disease. There diseases include:

• Irregular menstrual cycle

• Abundant and painful periods,

• Bleeding from the vagina during menopause,

• Suspected cancer.

During endometrial curettage, the doctor takes tissue samples of the uterus for histological analysis for correct diagnosis. Therapeutic curettage is carried out to treat gynecological diseases such as:

• Uterine fibroids. It is a tumor that can provoke heavy uterine bleeding. Scraping with this disease will help prepare a woman for surgery to remove fibroids and take endometrial tissue samples for further treatment,

• Endometritis. It is an inflammatory process of the walls of the uterus and endometrium. Scraping will help establish the diagnosis and prescribe an effective treatment,

• Polyps in the uterus and on the cervix. Cause severe bleeding during menstruation or independently. During gynecological cleaning, polyps are removed from the endometrium and sent for histological analysis. Polyps are often reborn into oncology, so histology will determine if a given disease is a threat to a woman’s life,

• Abortion or missed abortion. Scraping in these cases is carried out in order to remove residues of the embryo from the uterus, as this may threaten the health of the woman.

Complications after curettage

Gynecological cleaning of the endometrium is the removal of the upper layer of the uterus for the study and treatment of various gynecological diseases. As with any surgical intervention, scraping can leave behind a number of complications. There are some symptoms that speak of the development of the inflammatory process, when a woman urgently needs to see a gynecologist.

After curettage, bleeding from the vagina is observed for several days. A woman may feel general weakness and headache. Some patients have lower abdominal pain. These are normal phenomena, but every day they should become weaker.

But if a woman suffers from nausea, vomiting, fever, then there is the likelihood of such a dangerous complication as the hematometer after curettage, in other words, it is a collection of blood in the uterus and the development of various infections in it. A woman should monitor her state of health after cleansing, if the bleeding stopped very early, then you should inform your doctor. Treatment of hematometers is usually carried out in a medicamental manner - the patient takes antispasmodics, thereby relaxing the walls of the cervix. If the treatment does not give a positive effect, then repeated curettage is performed with cleansing of the uterus from blood clots.

In preparation for scraping, any woman is looking for a good doctor and a modern clinic. That's right, because your health must be trusted by professionals. In our medical center, gynecological cleaning of the uterine cavity is carried out by qualified specialists in the surgical unit, equipped with modern equipment. We will carry out the procedure quickly and efficiently. After the procedure, you will be given care and selection of medicines to help you quickly get back in shape.

Causes

Cervical spasm and fluid accumulation in the reproductive organ can be triggered by curettage and various pathologies (polyps in the cervical canal and other neoplasms in the urogenital system). Among the main causes of such violations are the following:

  • polyps and myoma. The most common pathologies are diagnosed in women during menopause and menopause. The probability of developing hematometers is minimal,
  • recently postponed labor. The risk of such disorders is due to ruptures and damage to the birth canal,
  • abortive activities and scraping. In the vast majority of cases, the complication arises from these procedures,
  • endometrial malignant tumors.

Causes of the pathological condition

Pathological conditions can occur for organic and functional reasons. In the first case, we are talking about a mechanical barrier to normal blood outflow. In the second, the disorder occurs due to muscle spasm in the cervical canal region.

There are several reasons for the observed pathological condition:

  • reduction of tensile properties of the cervical canal. There is a violation after curettage, frequent abortive measures and as a result of age-related changes at the time of menopause in women,
  • fusion of the hymen after inflammation,
  • cervical stenosis,
  • fibroids, cervical canal polyp,
  • spiral installation
  • swelling of the mucous membranes, triggered by an allergic reaction,
  • appearance of synechiae in the uterus,
  • abnormal development of the urogenital system, in which the patency of the genital tract is impaired,
  • overlap of the internal os of the cervical canal with a neoplasm.

Symptoms of Hematometers

This condition is accompanied by such clinical manifestations as:

  • the termination or rapid decrease in the volume of discharge after abortive measures, cleaning, cesarean section or natural births,
  • the absence of menstruation or their overly scanty amount at puberty. If a girl has no discharge (menarche) for a long time, then you can suspect anomalies of the development of the organs of the genitourinary system,
  • heaviness in the abdomen,
  • periodically appearing cramping back pain and lower abdomen, extending to the tailbone and sacrum. Pulling pains are pronounced during physical exertion and walking with quick steps,
  • frequent urination,
  • pain on palpation of the genital organ, a reduction or increase in the timing of its reduction in size,
  • hyperthermia, worsening of the general condition, feeling of complete weakness and malaise. Most often, similar symptoms are observed if an infection has joined, an inflammatory process has begun in the uterus,
  • heart palpitations, dizziness and nausea.

Sometimes the symptoms are mild or completely erased. To identify a pathological condition, you need to conduct a comprehensive diagnosis.

Postpartum

After successful completion of pregnancy (childbirth or cesarean section) such complications are possible. They can be provoked by tearing of the vagina, scarring on the genital organ, abnormal delivery, preeclampsia, and excessive stretching of the uterus if the fetus is large. Often there is a discharge with an unpleasant odor. As a rule, they indicate the beginning of the inflammatory process.

Postoperative

The absence of menstruation after the surgery is an alarming symptom. It is possible that a pathological condition has developed as a result of therapeutic curettage. At the same time, there may be blood clots in the discharge, pain, nausea and dizziness. Inflammation in the organ can lead to accumulation of pus in the uterus. Leaving such changes without attention is strictly prohibited. Need urgent medical assistance.

The use of traditional medicine

If scraping the organ cavity led to the development of hematometers, then the woman is recommended to perform such exercises as squats and bends. They contribute to the outflow of blood. The spasm is removed by applying heat to the stomach.

Infusions of viburnum berries and nettle, decoction of horseradish roots to a small extent contribute to reducing the risk of hematoma growth. Drugs stimulate blood clotting and can also stop bleeding.

It is also used in the process of treatment infusion based on elecampane and highlander pepper. This tool helps to increase the tone of the fibers and provokes a contraction of the uterine muscles.

Doctors strongly do not recommend to resort to self-treatment and use such folk remedies. Often, against the background of their use in the vagina and the reproductive organ, the inflammatory process begins, the bleeding increases, and the spasms become even more pronounced. In addition, decoctions and infusions are not able to fully eliminate the symptoms and solve the immediate problem.

The time required for the diagnosis, the selection of effective therapy and the elimination of disorders, is lost. As a result, even more serious complications can occur.

Conservative therapy

At a time when treatment is just beginning, the main goal is to remove the contents of the uterus. If the cause of the disturbances lies solely in the neck spasm, then in order to correct the problem, it will be sufficient to insert a catheter into the organ cavity and thus remove blood from it.

In the process of therapy are also used drugs No-spa, oxytocin or methylergometrine. An integrated approach contributes to the rapid elimination of muscle spasm.

If the condition began to develop after cesarean section or the natural resolution of labor, resort to the use of special vacuum devices. Most often, this involves the use of aspiration drainage of the internal part of the organ and the washing of the endometrium using solutions such as sodium chloride or furatsilin. This unpleasant procedure can be repeated daily for three, and if necessary, even four days. Due to this, the risk of the onset of the inflammatory process is significantly reduced.

If in the course of the diagnostic measures were found problems with the hymen, then it is dissected. Therapeutic scraping is carried out in the presence of placental lobes in the organ, as well as parts of the embryo, fetal membranes or blood clots.

The procedure of hysteroresectoscopy prescribed in the case of submucous myomas and polyps. They are removed during the procedure. Congenital septa are incised.

If the case is complex and serious pathologies and purulent processes are observed, then radical measures are resorted to - the fallopian tubes and the genital organ itself are removed.

Regardless of the cause of hematometers, after removing blood from the uterus, a woman’s health is restored with the help of anti-inflammatory drugs and antibiotic medicines. After the problem has been resolved, a full examination is required. Its main goal is to prevent such changes in the future. This is especially important in the presence of congenital anomalies of the genitourinary system.

A hematometer is a serious complication observed in the postpartum period after curettage of the uterine mucosa and abortive measures. The accumulation of blood in the reproductive organ can cause inflammation and the formation of pus. Pathological condition is strictly forbidden to leave without attention. Only if therapy is started in a timely manner, will it be possible to eliminate the problem and completely restore the reproductive system. Self-medication is an unacceptable measure.

When does girls

Hematometra can occur even in girls who do not live sexually. Causes are associated with malformations of the genital organs or abnormalities in the structure:

  • aplasia or atresia of the vagina - partial or complete underdevelopment of the vagina, its fusion in some area, associated with intrauterine developmental disorders,
  • hymen atresia - the presence of a dense hymen without a physiological opening for the exit of menstrual blood,
  • additional horn - pathology occurs if the uterus has a rudimentary horn,
  • rudimentary uterus - in addition to the normal structure, there is an additional horn or body of the uterus, not related to the external environment of the vagina.

The following signs of hematometers are characteristic:

  • abdominal pain - periodic (every three to four weeks), pulling, do not pass when taking analgesics and antispasmodics, may be aching or cramping in nature,
  • high temperature, dizziness, nausea - at the time of attacks,
  • painful urination - or difficulty urinating,
  • purulent discharge - with the addition of inflammation and fistula.

After childbirth

Hematometra after delivery is a serious danger. The uterus at this time has a large size and can accommodate an impressive amount of blood - up to 1 l or more. In fact, it is bleeding from the uterus with accumulation of blood inside - there are no external signs of pathology, which leads to late diagnosis and more complications.

A woman may make the following complaints:

  • heaviness and pain in the lower abdomen,
  • weakness, dizziness,
  • cardiopalmus,
  • a small amount of discharge from the genital tract.

The cause of postpartum hematometers is spasm of the cervix and atony of the uterus. As a result, a large amount of blood is secreted through the gaping vessels of the endometrium, but the "closed" neck does not allow it to go outside. At the same time the remains of fetal membranes are often found, therefore the condition is called a lohiometer.

Postpartum hematometers are more common in women:

  • after cesarean section
  • against the background of severe preeclampsia at the end of gestation,
  • with a large fruit,
  • at a lot of water on the eve of birth,
  • with multiple pregnancies
  • with interventions inside the uterus.

Will the next pregnancy be repeated?

Severe recovery after suffering blood loss, the need for a blood donor transfusion frightens a woman: what if everything happens again during the next pregnancy? But this probability is only in cases where the reason for poor uterine contraction is associated with the individual characteristics of the structure and functioning of tissues. If the hematometer has developed against the background of provoking factors (for example, multiple pregnancy or polyhydramnios), then in their absence the risk of such a complication is minimal.

After abortion, miscarriage, missed abortion

Hematometers are a frequent occurrence after diagnostic curettage, medical and surgical abortion, vacuum aspiration, including miscarriage or missed abortion. The reasons are as follows:

  • spasm of the cervical canal,
  • mechanical obstacle at the level of the inner throat.

The hematome symptoms are not as bright in this case. Sometimes a woman is disturbed only by minor pulling pains in the lower abdomen, which she associates with recent manipulation. Can also occur:

  • fever - with the addition of inflammation,
  • severe spasmodic pains in the abdomen,
  • abrupt termination of discharge - immediately after the manipulation.

When can you plan conception

Attempting an unsuccessful pregnancy overshadows a woman until such time as the couple again succeeds in conceiving and carrying out the baby. It is possible to plan, regardless of the amount of curettage, no earlier than in three months. If the hematometer was accompanied by other complications, the interval may be extended to six months or more. In each case, the time of successful pregnancy planning after hematometra should be considered individually along with your doctor.

Against the background of normal menstruation

Hematometra can occur in healthy at first sight women. The accumulation of blood clots occurs during menstruation in the presence of obstacles to the outflow of the contents of the uterus. This can provoke:

  • rigidity of the cervical canal tissue - after numerous scraping, including abortions,
  • adhesions and adhesions - in the area of ​​the inner throat of the cervix,
  • polyp - cervical canal,
  • submucous myoma - located near the cervix,
  • intrauterine device - and its displacement,
  • swelling of the tissues of the cervical canal - against the background of inflammation, allergies to drugs, contraceptives.

Symptoms formed hematometers on the background of menstruation cause a woman to seek medical help because of intense pain. They can be cutting, pulling, cramping. Pain arises due to increased pressure inside the uterus and effects on the internal pharynx. Additionally, urination may become more frequent due to the effect on the bladder.Or there are urges to defecate with retroflexion of the uterus (located with a backward slope).

In the menopause

A hematometer after menstruation in a woman (postmenopausal) is associated with diagnostic intrauterine procedures or benign or malignant tumors. This should be treated with caution and expanded diagnostic searches.

Symptoms of hematometers may be absent or minimal. It can be confused with serosometry (in the latter case, a clear liquid accumulates in the uterus). A vivid clinical picture is characteristic of the addition of inflammation or heavy bleeding.

Therapeutic tactics

Suspicion of a hematometer requires a serious examination and often immediate action by a doctor. This is especially true of postpartum complications. The use of folk remedies is fraught with serious consequences for the body, including the acquisition of chronic endometritis. The algorithm of actions is presented in the table.

Table - Diagnosis and treatment of hematometers

What is a hematometer in the uterus?

The concept of a hematometer refers to a pathological condition in which blood accumulates inside the uterus, which provokes the development of contractile disorders of the uterine body, followed by infection of the organ. There are a lot of causative factors for hematometers, although the invasive factor is considered to be predominant, that is, pathology occurs predominantly after surgical interventions performed on the organ.

Most often develops as postpartum effects (more than 87%). The second most popular factor is considered to be invasive intervention such as abortion, surgical or diagnostic curettage.

The difficulty is that more than 65% of cases of hematometers are detected when the ailment has already developed to its full potential and managed to provoke infectious complications, therefore, early diagnosis is of paramount importance. According to the ICD-10 classification, code N85.7 is assigned to the hematometer.

Depending on the etiology, hematometers are classified into 4 types:

  • Originated in the postpartum state,
  • Formed as a result of intrauterine intervention,
  • Appeared in the stenosis of the cervical canal,
  • Formed during obstruction processes.

Congestion due to acquired or congenital causes:

  • Congenital hematome form - this category includes intrauterine synechia or septum, vaginal atresia or cervical canal. If in childhood the pathology was not diagnosed and eliminated in childhood, then with the onset of menstruation, the formation of hematometers can occur.
  • Organic factors are a variety of uterine or cervical structures that create mechanical obstacles to the blood flow of menstrual flow, blood after an abortion, or diagnostic and therapeutic curettage. As such obstacles can be a variety of polyps and fibroids, oncopathology. Any abdominal or placental fragment during abortion, a bloody clot can also shut off the internal uterine pharynx.
  • The functional reasons for the formation of hematometers are due to cervical spasm after a medical termination of pregnancy or curettage of a frozen one. If the hematometer appeared in the first week after birth, then it is called a lohiometer, and it is provoked by uterine atony with weak labor or overdistension of the organ with large fetal size, uterine scars and hemorrhagic shock, separation of the child's afterbirth, etc.

A hematometer formed on the background of curettage or other intervention requires mandatory treatment, otherwise purulent inflammation develops, in which the uterus can be shown, which is fraught with irreversible infertility. Therefore, at the first suspicious signs you need to contact the specialists.

The main manifestations of blood accumulation include such signs:

  1. If on the first or second day of menstruation or after abortive intervention, curettage, or after delivery there was a sudden stop of blood discharge.
  2. Scanty or absent first periods in girls.
  3. The burden in the area above the pubis.
  4. Sudden increase in urinary urge.
  5. Periodically occurring pains of the collateral type in the lower abdomen, radiating to the tailbone, lower back or sacrum. During physical exertion or fast walking, they are noticeably strengthened.
  6. Long contraction of the uterine body after childbirth, a marked increase in the size of the organ after cesarean or natural delivery. When shifting or palpating, there is pain.
  7. Severe weakness or dizziness, nausea and palpitations become more intense if the hematometer has acquired impressive dimensions and continues to increase.
  8. Hyperthermic reactions and aggravation of the general condition, manifested in moderate weakness and chills, weakness and malaise.

Sometimes the symptoms appear erased and slightly, or absent. Diagnosis is based on a cumulative analysis of history, results of laboratory and instrumental examinations, gynecological examinations.

How to treat

The hematomere therapy is primarily aimed at eliminating the accumulation of blood from the uterine cavity, only then the etiological factors are eliminated, followed by ensuring the smooth flow of uterine contents.

  • If the cause of hematometers is occlusion of the cervix with particles of the placenta or fetus, blood clots, then the uterine cavity is emptied already at the stage of sensing.
  • If the causes lie in the atony of the organ, then medicinal stimulation of the contractile uterine activity is performed. Patients are prescribed medications such as uterotonics, such as oxytocin or methylergometrine, etc.
  • To prevent the development of complications of an inflammatory nature, NSAIDs such as Nimesulide or Ketonal and others are used.
  • If the measures taken do not help to completely empty the uterine body, then vacuum aspiration of the organ contents is carried out.
  • If there are lesions like fibroids or septa, polyps, they are removed by endoscopic intervention.

The earlier the accumulation of blood in the uterine cavity is detected and eliminated, the less the risk of developing complications.

Clinical manifestations

The main symptoms of hematometers:

  1. A sharp decrease or complete cessation of bleeding in the first days of menstruation after an instrumental or medical abortion, therapeutic and diagnostic curettage, in the early postpartum period or after cesarean section (reduction or cessation of lochia), etc.
  2. The absence or very scarce first menstrual flow in girls (with abnormal development of the genitals).
  3. Sensations of heaviness in the lower abdomen (in the suprapubic area).
  4. Periodic colicy pains in the lower abdomen, which are given to the lumbar region, sacrum, and coccyx. Such pains become more intense during fast walking and physical exertion.
  5. There may be more frequent urge to urinate.
  6. Increase in terms of uterus size reduction (subinvolution) or, on the contrary, its increase after delivery or cesarean section, pain on palpation and attempt to displace.
  7. Increased body temperature and worsening of the general condition - moderate weakness, chills (more often in the case of an infection), malaise and weakness.
  8. Dizziness, severe weakness, palpitations, nausea - in cases of a significant amount of hematoma and its continuing increase.

Very often, many of the subjective signs of hematometers are expressed slightly or not at all. Pathology diagnostics is based on a combination of anamnestic data, gynecological examination results and instrumental examinations.

During external examination, the painful uterus, which is enlarged by the “pasty” consistency, can be determined by the inconsistency of its size with the period of the postpartum period, swelling of the perineum or only the large and small labia is possible.

During the gynecological examination can be identified:

  • painful inspection,
  • congenital or acquired atresia of the virginal chaff, transverse septum of the upper third of the vagina, which take on the form of a protruding membrane through which the tumor-like formation (blood) of cyanotic coloration is visible, in some cases (with large amounts of blood), even the edema of the entire perineum is visible,
  • cyanosis and swelling of the mucous membrane of the vagina and cervix, the presence of tumors and cysts,
  • spasmodic neck and narrowed external opening of the cervical canal with little or no blood discharge from it after an abortion, spontaneous miscarriage or during menstruation,
  • parts of the fetus or membranes, a large blood clot after an abortion or miscarriage,
  • lack of blood in the days corresponding to the menstruation, in the presence of the intrauterine device,
  • the absence of lohia or their insignificant amount, which is inconsistent with the term of the postpartum period,
  • the release of blood through a catheter inserted through the cervical canal into the uterine cavity for diagnostic purposes,
  • The consistency of the uterus and pain during palpation or dislocation during a bimanual examination and other symptoms.

The hematometer can be diagnosed most reliably with ultrasound or through hysteroscopy (in severe cases). The latter allows for simultaneous treatment procedures. The main echo signs of blood retention in the uterus are the presence of fluid in it and an increase in the volume of its cavity. The benchmark is the excess of 3-5 mm of the normal rate of anteroposterior size. In the presence of blood in the fallopian tubes is determined by their thickening.

In addition, ultrasound can often be used to diagnose the cause of blood retention — a reduction in the diameter of the internal or / and external os, a submucous myoma, intrauterine synechia, congenital developmental anomalies, etc.

Can hematometers resolve themselves?

If an obstacle to the outflow of the contents of the uterine cavity is functional (spasm of the cervix or hypotension of the uterus), then sometimes this possibility exists. However, in most cases, the hematometer does not pass on its own, which requires appropriate treatment.

The dangers of using traditional medicine

Traditional medicine is recommended exercise in the form of bends and squats, which should contribute to the outflow of blood, heat to the lower abdomen in order to eliminate spasm.

In addition, tincture or infusion of water pepper and elecampane herbs are used to improve the tone of smooth muscle fibers and uterine contractions, nettle infusions, viburnum berries, and horseradish decoction, which should help (to some extent) reduce the likelihood of hematoma buildup by increasing blood clotting properties and stop bleeding.

However, such self-treatment with folk remedies in many cases can only increase the bleeding (heat, physical exertion) and the severity of cervical spasm (tincture or infusion of water pepper and elecampane herbs), and the above medicinal plants (nettle, viburnum, horseradish) not able to somehow really affect in terms of stopping or reducing bleeding.

At the same time, time is lost, which must be used in order to correctly diagnose the causes of the pathology and to conduct effective conservative or surgical treatment.

Why does pathology arise?

As a rule, the hematometer develops after childbirth or curettage of the uterus. Scraping involves removing the upper layer of the mucous membrane of the organ, which is necessary when abortions or missed abortion. Endometrium (uterine mucosa) in women is regularly updated, which manifests itself in the form of menstruation.

In the absence of fertilization, this layer is rejected and leaves the uterus, recovering anew in the next cycle.

The cause of gametometers is usually a physiological impairment in the uterus, when the uterine walls cannot contract sufficiently to withdraw blood from the cavity. After delivery, fragments of the placenta may remain in the cavity, and after abortion, parts of the embryo and mucous membranes, which leads to the formation of hematometers.

The pathological cause of the disease may be a spasm of the cervical canal, due to which the walls of the uterus close and do not allow blood to leave the cavity. The hematometer, which appears after curettage or so-called gynecological cleaning, develops according to the same scenario as after an abortion.

What is the curettage of the uterus?

There are several ways of gynecological cleaning, depending on the tasks.

In modern medical centers, diagnostic curettage is performed, which is designed to determine the presence of a particular pathology in such situations:

  • suspicion of cancer,
  • bleeding during menopause,
  • too heavy or painful menstruation,
  • menstrual irregularities.

For diagnostic purposes, a specialist takes a sample of the endometrium for further histological studies.

With regard to the therapeutic purposes of gynecological cleaning, then they include the treatment of such diseases:

  • endometritis. Such a violation is expressed in inflammation of the walls of the uterus or endometrium,
  • polyps on the cervix or inside the uterus. As a result of this disease too abundant discharge occurs during menstruation. Gynecological cleaning allows you to remove polyps before they become a serious threat to the patient’s health or even develop into an oncological disease,
  • uterine fibroids. This tumor causes uterine bleeding. Thanks to scraping the body is prepared to remove the tumor,
  • missed abortion. Gynecological cleaning is performed to extract the remains of embryos from the uterus.

Thus, the procedure is simply necessary in some cases in order to diagnose and treat many gynecological diseases. However, this surgical intervention, like any other operation, may entail certain complications. Some signs indicate the development of inflammatory processes in the uterus.

Usually, the recovery period after gynecologic cleaning is accompanied by vaginal bleeding, general weakness and pain in the lower abdomen.

However, in the normal course of recovery, these symptoms disappear after a while. As for the complication after such an operation, it can manifest itself in the form of a hematometer - a dangerous phenomenon that entails the development of infections and inflammations.

What is a hematometer and what are the principles of its treatment?

At the first detection of signs of hematometers, a woman should immediately consult a doctor. If, after a gynecological cleaning, the bleeding stopped too quickly, this can be a clear signal for the development of the disease.

The characteristic symptoms of hematometers can be considered:

  • sudden cessation of discharge after curettage or childbirth,
  • feeling of heaviness in the lower abdomen,
  • lack of menstruation over a long period
  • general weakness and malaise,
  • pain in the abdomen, aggravated by physical activity.

In addition, in the presence of an inflammatory process, the patient may experience an increase in body temperature, as well as the spread of pain in the lumbar region and the sacrum.

There may also be a discharge with a specific odor, externally reminiscent of ichor. With internal bleeding, dizziness and fainting can sometimes occur, as well as disorientation in space.

Treatment of hematometers after curettage or childbirth, as a rule, begins with drug therapy. The patient is prescribed antispasmodic drugs to relax the walls of the cervix. In the absence of the effectiveness of drug treatment, doctors insist on the repetition of gynecological cleaning. During the procedure, the entire contents of the uterus is removed, and therapy continues to eliminate inflammation. Antibacterial treatment may also be needed.

Late treatment of hematometers can be the impetus for the development of a number of dangerous diseases of the female reproductive system, blood poisoning and infertility. However, if all the requirements of gynecology are met and an annual examination is made, the likelihood of complications and any unpleasant consequences is excluded.

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