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Hematometra or hemometra is a medical condition involving collection or retention of blood in the uterus. It is most commonly caused by an imperforate hymen or a transverse vaginal septum.

Signs and symptoms

Hematometra typically presents as cyclic, cramping pain in the midline of the pelvis or lower abdomen.^[1] Patients may also report urinary frequency and urinary retention.^[2] Premenopausal women with hematometra often experience abnormal vaginal bleeding, including dysmenorrhea (pain during menstruation) or amenorrhea (lack of menstruation), while postmenopausal women are more likely to be asymptomatic.^[3] Due to the accumulation of blood in the uterus, patients may develop low blood pressure or a vasovagal response.^[4] When palpated, the uterus will typically feel firm and enlarged.^[4]

Pathophysiology

Hematometra develops when the uterus becomes distended with blood secondary to obstruction or atresia of the lower reproductive tract—the uterus, cervix or vagina—which would otherwise provide an outflow for menstrual blood.^[2] It is most commonly caused by congenital abnormalities, including imperforate hymen, transverse vaginal septum or vaginal hypoplasia. Other causes are acquired, such as cervical stenosis, intrauterine adhesions, endometrial cancer, and cervical cancer.^[3]

Transvaginal ultrasonography of a hematometra after childbirth, seen as a hypoechoic (darker) area within the uterine cavity. The cervix is located to the left in the image, and the fundus is located to the right.

Additionally, hematometra may develop as a complication of uterine or cervical surgery such as endometrial ablation, where scar tissue in the endometrium can "wall off" sections of endometrial glands and stroma causing blood to accumulate in the uterine cavity.^[1] It can also develop after abortion,^[4] as well as after childbirth.

Diagnosis

Although hematometra can often be diagnosed based purely on the patient's history of amenorrhea and cyclic abdominal pain, as well as a palpable pelvic mass on examination, the diagnosis can be confirmed by ultrasound, which will show blood pooled in the uterus and an enlargement of the uterine cavity.^[4]^[5] A pyelogram or laparoscopy may assist in diagnosing any congenital disorder that is suspected to be the underlying cause of the hematometra.^[2]

Management

Hematometra is usually treated by surgical cervical dilation to drain the blood from the uterus.^[3] Other treatments target the underlying cause of the hematometra; for example, a hysteroscopy may be required to resect adhesions that have developed following a previous surgery.^[1] If the cause of the hematometra is unclear, a biopsy of endometrial tissue can be taken to test for the presence of a neoplasm (cancer).^[5] Antibiotics may be given as prophylaxis against the possibility of infection.^[3]

References

^ ^a ^b ^c Bradley, Linda D.; Falcone, Tommasco (2008). Hysteroscopy: Office Evaluation and Management of the Uterine Cavity. Elsevier. ISBN 9780323074667.
^ ^a ^b ^c Conry, Jeanne A. (2002). "The Enlarged Uterus". Manual of Outpatient Gynecology (4th edition ed.). Lippincott Williams & Wilkins. ISBN 9780781732789.
^ ^a ^b ^c ^d Smith, Roger (2008). Netter's Obstetrics and Gynecology. Elsevier. p. 287. ISBN 9781416056829.
^ ^a ^b ^c ^d Ogburn, Tony; Taylor, Betsy (2013). Procedures in the Office Setting, An Issue of Obstetric and Gynecology Clinics. Elsevier. ISBN 9780323261135.
^ ^a ^b Lentz, Gretchen M.; Lobo, Rogerio A.; Gershenson, David M.; Katz, Vern L. (2012). Comprehensive Gynecology (6th edition ed.). Elsevier. pp. 406–407. ISBN 9780323091312.

UpToDate Contents

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1. 子宮内膜アブレーションの概要 an overview of endometrial ablation
2. 妊娠中絶の概要 overview of pregnancy termination
3. 妊娠付属物遺残 retained products of conception
4. 子宮頸部の先天性奇形および子宮頸部良性病変 congenital cervical anomalies and benign cervical lesions
5. 子宮腔癒着 intrauterine adhesions

English Journal

An unusual case of cervical diverticulum identified by presence of 3 cavities at diagnostic hysteroscopy.

Stamatopoulos C, Tsimpanakos I, McKenzie-Gray B, Gkioulekas N, Korkontzelos I, Magos A.SourceDepartments of Obstetrics and Gynecology, Royal Free Hospital, Hampstead, London, UK.
Journal of minimally invasive gynecology.J Minim Invasive Gynecol.2013 Mar;20(2):238-40. doi: 10.1016/j.jmig.2012.10.004.
Herein is presented the case report of a patient who had severe dysmenorrhea since menarche, known right unicornuate uterus with a left rudimentary horn, and recurrent hematometra. Previous hysteroscopic drainage of the hematometra temporarily alleviated the symptoms. At subsequent hysteroscopy, 3 c
PMID 23465259

Primary amenorrhoea due to a rare cause: epidermolysis bullosa causing haematometra.

Singh C, Tripathi R, Sardana K, Mala YM.SourceDepartment of Obstetrics and Gynaecology, Maulana Azad Medical College, New Delhi, India. chanchalsngh@gmail.com
BMJ case reports.BMJ Case Rep.2013 Jan 2;2013. pii: bcr2012007542. doi: 10.1136/bcr-2012-007542.
A 27-year-old woman with junctional epidermolysis bullosa (EB) presented with primary amenorrhoea and massive haematometra. Considering her severe physical handicap and anticipated problems in optimising menstrual hygiene, the patient and her parents opted for hysterectomy which was performed uneven
PMID 23283611

Massive Hematometra due to Congenital Cervicovaginal Agenesis in an Adolescent Girl Treated by Hysterectomy: A Case Report.

Gasim T, Al Jama FE.SourceDepartment of Obstetrics and Gynecology, College of Medicine, University of Dammam, Dammam, Saudi Arabia.
Case reports in obstetrics and gynecology.Case Rep Obstet Gynecol.2013;2013:640214. doi: 10.1155/2013/640214. Epub 2013 Feb 28.
A case of massive hematometra with a bicornuate uterus in a 14-year-old mentally handicapped girl complicated by vaginal agenesis and absent cervix is presented. She was managed by abdominal hysterectomy and right salpingo-oophorectomy that included the ovarian cystadenoma. The left ovary was conser
PMID 23533866

Japanese Journal

直腸肛門奇形に合併した子宮留血腫に対する治療戦略

望月響子,大浜用克,新開真人,武浩志,北河徳彦,工藤博典,畑田智子
日本小児外科学会雑誌 46(7), 1136-1140, 2010-12-20
直腸肛門奇形に合併した子宮留血腫の治療法を検討した.症例1:12歳女児.肛門膣前庭瘻,重複膣,重複子宮.子宮・卵管留血腫,子宮頸部閉鎖症に対し,開腹子宮膣開窓術を行った.3か月後開窓部閉塞を認め,直視下子宮膣開窓部再開通術を行い,マレコーカテーテルを留置した.7か月後抜去し月経血排泄障害はない.症例2:12歳女児.直腸総排泄腔瘻,結腸欠損,重複子宮.子宮・卵管留血腫,子宮頸部閉鎖症に対し,開腹子宮 …
NAID 110007989308

腹腔鏡下手術を施行した、非交通性副角子宮に局側卵巣子宮内膜症性嚢胞と強度の癒着を伴った単角子宮の一例

軸丸三枝子,江上りか,渡邊良嗣,福原正生,宮原明子,新谷可伸,合志礼子,宮脇聡子,中村元一
日本産科婦人科内視鏡學會雜誌 = The journal of the Japan Endoscopy Society of Obstetrics and Gynecology 26(2), 439-443, 2010-12-01
… A unicornuate uterus with a non-communicating rudimentary horn is a rare Müllerian anomaly that has been associated with various comorbidities including hematometra, endometriosis and obstetric complications. …
NAID 10029376775