Hematometra - this accumulation of blood in the uterus as a result of violations of the physiological mechanisms of its evacuation.Essentially, hemometra - uterus is filled with blood, which can not leave its limits.It is quite rare disease and occurs infrequently.
hematometra Among the reasons there are congenital anomalies of sexual development, reproductive tract tumors, incorrect surgical procedures, a difficult birth and a few inorganic causes.
uterus communicates with the vaginal cavity through the cervical canal.It is located in the lower uterine segment narrowed significantly - the cervix.Cervical canal from the uterus and vagina has two physiological narrowing - outside (on the side of the vagina) and internal (from the mother side) shed.Mouths are formed by dense connective tissue and are similar to the anatomical "flap" can skip or delay any exudate - menstrual blood, uterine discharge.
uterine cavity becomes closed in the event of obstacles to the formation of the
Hematometra does not always mean a complete closure of the uterine cavity.Sometimes blood in the uterine cavity is delayed due to the difficulty of its evacuation, for example, by incomplete restriction of the cervical canal.Then a pain syndrome in the clinic joins a long illness, poor spotting.
blood is considered an ideal breeding ground for harmful bacteria.Prolonged uterus accumulated large amounts of blood inevitably leads to the development of an infectious inflammation clinic.
Hematometra necessarily require medical intervention.Because most of it is formed after childbirth or curettage, for diagnosis or abortion, diagnosis is carried out quickly and is not difficult.It carried out a pelvic examination and ultrasound scanning.
only effective treatment hematometra - evacuation of the uterus, followed by anti-inflammatory therapy.After cleaning the uterine cavity of the accumulated blood is also necessary to restore patency of the cervical canal.
term "hemometra uterus" as used by patients, is not correct.The word "hemometra" is composed of two Greek words: haemato (blood) and metra (womb), that is, it indicates only the uterine pathology.As in any other organ hemometra, by definition, can not be formed, "hemometra uterus" as a diagnosis does not exist.
Is a pregnancy after hematometra?This question is often heard in the office of the gynecologist and has no clear answer, as each case has its hematometra causes and negative consequences.Pregnancy after hematometra possible if the disease is diagnosed in time, it is not associated with severe purulent inflammatory changes in the endometrium, as well as congenital malformations of the genital tract.
Any obstacle flowing from the uterine cavity blood is a cause hematometra.They can be conventionally delimit on:
- Congenital, that is associated with impaired development of the genital organs.Malformations of the vagina begin to form on the stage of the embryo, so the newborn girl has been properly developed genitals.Variations in sexual development is usually diagnosed in early childhood when visiting the children's gynecologist.If such inspection is not carried out, a congenital anomaly is detected and undetected during the formation of menstrual function.
- Physiological.Are abnormal spasm of the muscle wall of the cervical canal.As a result, the walls of the cervix are closed, and the blood can not properly evacuated from the uterine cavity.
Hematometra after birth can also be generated for physiological reasons, when the background of intense tribal uterine wall during the postpartum period can be reduced properly (Aton) to evacuate the blood.As a result, the uterine cavity accumulates blood that folds, condenses and forms clots and atonic uterus is not able to "push" the thickened blood out.
Hematometra after medaborta can sometimes be formed for similar reasons: due to spasm of the cervical canal or poor uterine contractility.
- Pathological.Violation of the free flow of blood from the uterus may occur due to the presence of mechanical obstruction in the cervical canal and the uterine cavity.Large polyps of cervical canal on a broad basis can greatly distort or completely block the cervical cavity.
mechanical obstacles to the flow of blood from the uterus may become fibroids located in the uterine cavity.If uterine fibroids is located close to the inner zevu, grows it can completely or partially block the exit from the womb, but is born submucosal fibroids able to reach the cervical canal and the "cork" it completely.
Hematometra after abortion may occur in case of improper execution, when the uterus is left to a small section of the endometrium, or a piece of the destroyed fetus.
Hematometra diagnosed after birth on a background of incomplete evacuation of the placenta, when the uterine cavity is a small piece of it.
Another reason is hematometra stenosis (narrowing) of the cervical canal.Cervical canal stenosis may be the result of aging changes in the structures of the cervix after surgical procedures, radiation therapy.Hematometra after curettage for any purpose (diagnosis, treatment) can also be caused by stenosis of the cervical canal.
Reliable hematometra cause can be established in most cases, but sometimes it is formed by an inexplicable reasons.
Symptoms and signs hematometra
Note that hemometra is a consequence not only menstrual congestion, but any blood in the uterine cavity.Therefore, there are:
- Hematometra after medaborta.Complete removal of all the mucous layer is associated with the formation of an extensive wound surface in the uterus and a large amount of damage to the small blood vessels.Hematometra after curettage is formed by fragments "scraped" the mucosa and wound blood and sometimes in the womb of the fruit is delayed.
- Hematometra after childbirth.More often formed as a result of postpartum uterine atony and cervical spasm, as the cause may be a piece of placenta remaining in uterus after childbirth.During labor in place of rejection of the placenta in the uterus remains a wound site.It closes healthy tissue relatively quickly, but postpartum secretions of a small amount of blood stained pink.Postpartum lochia distinguished name, so in the case of clusters formed in the womb lohiometra.
- Hematometra due to the delay of menstrual blood.Menstrual blood accumulates in the uterus in the presence of malformations of the cervical canal stenosis, tumors and tumor-like growths.
hematometra Symptoms depend on the cause of its occurrence and the amount of liquid accumulated in the uterus content.
If hemometra appeared as a result of defects, it is diagnosed in young girls, complained of the absence of menstruation (primary amenorrhea) or their soreness.Most among genital malformations found complete or partial absence of the vagina in the correct development of the uterus.When it comes to menstruation, the blood can not be formed properly evacuated and the accumulation begins to fill in all the adjacent cavity.During the examination, the doctor found blood congestion not only in the uterus, it is present in tubes, cervical canal and the existing part of the vagina.
Hematometra after abortion, as well as after birth, formed a few days later, but the first clinical signs appear after the uterus builds up a sufficient amount of blood.A large amount of blood pererastyagivaet uterine wall and presses on nerves.The uterus is not able to "see" the cause of such changes and meets power reduction, trying to "push" that prevents it.There are aching or dragging pain in the lower divisions, and some patients compared the pain arising from the birth pangs.
Hematometra has specific symptoms that suggest it is already at the stage of the primary survey of the patient.These are considered to be any abrupt cessation of bleeding after childbirth or curettage.
presence of blood in the uterus is almost always provokes local inflammation.In conditions of reduced immunity against the backdrop of the endometrium begins hematometra infectious process.It appears fever, deteriorating health and amplify pain.The contents of the uterus is infected, it becomes purulent, and instead appears hematometra pyometra - the uterus filled with pus.
amenorrhea and cramping considered typical clinical signs hematometra, other symptoms may be absent.
Diagnosed hemometra relatively easy.On palpation determined painful, enlarged, myagkovataya uterus.However, similar data can be obtained after examination of the patient with uterine pregnancy, so before you proceed with diagnostic search, carried out the necessary tests.
After excluding possible probing uterine pregnancy the uterus.A thin sterile tube is inserted through the cervix into the uterine cavity.This will pour blood or pus.
vaginal ultrasound scanning sensor helps determine the presence of fluid in the uterine cavity, fibroids or polyps to see and identify "problem" place, preventing the flow of blood from the uterus.Also on ultrasound visualized genital malformations.
Laboratory diagnosis (swabs "flora", bakposev PCR) is needed for the early detection of infection, which always accompanies hematometra, but not always clinically evident.
in complex clinical cases performed a hysteroscopy.Using a special optical device, the doctor can directly examine the state of the uterine cavity and cervical, and if it becomes necessary, eliminate the cause hematometra.
Eliminate hematometra means to eliminate the cause of restoring the possibility of normal evacuation of uterine contents.For most women, the uterus is emptied during a simple sounding the uterine cavity.
Even the most successful evacuation of blood from the uterus does not preclude its re-accumulation, if not eliminate the cause hematometra.In case of delay parts of the fetus after abortion or pieces of placenta after childbirth, stop bleeding without their removal is not possible, therefore, made scraping the uterine cavity or vacuum - aspiration of its contents.If a defect is detected the placenta immediately after birth, is done manual examination of uterine cavity.
Cervical polyps and submucous (submucosal) fibroids create conditions for hematometra relapse, so they should be removed.
Once the uterus is freed from an excess of blood, is necessary to restore muscle tone and contractility of the walls.Used reducing agent (such as oxytocin) and antispasmodics.
Regardless of the inflammatory symptoms, antibiotic therapy is carried out, because the continued presence of blood in the uterus is associated with a high risk of subsequent septic complications.
only surgical treatment helps with hematometra against the backdrop of malformation of the genitals.