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This is an accumulation of blood within the uterus.
- It may be caused by Müllerian duct anomalies.
- Imperforate hymen.
- In older women, it may be secondary to carcinoma of cervix or cervical stenosis (eg following cone biopsy).
- Other causes include infection with Listeria monocytogenes, laser endometrial ablation, uterine curettage and cervical cryocoagulation or electrocoagulation.[2, 3]
- It 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.
- Amenorrhoea, but there may be some menstrual blood flow.
- Lower abdominal swelling and tenderness.
- It may present with severe primary dysmenorrhoea.
- It may be associated with pyometra, especially after termination of pregnancy, when the patient may have a high fever and other evidence of infection.
- If due to an imperforate hymen, and therefore associated haematocolpos develops, the hymen may bulge and exhibit a bluish discoloration. CA-125 and CA19-9 may be elevated.
- Abdominal ultrasound.
- MRI scan may be required if the ultrasound result is unclear.
This will depend on the cause, eg imperforate hymen can be incised.
Further reading and references
Dadhwal V, Mittal S, Kumar S, et al; Hematometra in postmenarchal adolescent girls: a report of two cases. Gynecol Obstet Invest. 2000
Gomez Arzapalo E, Perez Mendizabal A, Herrera Avalos I, et al; [Hematometra & Listeria monocytogenes] Ginecol Obstet Mex. 2001 May
McCausland AM, McCausland VM; Long-term complications of endometrial ablation: cause, diagnosis, treatment, and prevention. J Minim Invasive Gynecol. 2007 Jul-Aug14(4):399-406.
Grimes DA, Creinin MD; Induced abortion: an overview for internists. Ann Intern Med. 2004 Apr 20
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
Buyukbayrak EE, Ozyapi AG, Karsidag YK, et al; Imperforate hymen: a new benign reason for highly elevated serum CA 19.9 and CA Arch Gynecol Obstet. 2008 May277(5):475-7. Epub 2007 Nov 7.
Chircop R; A case of retention of urine and haematocolpometra. Eur J Emerg Med. 2003 Sep