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This is an accumulation of blood within the uterus.

  • It may be caused by Müllerian duct anomalies.[1]
  • 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.[4]
  • Amenorrhoea, but there may be some menstrual blood flow.[5]
  • 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.[6]
  • 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.

It is a rare cause of urinary tract obstruction and urinary retention.[7]

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Further reading and references

  1. Dadhwal V, Mittal S, Kumar S, et al; Hematometra in postmenarchal adolescent girls: a report of two cases. Gynecol Obstet Invest. 2000

  2. Gomez Arzapalo E, Perez Mendizabal A, Herrera Avalos I, et al; [Hematometra & Listeria monocytogenes] Ginecol Obstet Mex. 2001 May

  3. 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.

  4. Grimes DA, Creinin MD; Induced abortion: an overview for internists. Ann Intern Med. 2004 Apr 20

  5. 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

  6. 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.

  7. Chircop R; A case of retention of urine and haematocolpometra. Eur J Emerg Med. 2003 Sep

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