Why is blood retained in the uterus?
Normally, the contents of the uterine cavity freely exit through the cervical canal. If the canal is blocked, and the mucous membrane continues to be rejected or postpartum bleeding continues, the cavity is stretched by the accumulating blood. The obstacle can be functional - spasm of the cervical muscles after the intervention, and mechanical - a clot, remnants of placental tissue, cicatricial narrowing, polyp or fibroid node blocking the exit. In teenage girls, the cause may be a congenital hymen or vaginal septum, due to which menstrual blood does not find a way out.
- Spasm of the cervical canal after intervention
- Blood clots and tissue debris after childbirth or abortion
- Cicatricial narrowing after conization or curettage
- Polyp or fibroid node in the area of the internal pharynx
- Adhesions inside the uterine cavity
- Congenital hymen or vaginal septum
- Tumor of the cervix or uterine body
Symptoms
The main sign is inconsistency: there is pain, but no discharge. After childbirth or abortion, a woman notices that lochia or spotting has abruptly stopped, and at the same time an increasing cramping pain has appeared in the lower abdomen, radiating to the lower back and sacrum. The abdomen may feel tense, nausea, weakness, and dizziness may occur. If an infection occurs, the temperature rises, chills and purulent discharge with a smell appear. Adolescents with a congenital obstruction have cyclical complaints: monthly pain without menstruation.
- Sudden cessation of bleeding
- Cramping pain in the lower abdomen
- Referral of pain to the lower back and sacrum
- Feeling of fullness and heaviness
- Nausea, weakness, dizziness
- Fever and chills during infection
- Cyclic pain without menstruation in adolescents
Diagnostics
Complaints and data about recent childbirth, abortion or surgery help to suspect a hematometra. Upon examination, the gynecologist notes an enlarged, painful uterus with a soft consistency. The key study is ultrasound: an expanded zone with heterogeneous contents is visible in the cavity, its volume is measured and the presence of tissue remains is assessed. A complete blood count shows the degree of blood loss and signs of inflammation. To simultaneously clarify the cause and treatment, hysteroscopy is used, which allows you to examine the cavity from the inside, remove clots, tissue remnants and dissect the adhesions.
- Examination by a gynecologist with two-manual examination
- Ultrasound of the uterus, cavity measurement and content assessment
- Complete blood count and C-reactive protein
- Smear and culture if infection is suspected
- Pregnancy test if necessary
- Hysteroscopy to examine the cavity and remove the cause
- MRI for suspected developmental defects in a teenager
Treatment
There is only one task - to restore the outflow. When there is a spasm of the cervical canal, antispasmodics and gentle probing or expansion of the canal are sufficient, after which the contents come out and the pain quickly subsides. For tissue remnants and dense clots, vacuum aspiration or hysteroscopy is performed to remove them; They try to scrape out the cavity blindly no more often than necessary. If there are signs of inflammation, antibiotics are prescribed; if there is significant blood loss, iron supplements are prescribed. If the cause was a developmental defect in a teenager, surgical correction is required, which is planned by a gynecologist.
- Antispasmodics and dilation of the cervical canal
- Vacuum aspiration of cavity contents
- Hysteroscopy with removal of tissue remnants and adhesions
- Antibacterial therapy for infection
- Drugs that contract the uterus as prescribed by a doctor
- Treatment of anemia
- Surgical correction of congenital obstruction
- Control ultrasound after emptying the uterus
