Hematometer

A hematometer is a disease characterized by the accumulation of blood in the uterine cavity, which disrupts its contractility with possible further infection. This condition develops for many reasons, but in most cases is a consequence of an invasive intervention. The complications and consequences of this condition are very serious, so you need to diagnose and treat this pathology in time.

[1]

Epidemiology

The epidemiology of this problem indicates that among all the possible causes for the development of this condition, postpartum complications account for more than 88% of cases. The second most common cause is invasive intervention - abortion and surgery. More than 65% of cases of hematomas are diagnosed already at the stage of complications, that is, with infection, which confirms the huge role of preventive diagnostics.

[2], [3], [4]

Causes of the hematometrs

The hematometer develops due to the accumulation of blood between the layers of the endometrium, and for this several conditions are necessary. Normally, the menstrual cycle is the monthly allocation of blood by desquamation of the functional layer of the endometrium. This happens despite the fact that the structure of the endometrium is not broken and the release of hormones contributes to this phenomenon. In order for blood to accumulate in the uterus, it is necessary that the structure of the endometrium layers be broken and there was a barrier in the way of the outflow of blood from the uterus. Therefore, the reasons for the development of hematomas are operative or other invasive intervention, which can disrupt the structure of the endometrium.

Most often the hematometer develops after childbirth, against the background of Caesarean section or invasive intervention in the period of the birth of the membranes. Pregnancy and childbirth can be considered the most common cause of development of hematomas. The fetus is tightly connected to the uterus for ten weeks, they have a common blood circulation and the fruit membranes are constantly in contact with the endometrium. After the birth of the child, a large wound surface forms, which bleeds. Immediately after birth, the uterus is reduced, which is a protective mechanism for the development of large bleeding and hematomas including. But if for certain reasons there was not enough contraction of the uterus, the blood can accumulate in the uterine cavity. The pathogenesis of the formation of hematomas is not only in the accumulation of blood, but also in the violation of its outflow from the vagina. Therefore, one more condition is the uterine excesses or uneven contraction of its different parts. It is after the birth that the uterus can contract very strongly and move to the position of strong flexion - anteflexio or retroflexion, or the lower segment may contract and spasm, blocking the exit from the uterus. Therefore, childbirth is the most common cause of the development of such a condition. Based on this, it is possible to identify the main risk factors for the development of hematomas. Such factors include:

• births complicated by bleeding in the third period - this contributes to the disruption of the structure of the endometrium and the blood that accumulates can freely pass through the layers of the endometrium;
• a large fetus or twin genera - this is also an additional factor in the trauma of the birth canal;
• ruptures of the uterus or cervix during childbirth;
• Hypotension or atony of the uterus in labor does not allow the uterus to contract normally;
• concomitant fibromy can alter the structure and thickness of the endometrium and disrupt normal postpartum discharges of blood and fetal membrane residues;
• frequent abortions or miscarriages in an anamnesis lead to a disruption of the normal structure of the endometrium;
• inflammatory diseases of the uterus in the anamnesis - endometritis or myometritis - disrupt the process of contraction of the uterus after childbirth.

[5], [6], [7]

Risk factors

Taking into account these risk factors, other causes of hematomas development come out of them. One of such reasons is the intervention on the uterus, which is accompanied by scraping its cavity - abortion, miscarriage, ectopic pregnancy. All these cases are accompanied by bleeding, in which blood can pass through the damaged layers of the endometrium and accumulate there. The hematometer after scraping of the frozen pregnancy develops quite often, since the fruit membranes are more closely fused with the endometrium. The dead fetus in this case enhances the synthesis of connective tissue, which promotes a strong connection with the uterus. Therefore, after removing the fetus and scraping the fruit site, often there are synechiaes that do not allow to remove everything completely - and this is a big risk of developing hematomas.

The hematometer after cesarean can only develop if an incomplete revision of the uterine cavity has been performed, or it has significantly decreased, and has greatly altered the position. In this case, those uterine discharge, which should normally be after childbirth, can not go out and accumulate, "impregnating" the uterine cavity.

A hematometer after a medical abortion can develop in case of misconduct or the implementation of all recommendations. After all, abortion also leaves behind a large wound surface, and for some time the remains of blood should go out with secretions. Thus it is necessary to observe bed rest and not to lift weights. If there were any violations, it could cause a reduction in the uterus, which leads to a violation of its topic, so there may be a barrier to the discharge. This will cause the development of hematomas.

Girls can also develop a hematometer and the cause may be partially or completely overgrown maiden. In this case, the menstrual blood of a girl may not all come out, but some amount of it remains. It accumulates in the cavity and gradually infiltrates the endometrium, which can lead to serious complications.

Women in menopause can also develop this condition. At the same time, the main reason is the age-specific features of women. In this period, menstruation is unstable, they often have scanty character and go through two months. Along with this, the size of the uterus itself, the cervical canal and the vagina decreases, which leads to the fact that menstruation may not completely exit. This will cause the development of hematomas.

Given a number of reasons for the development of this pathological condition, it is necessary to conduct a thorough diagnosis of any symptoms in women at risk to timely diagnose and begin treatment.

[8], [9], [10]

Symptoms of the hematometrs

The hematometer after delivery is most often developed and the clinic is not always clear. The first signs can appear already on the second day after childbirth, and sometimes can appear only in a week. In normal conditions, all the remains of the fetal membranes, the maternal part of the placenta and the remains of blood are released after birth with special secretions - lochia. They have a cyclicity and immediately after childbirth have a red color, then a light shade of red, and then become white serous excretions. It is the first three days allocated part of the blood, which can linger in the uterus with the development of hematomas. Therefore, the first and main diagnostic sign of the development of such a state is the absence of lochia or their lean character. Further, there may be other symptoms that are already associated with the accumulation of blood in the cavity. Then the woman feels a pulling pain in the lower abdomen, a feeling of bursting into the pelvis. The uterus can grow in size and press on adjacent organs, which can affect the appearance of other symptoms - frequent urination or a feeling of filling the bladder.

If the hematoma develops after menstruation, then the symptoms of pain in the lower abdomen are very pronounced and are often accompanied by nausea and a headache. The hematometer in postmenopause often develops against a background of uterine myoma. Then the increase in the uterus in size and the change in the structure of the myometrium due to the number of nodes leads to the fact that the menstrual secretions accumulate with the development of this pathology. Simultaneously with the growth of fibroids, the symptoms of hematomas may not appear until the moment when the volume of blood does not become significant. Then there is pain in the abdomen and there may be a discharge from the vagina of an unpleasant nature. There may be purulent discharge, which indicates the appearance of complications.

After abortion, there may also be spotting for a while, and the absence of them or any other discharge may be a symptom of hematoma development, so care should be taken to isolate after surgery. Allocations after hematomas against the background of treatment are normalized: first there are small bloody discharge, and then serous and usual milky color.

A moderate hematometer may not be manifested at all, since a small volume does not contribute to any changes. But in the long term, a chronic hematometer can develop. This is a condition in which a small amount of blood always accumulates in the uterine cavity, which does not affect the woman's condition in any way. This can be if there is a small defect in the bottom of the uterus or the angle of the uterus after any operation where some blood can accumulate. Over time, this blood can be allocated, and in its place another forms. This corresponds to the concept of chronic hematomas.

[11], [12]

Complications and consequences

The consequence of hematomas can often be infection with the development of a large foci of infection. Blood is a nutrient medium for most microorganisms. In the vagina, there are not only Dodereillin sticks, but also many conditionally pathogenic and pathogenic microbes that multiply rapidly when this environment appears. Then there are symptoms of intoxication, the body temperature rises, the pain becomes very severe and pus or blood with pus is released from the vagina. This is the most common complication that occurs against the background of hematomas and is diagnosed already when these complications occur.

The most serious complication of hematomas after abortion can be considered a bubble drift. This is a pathology that has a high degree of malignant degeneration. It develops if the remains of the fetal membranes are fixed on the endometrium due to incomplete abortion. As a result, a hematometer may be formed, which aggravates the condition due to late diagnosis. This condition requires immediate surgical intervention, which can threaten the extirpation of the uterus.

Symptoms of this condition can not always be diagnosed at the initial stage, but in the future, when the nature of such secretions changes, one must suspect a violation of the state of health.

[13], [14], [15], [16],

Diagnostics of the hematometrs

Diagnosis of hematomas after childbirth is not difficult, because in the postpartum period, a woman for three days is under the close supervision of doctors. The doctor immediately after childbirth controls the status of the mother and she also assesses postpartum discharge. Next, on the first day and until the end of her stay in the maternity home, a woman is examined and evaluated for her condition. Therefore, if the allocation is not sufficient or their character does not correspond to normal lochia, then there is a suspicion of the possible development of hematomas. In addition, the doctor assesses the condition of the uterus, its tone, contraction and possible disruption of location.

Diagnosis of hematomas, which occurs in girls after menstruation against the background of an infected maiden spittle is slightly complicated. Here it is necessary to find out from the girl the time of the menarche, their character and the volume of secretions. As a rule, at the beginning of the cycle, the amount of secretions is abundant and the duration is not less than five days. If the girl points out the meager nature of the discharge and pain in the abdomen, regardless of menstruation, you need to examine the girl. When looking at the mirrors, you need to carefully assess the condition. The benefit of hematometers is evidenced by the strain of the maiden's spittle, its murky color and soreness in palpation.

After abortion, there should also be vaginal discharge according to the type of menstruation, so if a woman complains, then it is necessary to clarify the nature of the discharge and whether they were at all. It is necessary to examine the woman in the mirrors and if there are hematomas, the examination will cause pain, there may be changes in the cervix in the form of spasms or discharge from the cervical canal. With bimanual palpation, you can determine the limited mobility of the uterus, its tension.

Analyzes that must be carried out with suspicion of a hematometer should rule out complications. Therefore, it is necessary to conduct a general analysis of blood, urine, in some cases a biochemical blood test. Changes that may be - a decrease in hemoglobin or anemia of the first degree, if there are infectious complications, there can be leukocytosis with a shift of the formula to the left.

If the hematometer is complicated by infection with the development of endometritis, then the analysis of vaginal discharge with the determination of the pathological flora and its sensitivity to antibacterial agents must be carried out.

Instrumental diagnosis is needed to clarify the diagnosis if hematomas are suspected. The main method of diagnosis is ultrasound. This method allows you to diagnose the presence of blood in the uterine cavity, and helps to clarify its number, the condition of the uterine wall, blood circulation, the position of the uterus and appendages. Echo signs of hematomas are changes in the signal in the uterine cavity in the form of areas of enlightenment of varying intensity. The uneven edge of the signal makes it possible to judge the presence of fluid, and if the blood has clots, then areas of greater signal intensity are determined. You can also determine the change in the location of the uterus in relation to the midline and violation of the topic.

[17], [18], [19], [20]

Differential diagnosis

Differential diagnosis of postpartum hematomas should be performed with insufficient uterine involution, postpartum septic complications. Insufficient involution of the uterus occurs after delivery complicated by hypotension or atony of the uterus or weakness of delivery. As a consequence, after the delivery, the uterus does not contract sufficiently and the tonus can be disturbed, which, when palpated, can resemble a hematometer due to an increase in its size. But unlike hematomas, with insufficient involution, excretions are not violated and there are bloody lochia in the first three days. Postpartum septic complications in the form of endometritis or parametritis are accompanied by an increase in the uterus in size, increased tone, tenderness in palpation. But unlike hematomas, with inflammatory processes there is an increase in temperature to hectic digits and symptoms of intoxication are expressed.

If the hematometer develops in a woman in menopause, then differential diagnosis with uterine myoma is necessary. Both pathologies are characterized by an increase in the uterus in size, but the main diagnostic sign of fibroid is palpation of the compacted uterus, enlarged due to myometrium. With a hematometer, the uterus is enlarged due to the contents in it, and the structure itself is not changed. In addition, ultrasound can accurately determine the presence of fluid in the cavity or fibroids.

Proper diagnosis and management of the postpartum period, as well as timely consultations of the doctor allow you to establish a diagnosis in time and conduct adequate therapy.

Treatment of the hematometrs

The drugs that are used in the treatment of hematomas have several directions. It is necessary to eliminate the blood that exists in the uterine cavity, stop bleeding, if it is available and use drugs to reduce the uterus or regulate its tone, it is also necessary in this case to take antibacterial drugs to avoid the endometritis. First of all, it is necessary to eliminate blood, which is to avoid complications, for this purpose use drugs that help stop bleeding and prevent further blood secretions. Etamsylate with a hematometer can be used in complex therapy at the initial stage.

1. Etamsylate is a drug from the group of systemic haemostatic agents that can be used to stop blood production if the hematometer is caused by trauma to the birth canal or there is a source of bleeding. The drug has a predominant effect on platelet cells and capillaries, which contributes to the activation of the vascular-platelet link in stopping bleeding. The method of using the drug to stop bleeding intravenous, which accelerates the effect of the drug. Dosage of the drug - 10 milligrams per kilogram, on average use one ampoule three or four times a day. Side effects are possible in the form of jaundice, the appearance of a rash, itching of the skin, a sensation of fever in the face and a decrease in pressure. Precautions - use with caution in patients with asthma and varicose veins.
2. But-shpa with a hematometer is used without fail, if there is a spasm of the uterus or an increase in its tone, which led to a sharp bend. The effect of spasmolytic therapy is expressed immediately and the tone of the uterus decreases, which leads to a better outflow of blood. Therefore, the use of spasmolytic therapy is pathogenetically justified.

But-shpa is a spasmolytic of myotropic action, the active substance of which is drotaverine. The drug reduces the tone and motor activity of the smooth muscles of the internal organs, dilates the blood vessels. Thanks to this, an analgesic effect occurs, and it also has a good effect on the tone of the uterus. The method of application with a hematometer is mainly intramuscular. Dosage - 2 milliliters of the drug must be entered, then it can be repeated no earlier than an hour later. Side effects that can be skin hyperemia, fever, chills, body t ° increase, weakness, heart palpitations, arterial hypotension headache, dizziness, insomnia, nausea, constipation, vomiting, local reactions at the injection site. Precautions - do not use in congenital pathologies - malabsorption and lactose intolerance.

1. Duphaston with a hematometer is used very widely already in the period after the active release of a certain amount of blood from the uterine cavity. When the bulk of the blood that formed during the hematometer came out against the background of therapy or surgery, that is, some endometrial sites that contain hemolyzed blood after hematomas. To convert the endometrium into a secretion phase with further maximum purification of the uterus, additional amount of progesterone is needed.

Dufaston is a monocomponent hormone drug, the main active ingredient of which is dydrogesterone - a synthetic analogue of progesterone. The drug acts only on the endometrium, the epithelium of the cervical canal and the vagina, stimulating the rejection of the functional layer. Therefore, hematomas are used in therapy as an additional therapy. The method of application of the drug is in tablets, the dosage is individual under the control of the dynamics of uterine secretions. Side effects - dizziness, drowsiness, pain in the mammary gland, skin itching, vomiting, fluid retention with the formation of edema. Precautions - it is important to monitor the dosage of the drug and the effect of this dose.

1. Macrocepha is a beta-lactam antibiotic of the third generation of cefoperazone, is particularly effective when acting on gram-positive and gram-negative flora. The drug has a bactericidal effect on possible anaerobic pathogens of infection, so it can be used for preventive purposes in gynecology. Dosage of the drug - 1000 milligrams once a day, taking into account the preventive intake, intramuscularly five days. Side effects are possible with the influence on the stomach - develops colitis or dysbiosis, which manifests itself by bloating, a violation of the stool. Precautions - do not use the drug for allergies to antibiotics-penicillins, as well as for congenital fermentopathies.

Operative treatment hematometers are used in cases when spasmolytic therapy is not enough to reduce the uterine tone and evacuation of blood. Surgery may have a different volume. With an overgrown maiden nerve and as a result of this formation, the hematometers conduct only a small puncture of the hymen, or if this is not enough, then defloration. If the hematometer was formed in the postpartum period, then perform a manual revision of the uterus or, if necessary, scraping. The hematometer after abortion often requires scraping to avoid complications. Therefore, invasive intervention is part of the treatment of hematomas in any case, with the addition of spasmolytic, antibacterial and hormonal therapy.

Vitamins with a hematometer are used for more effective rehabilitation and recovery of the female body. To this end, you need an increased amount of vitamin C, B, and A. If there is anemia after a serious loss of blood due to interference, then adequate nutrition or even iron supplements is recommended at the second degree of anemia.

Physiotherapeutic treatment is very effective at the stage of convalescence for restoration of uterine circulation, normalization of ovarian function and epithelium. For the purpose of treatment, thermal procedures and magnetic therapy can be used. In the postpartum period, it is better to refuse from thermal procedures and breastfeeding from thermal procedures, you can use spa therapy.

Alternative treatment of hematomas

Alternative treatment can be used in complex therapy, both to stop bleeding, and to normalize uterine discharge after recovery. For this purpose, you can use compresses, vaginal tampons or infusions of herbs that affect different parts of the process. Treatment of hematomas at home should be a complete course, using hemostatic and antispasmodic herbs.

1. Nettle with a hematometer is used to reduce the severity of blood loss and normalization of the endometrium against the background of treatment. For medicinal broth, you need to take one hundred grams of dioecious nettle and insist in hot water. In an acute period, you can take half a cup of broth every three hours. Then you can drink the broth twice a day.
2. A warm warmer on the bottom of the stomach has good antispasmodic properties, it also reduces stress and promotes relaxation of the uterus. To do this, you need to collect warm water (not hot!) In the heating pad and put on the bottom of the stomach. After this, it is necessary to occupy the position on the side, which improves the outflow of the contents of the uterine cavity.
3. At home, you need to perform small exercises that have a draining effect and improve the cleansing of the uterine cavity from all discharges. To do this, it is necessary to squat in a pose position at a slow pace no more than five times. Next, you have to bend over to the side, pulling your hands to the side surfaces of your knees. The last - you need to lie on your side for five minutes, then change sides. Such light exercises will help to better resolve the disease, but they can only be used if there is not a lot of bleeding and there are no other contraindications.

Herbal treatment of hematomas affects not only the state of bleeding, but also there are many herbs that contribute to the relaxation of the uterus and normalize the overall condition by replenishing the volume of blood loss.

1. Tincture of water pepper with a hematometer is used as a haemostatic agent. To make the tincture you need to take a hundred grams of water pepper, pour the same amount of alcohol and insist for two days. After that, you need to add six tablespoons of honey and a liter of water. Drink the tincture on the pile four times a day. This tincture still increases the overall immunity and has a tonic effect.
2. Especially effective in the treatment of hematomas and further hormonal disorders infusion of anise root and horseradish root. To make medicinal tea you need to take 10 grams of both ingredients, fill with water in the amount of half a liter, and then after it tinges for twenty minutes, strain and drink.
3. Tea from the stems of raspberries, berries of viburnum and bilberry leaves normalizes the tone of the myometrium, improves microcirculation and the outflow of blood in the uterus. For tea, you need to take equal parts of all the ingredients, soak and drink instead of tea.
4. Grass elecampane is a plant whose effect is to improve the tone of the uterus and reduce the severity of spasmodic pain. To prepare the medicine, three tablespoons of washed and cut elephant leaves should be boiled for five minutes in a liter of clean water, then add a few spoons of honey and mix. After the tea has cooled, you need to drink it three times a day for half a cup.

Homeopathy is used both in the acute period and in the period of remission to restore normal menstrual function after hematomas. To do this, use herbal preparations and medicines of inorganic origin. The main approach to choosing a drug is symptomatic.

1. Agnus-plus is a plant that improves trophic myometrium, reduces the severity of the edema of the postnatal pathways and has a number of antibacterial substances. The drug is especially effective in the treatment of hematomas in an acute period, when the uterine tone is most elevated and the vessels are spasmodic. The way of using the drug is parenteral and the dosage starts with three granules every three hours on the first day, then you need to take three granules every six hours the next day, and from the third day three pellets twice a day. Side effects can be on the first day of admission as an increase in the pulling pain in the lower abdomen, which occurs after several hours.
2. Quercus-edas is a homeopathic medicine that is used to treat hematomas in women in the menopause period. The drug acts not only on the accumulation of blood, but in addition it regulates the hormonal background, which is very important for the further normalization of discharge in women of this age. The medicine is dosed four drops in the morning and in the evening, the method of application - you need to dissolve drops in a lot of water. Side effects can occur at a high dose - there is dizziness, headache, general weakness.
3. Nicomel is a homeopathic medicine that is used in complex treatment of hematomas complicated by endometritis. The drug does not allow the infection process to go to the chronic stage. The method of application of the drug is parenteral. Granules need to be chewed up to complete dissolution, it is not recommended to swallow whole. Dosage is two granules twice a day. Side effects can be in the case of a combination with iodine preparations - then there may be allergic manifestations.
4. Galium-hel is an inorganic homeopathic preparation. Used to treat bloody uterine discharge of any type, including hematomas, which can be complicated by uterine secretions already in the period of remission. The way of using the drug depends on the form. Dosage in case of taking drops - one drop five times a day, and with capsules - two capsules three times a day. Side effects are possible in the form of hyperemia of the skin of hands and feet, as well as sensation of heat. Precautions - do not use in combination with preparations of bee origin.
5. Pionia-plus is a homeopathic remedy of plant origin, which is effective with a hematometer in the postoperative period during the abortion. Used for treatment in patients who complain of discharge after an abortion with abdominal pains and irregular menstruation. Issued in the form of drops and used in a dosage of three drops every day. The course of treatment can begin immediately after the appearance of complaints, and before planning a pregnancy or after restoring a normal cycle, you can stop taking the drug. Precautions - In the presence of infertility or miscarriage in history, you should use the drug with caution. Side effects may manifest as impaired intestinal function.

The use of alternative and homeopathic remedies should only be combined with other medications and only after consulting with the doctor, since the rapid possibility of infection increases the risk of complications in untimely treatment.

[21], [22], [23], [24], [25], [26], [27]

Prevention

Prevention of the development of hematomas in the postpartum period is very important, since it is at this point that the status of the uterus is a risk factor for the development of pathology. Therefore it is important to follow all the doctor's recommendations. If the birth was complicated or there was a cesarean section, then it is impossible to raise the severity, including the baby, for the first two days. But at the same time, you need to get up and move soon after the operation, this leads the uterus into tone and prevents postpartum complications.

Prevention of hematomas after abortion is a protective regimen with careful monitoring of the condition and discharge from the uterus.

[28], [29], [30]

Forecast

The prognosis of hematomas for recovery is favorable in case of timely diagnosis. Rehabilitation after such a disease is not difficult, so the workability is restored quickly.

The hematometer is a condition that often occurs in the postpartum period in women against a background of complicated births. In this case, the blood and remnants of amniotic membranes accumulate in the uterine cavity. This condition can be asymptomatic for some time, therefore it threatens with complications, which are dangerous for health. To avoid such a problem, you should always carefully monitor your health and if you have any symptoms - contact a specialist.