From the Guidelines
The treatment for Hematometra (accumulation of blood in the uterus) is suction dilation and curettage, preferably performed under ultrasound guidance, to reduce the risk of uterine perforation. This approach is recommended for women who wish to preserve fertility, as stated in the 2019 NCCN clinical practice guidelines in oncology 1. The procedure should be accompanied by the administration of Rho(D) immunoglobulin for patients with Rh-negative blood types, and uterotonic agents such as methylergonovine and/or prostaglandins to reduce the risk of heavy bleeding. Some key considerations for the treatment of Hematometra include:
- The use of ultrasound guidance to minimize the risk of uterine perforation
- The administration of Rho(D) immunoglobulin for Rh-negative patients
- The use of uterotonic agents to reduce bleeding
- The consideration of hysterectomy as an alternative for women who are older or do not wish to preserve fertility It is essential to note that prophylactic chemotherapy at the time of uterine evacuation is controversial and not recommended as a standard practice, as stated in the Cochrane database review 1. Histopathologic review and possible genetic testing are necessary to confirm the diagnosis. In terms of post-procedure care, patients should be monitored for any complications, and a follow-up ultrasound is recommended to confirm resolution of the Hematometra. Overall, the goal of treatment is to address the underlying cause of the blood accumulation, prevent further complications, and improve the patient's quality of life.
From the Research
Treatment Options for Hematometra
- Dilation and curettage (D&C) is a treatment option for hematometra, as seen in a case report of an adolescent female with hematometra who was treated with D&C and advised to discontinue depot medroxyprogesterone acetate use 2.
- Hysteroscopy is also a viable option for the diagnosis and treatment of conditions related to hematometra, such as endometrial polyps, and allows for both histological diagnosis and effective treatment 3.
- Cervical dilatation and evacuation of the accumulated blood, followed by the placement of a temporary stent to maintain cervical patency, is another treatment approach for hematotrachelos, a condition related to hematometra 4.
Considerations for Treatment
- The choice of treatment for hematometra may depend on the underlying cause of the condition, such as congenital anomalies or prior surgical procedures causing an obstruction of the genitourinary outflow tract 2.
- D&C is not recommended for the diagnosis and treatment of endometrial polyps, and hysteroscopy is preferred due to its high diagnostic value and ability to provide both diagnosis and treatment 3.
- The treatment of hematometra should be individualized, taking into account the patient's specific condition, medical history, and other factors, such as the use of certain medications like depot medroxyprogesterone acetate 2.