P-250: A Case Report of Postabortal Hematometra

Objective: Hematometra is a rare and delayed complication of medical termination of pregnancy. Acquired acute hematometra also termed the postabortal syndrome or the redo syndrome is a rare complication of suction evacuation with incidence ranging from 0.1 to 1 per 100 suction curettage abortions. The treatment consists of prompt evacuation of both liquid and clotted blood leading to rapid resolution. An oxytocic is administered after the repeat evacuation.Materials and Methods: A 31 year old woman, G2L1A1 was admitted on 19th April, 2014 in emergency with the complaint of acute pain in abdomen associated with amenorrhoea of 22 weeks, nausea, infrequent spotting, and frequent urge for defecation and micturation. She gave history of colicky pain in the lower abdomen since her induced abortion on 23rd January, 2014. Her symptoms aggravated since the last 2 days. Her BHCG test was negative on admission. On examination she was hemodynamically stable but was pale. Her pulse was 100/minute and regular, blood pressure 100/70 mm Hg, and temperature 37.40 c. Respiratory and cardiovascular systems were normal. Abdominal examination revealed tenderness in the lower abdomen without any palpable lump. Vaginal and speculum examinations revealed healthy vulva, vagina, and cervix with very scanty dark blood stained discharge. The uterus was tender, retroverted, 7 to 8 weeks size with closed cervical os, and with tender right adnex. On interrogation, she gave history of suction curettage at 9 weeks gestation for IUFD on 23rd January, 2014 after which she had no menstruation. Her previous menstrual cycles were of 30 days with 4 days bleeding. She had a full term vaginal delivery 6 years ago. Investigations showed hemoglobin 10.5g/dL, WBC count 8900/ mm3, differential count – P72 L28, blood group B+, nonreactive HIV and HbsAg,BHCG negative. Results: Conservative treatment was started with intravenous fluids and antibiotics. Her vital signs remained stable but colicky pain continued which needed injectable analgesic at frequent intervals. Vaginal sonography showed thin endometrium and intra cavity fluid 15 mm with right adnexal cystic mass 2.5 cm and free fluid 7-8 mm. On 20th April, 2014 hematometra was drained by intra cervical canal catheter then she received misoprostol 200 μgq4hfor 24 hrs. She was discharged on 5th April, 2004 with metronidazole and doxycycline. Until follow paint has not any pain or symptom. Conclusion: This case showed that postabortal hematometra can be treated by intra-cervical catheter drainage.