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The fluid consists of cervical and endometrial mucus or in rare instances urine accumulated through a vesicovaginal fistula proximal to the obstruction. In some cases, it is associated with Bardet-Biedl Syndrome. [1] If it occurs in prepubertal girls, it may show up as abdominal swelling. It may be detected by using ultrasound.
Additionally, hematometra may develop as a complication of uterine or cervical surgery such as endometrial ablation, where scar tissue in the endometrium can "wall off" sections of endometrial glands and stroma causing blood to accumulate in the uterine cavity. [1] It can also develop after abortion, [4] as well as after childbirth.
Pelvic and vaginal ultrasounds are helpful in the diagnosis of PID. In the early stages of infection, the ultrasound may appear normal. As the disease progresses, nonspecific findings can include free pelvic fluid, endometrial thickening, uterine cavity distension by fluid or gas.
A small amount of anechogenic-free fluid in the recto-uterine pouch is commonly found in both intrauterine and ectopic pregnancies. [5] The presence of echogenic fluid is estimated at between 28 and 56% of women with an ectopic pregnancy, and strongly indicates the presence of hemoperitoneum . [ 5 ]
Sonography can demonstrate that the pregnancy is outside an empty uterus, there is reduced to no amniotic fluid between the placenta and the fetus, no uterine wall surrounding the fetus, fetal parts are close to the abdominal wall, the fetus has an abnormal lie, the placenta looks abnormal and there is free fluid in the abdomen.
The rupture is usually at the bottom of the uterus, over the cervix, causing a gush of fluid. This gush may be quite small (such as 50ml), or it can be significantly large (200-300ml) depending upon amount of fluid in the amniotic sac, and to what extent the fetal head is plugging the hole and retaining fluid in the sac. [8]
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In the second trimester, a standard ultrasound exam typically includes: [12] Fetal number, including number of amnionic sacs and chorionic sacs for multiple gestations; Fetal cardiac activity; Fetal position relative to the uterus and cervix; Location and appearance of the placenta, including site of umbilical cord insertion when possible