HEMATOMETRA; HYDROMETRA; PYOMETRA.
If there exists in the genital tract any obstruction that prevents
the escape of menstrual blood, the uterus will become distended and
the condition of _hematometra_ will be present. If the retained fluid
consists chiefly of the mucous secretion of the utricular glands, the
condition is described as _hydrometra_; or if suppuration has taken
place, so that the uterus becomes distended with pus, the condition is
called _pyometra_.
[Illustration: FIG. 135.--Hematometra.]
The uterine walls may be very much attenuated by the distention, or the
muscular coat may hypertrophy as the accumulation progresses.
The cause of these conditions may be congenital or acquired atresia
of any part of the genital tract. The symptoms usually appear after
puberty. The menstrual period is accompanied by intense bearing-down
pain in the region of the uterus. There is no appearance of menstrual
blood. A round tumor may be felt in the hypogastrium. Examination will
reveal the obstruction in the cervical canal. Sometimes the chief
accumulation and distention occur in the cervix; in other cases the
body of the uterus is chiefly affected.
Distention of the Fallopian tubes, with the formation of hematosalpinx,
hydrosalpinx, or pyosalpinx, often accompanies old cases of hematometra.
The =treatment= consists in relieving the obstruction and in
maintaining the patulous condition of the genital tract. If the cervix
is the seat of the obstruction, it should be punctured with a trocar
and thoroughly dilated. It may be necessary to practise repeated
dilatation in order to keep the canal open.
The accompanying disease of the Fallopian tubes may persist after
drainage of the uterus, and salpingo-oöphorectomy or hysterectomy may
be ultimately required.