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Fluid in the uterus

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Liquid in the uterus is a collection of liquid secretion in the uterine cavity of various origins. The accumulation of fluid of any origin in the uterus determines ultrasound scanning. Echoes of fluid in the uterus are not always accompanied by a clinical picture and often serve as an excuse for additional diagnostic measures. The presence in the uterine cavity of the "free" fluid is only a symptom that accompanies several pathological conditions and is not a diagnosis.

After ascertaining the presence of fluid in the uterus, a number of diagnostic measures are always conducted to find the cause of this condition. It should be noted that the presence in the uterine cavity of the fluid is not always associated with a serious pathological process, and may be associated with completely harmless physiological causes and even independently disappear.

The causes of the appearance of fluid in the uterus are very diverse, as is the composition of this liquid. It is the nature of the uterine content that often indicates the cause of its appearance. If the serous fluid is present in the uterus, the condition is classified as a serosimeter. The accumulated fluid in the uterus after delivery is a postpartum discharge( lochia), therefore it is called a lochiometer. When the infectious inflammatory process is expressed, the uterus can accumulate a fluid containing pus and form a pyometra.

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Accumulated in the first few days after curettage for abortion or diagnosis, the fluid in the uterus is the blood that flows out of the damaged vessels. The blood accumulated in the uterus, as a rule, is evacuated outward independently, but sometimes, for pathological reasons, it remains in the uterine cavity and accumulates. The blood-filled uterus is called the hematometer.

Conditionally all the reasons leading to the impossibility of the outflow of any liquid secretion from the uterine cavity can be divided into:

- organic when a mechanical obstacle forms on the way of fluid outflow;

- functional, caused more often by inflammation and / or hormonal failure.

Sometimes the fluid initially accumulates not in the uterus, but in the cavity of the fallopian tubes( hydrosalpinx), then "descends" into the uterus.

Fluid in the uterus during pregnancy during ultrasound scanning is often recorded, but sometimes it is not found during a second examination, especially if the amount of liquid was minimal. The situation is assessed according to the clinical picture and the nature of the liquid contents: if the pregnant uterus accumulates blood or pus, the treatment is started immediately.

Fluid in the uterus can accumulate in patients of any age. In the reproductive age, this condition is more often associated with inflammatory diseases, and the accumulated fluid in the uterus after menopause provokes hormonal dysfunction.

The conclusion "fluid in the uterus" often frightens the patient. However, it should be noted that a small amount of fluid in the uterine cavity without a concomitant clinic of the infectious process or bleeding does not threaten women's health. However, this does not mean that you do not need to look for the cause of this condition, because even the most innocuous serous secret can eventually provoke a purulent inflammation.

Liquid in the uterus can be liquidated only after ascertaining its cause. After an additional examination, the specialist decides on further tactics. In fact, fluid therapy in the uterus is equivalent to treating its cause. In some situations, it is necessary to pre-empt the uterus, and then treat the underlying disease.

Causes of fluid in the uterus

Where does the fluid in the uterus come from? First of all, its source is the numerous glandular structures located in the mucous layer. They constantly produce serous fluid, but its quantity is small. If inflammation processes are triggered in the endometrium, the glands actively secrete the fluid to "wash off" the infection, not allowing it to enter the underlying layers. Therefore, in inflammatory processes of the endometrium, the amount of uterine discharge increases, and if a pathogenic microflora joins it, it becomes purulent.

Another source of liquid contents in the uterus is the blood vessels. When they are damaged, blood enters the uterus. The largest amount of blood in the uterus appears after scraping the mucosa and after childbirth.

There are also numerous glands in the lining of the cervix( cervical canal) of the epithelium, they can also sometimes cause fluid accumulation in the uterus.

Fluid in the uterus accumulates in a situation where it can not leave its cavity on its own. Often in the way of the liquid secret there is some anatomical obstacle that completely or partially blocks the outflow pathways. Among the mechanical causes of fluid accumulation are more common:

- myomatous nodes, especially located near the mouth of the cervical canal, or a single uterine myoma large, deforming the uterine cavity;

- polyps in the uterine or cervical cavity;

- narrowing of the cervical canal;

- malformations of the genitals;

- endometriosis( adenomyosis) of the uterus.

Among the inorganic causes of congestion of serous fluid in the uterus, inflammatory processes in the endometrium and dyshormonal failures are leading.

In addition to the uterus, the fluid is able to accumulate and fallopian tubes. As a result of inflammatory changes, the lymph drainage and blood supply in the tubes are violated, and a serous fluid begins to accumulate in them, that is, hydrosalpine is formed. The fallopian tube is stretched and deformed, and then, if the liquid continues to accumulate, the hydrosalpinx breaks into the uterine cavity. In this situation, during the ultrasound scan, the "healthy" uterus and a small amount of fluid in it are visualized. A dangerous condition is a pyosalpinx - a fallopian tube with purulent contents. If a purulent cavity is opened and emptied into the uterus, purulent inflammation can also begin in the endometrium.

Sometimes the presence of fluid in the uterus is associated with ectopic( tubal) pregnancy.

However, the presence of these conditions, whether organic or functional disorders, does not always provoke accumulation of a liquid secretion in the uterus. As a rule, every patient with a diagnosed fluid in the uterine cavity observes the presence of provoking factors that interfere with the body's ability to cope with the anomaly that has arisen. Most often such are:

- "Harmful" propensities( alcohol, smoking).It has long been undisputed that harmful habits not only reduce the ability of the immune system, but also provoke hormonal dysfunction, which means prematurely exhaust and "age" the reproductive system.

- Trauma of the uterus tissues, and the cervical canal, including during abortion, diagnostic or therapeutic manipulation. After mechanical damage in the tissues during the epithelization, scars and adhesions are often formed. They deform the uterine and / or cervical cavities, so conditions are created for the accumulation of inflammatory fluid and menstrual blood in them.

Multiple curettage of the uterus in order to terminate unwanted pregnancy undoubtedly increases the likelihood of structural and inflammatory changes in the tissues of the uterus, which means predispose to the accumulation of fluid.

- Indiscriminate sexual life, especially in the absence of proper measures to prevent infections and pregnancy. Quite often the change of partners, in addition to unnecessary pregnancy, is the cause of sexual infections.

- Menstrual dysfunction. Mucous genitalia react sensitively to changes in the hormonal background, so a serious hormonal failure can change their normal functioning.

- Substitution therapy with hormonal drugs. The fluid in the uterus after menopause is often a consequence of hormonal correction of severe menopause. Fluid in the uterus in the elderly, in addition to hormonal, can have an inflammatory nature. In the absence of the proper estrogenic effect, the mucous membranes become vulnerable and poorly cope with undesirable microbes.

Fluid in the uterus in old age is often associated with atresia( narrowing) of the internal pharynx - the junction of the cervical cavity with the uterus. This condition pathology is not considered as it relates to age-related changes.

Fluid in the uterus during pregnancy should not be present, except for the amniotic fluid filling the fetal bladder in which the developing fetus is located. In the early stages, fluid in the uterus suggests an ectopic pregnancy. If in the pregnant womb the processes of rejection of the placenta( child's place) are started, the blood in the uterine cavity can accumulate.

Fluid in the uterus after delivery( lokhiometra) is classified as an early postpartum complication. After the fetus is expelled and the placenta is torn off during the delivery process, the uterus retains a vast wound surface that gradually heals. In addition to the regeneration of the damaged epithelium, after the birth the uterus begins to gradually return to the original value, these physiological processes are united by the concept of involution. The most intensive involutive processes in the uterine wall occur in the first two days after birth, when the musculature of the uterus is rapidly shrinking. With each contraction, the uterus "throws out" the postnatal discharge that has accumulated in it - the lochia. Their color depends on the amount of blood present. After childbirth, when the wound in the uterus is still "fresh", the detachable contains a lot of blood and is colored, respectively, in red. Then the color of the uterine discharge varies, and after six weeks it becomes light and lean.

Accumulation of fluid in the uterus after childbirth begins in a situation where an obstruction in the way of the lochis is formed in the form of a small fragment of the afterbirth, a scrap of the fetal membrane or a blood clot( thrombus).Sometimes the processes of involution proceed incorrectly, and the uterine wall is reduced insufficiently. Weak contraction of the uterus( hypotension) or its absence( atony) leads to the inability to "throw" the lochia outward, and they accumulate in the uterine cavity.

For similar reasons, the liquid( blood) in the uterus accumulates after abortion, when the uterus is poorly contracted, and the cervical canal is spasmodic. The fluid accumulated in the uterus a few days after the abortion often indicates an inflammatory process, especially if there are pain and fever.

If fluid accumulates the cervical canal, then the presence of cysts is diagnosed therein.

It should be noted that the liquid in the uterus of a healthy woman in the middle of the cycle refers to a temporary physiological condition and indicates an ovulation that has occurred.

Symptoms of fluid in the uterus

No "special" symptoms of fluid in the uterus does not provoke. More often there is a clinic of the disease, which triggered the accumulation of fluid. Often the only sign of fluid in the uterus is the conclusion of an ultrasound specialist.

Because the nature of the contents of the uterus can be different( blood, pus, serosa, lochia), the clinic of the underlying disease also changes.

Fluid in the uterus can trigger the following symptoms:

- Enlargement of the uterus in the presence of a significant volume of liquid contents. Diagnosed with a gynecological examination palpatory, and then confirmed by ultrasound.

- Pain, more often stupid, aching. Overgrown with liquid, the uterus presses on the nerve endings, provoking pain. If fluid in the uterus appears as a result of a pronounced inflammatory process, the pain may be associated with inflammation, and not with fluid.

- Unusual vaginal discharge. If the uterine cavity is not completely closed, the accumulated liquid contents may leak into the vaginal cavity. Serous discharge is watery and light with a grayish hue;Purulent discharge at pyometra more dense, yellow-green, sometimes with an unpleasant odor. The presence of pus in the uterus is always expressed "bright": in addition to unusual discharge, there are signs of intoxication( fever, malaise) and severe pain.

With active physical movements or intimacy, when the uterine musculature is contracting, secretions are intensified.

- Menstrual dysfunction. When the glandular structures of the endometrium work in an intense rhythm, the accumulating fluid disrupts the normal processes of rejection of the mucous layer, and the monthly passes incorrectly.

- Delay of the next monthly. Menstrual blood can accumulate in the uterus. With a hematometer, the menstrual period either is absent or is very meager against a background of delay and pain.

A specific clinic is the uterus, the accumulated lochia after childbirth. As a rule, the first signs of unpleasantness appear in the first postnatal week, when the number of lochi begins to decrease dramatically, and then they stop. Lohia accumulate, stretch the uterine cavity, provoking painful sensations and fever. When viewed, the enlarged and painful uterus is palpable.

Ultrasound scanning detects the presence of fluid in the uterine cavity for the following visual signs:

- uterus enlargement in size;

- the uterus has a deformed outer contour( outer outlines);

- enlarged uterine cavity of irregular shape;

- a change in the shape of the cervical cavity: narrowing down to complete closure of the walls or significant deformation.

- the lochia accumulated by the womb have an inhomogeneous appearance due to the contained fragments of the decidua and elements of the coagulated blood.

- sometimes during ultrasound examination you can find the cause of accumulation of uterine contents - myomatous nodes, polyps, inflammatory changes in mucous membranes;

- if the cause of fluid in the uterus is adenomyosis, the study visualizes the presence of endometriotic foci( heterotopia).

If the cause of fluid in the uterus is not obvious, a number of refined studies are required to identify signs of infectious inflammation, a violation of hormonal function. To study the structure of the endometrium, a diagnostic curettage is required.

The diagnosed fluid in the uterus during early pregnancy requires clarifying the location of the fetal egg and determining the amount of the "pregnancy hormone"( chorionic gonadotropin, hCG).Express diagnostics, which women spend to ascertain a pregnancy of a small period, gives an equally positive result, both in the uterine and ectopic localization of the fetal egg. Therefore, it is necessary not only to detect hCG, but also to determine its number. With ectopic embryo localization, its numbers are always less than in normal pregnancy.

Pregnancy of ectopic localization sometimes does not appear clinically, but its presence can be assumed if:

- in the uterus, ultrasound scanning visualizes the fluid, but the fetal egg can not fail;

- there are data on the delay of another menstruation;

- express test positive;

- the patient feels pregnant;

- there are minor smearing vaginal discharge.

Fluid in the uterus, especially when there are many, in the elderly requires special attention, since it may indicate a hyperplastic process.

The list of ailments that can provoke the accumulation of liquid by a womb is large enough, so it's almost impossible to talk about everything.

Treatment of fluid in the uterus

Fluid therapy in the uterus depends on its number, composition and cause, but all activities are divided into two main stages: evacuation of liquid contents from the uterine cavity and therapy of the cause of its accumulation.

First you need to establish the presence of signs of infection. If they are absent, like the patient's complaints, then with a small amount of serous fluid( less than 5 mm), observation is possible with mandatory use of ultrasound. During this period the body should "help" independently to rid the uterus from the liquid medically. A short course of drugs improving the state of the uterine circulation( aloe, detralex, fibs and the like) is prescribed, stimulating the regeneration of the epithelium, vitamin complexes.

Medical treatment is supported by physiotherapy. Often after a full course of treatment, a control ultrasound examination does not find liquid in the uterine cavity.

However, another, more unfavorable scenario is possible, when instead of the expected result the process begins to progress, the fluid accumulates. In such a situation, there is a risk of infection of the contents of the uterus, so a more aggressive path is chosen - mechanical removal of the fluid through the enlarged artificially cervical canal followed by antibiotic therapy.

If a small( up to 5 mm) volume of fluid is visualized in the primary diagnosis, but there are signs of an infectious-inflammatory nature, antibiotic therapy( amoxicillin, cefazolin, ornidazole and analogues) begins immediately. In parallel, forced emptying of the uterine cavity.

The only way to eliminate accumulated blood from the uterus is surgical. The majority of simple enough probing of the uterine cavity. However, if you do not eliminate the cause of this condition, it will be repeated again. If the blood accumulates in the uterus after abortion due to delayed parts of the embryo or after childbirth on the background of the remaining placenta in the uterus, stopping the accumulation of blood is possible only after the mechanical removal of "foreign" particles, that is, curettage.

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