Hematometrocolpos following Low Transverse Cesarean Delivery
Iatrogenic causes of hematometrocolpos are rare but have been reported after radiation therapy and vaginal deliveries causing obstetric trauma resulting in vaginal/labial adhesions. Few cases of hematometra following cesarean section have been reported in the literature; however, hematometrocolpos following cesarean section has not been yet been described, and the incidence is unknown. Most cases of hematometrocolpos are seen in adolescents, as a result of abnormal development of the lower genital tract. The most common congenital anomaly resulting in hematometrocolopos is imperforate hymen; however, transverse vaginal septum and agenesis of the lower vagina may also be etiologies of this pathology. Amenorrhea in the postpartum period is common, occurring most frequently secondary to lactation. Rarely, postpartum amenorrhea may be associated with pituitary dysfunction following postpartum hemorrhage or intrauterine adhesions secondary to pregnancy-related curettage. A 43-year-old multigravida underwent a low transverse cesarean delivery complicated by uterine dehiscence, as well as cervical and vaginal lacerations. The repair resulted in lower genital tract obstruction. She presented seven months afterward with severe abdominopelvic pain and secondary amenorrhea, which resolved after vaginal dilation and excision of the vaginal scar.