Ultrasound Detection of Vault Hematoma Following Vaginal Hysterectomy and Their Relation to Morbidity

Heo, Jin Sook; Lee, Woo Young; Jun, Hyun Ah; Kim, Hong Bae; Lee, Keun Young; Kang, Sung Won

Abstract

OBJECTIVE
To assess whether ultrasound detection of vault hematoma can be used as a predictor of post-operative morbidity following vaginal hysterectomy.
METHODS
Prospective observational study of 418 consecutive cases of vaginal hysterectomy was performed between December 2000 and May 2001. The transvaginal sonographic examination of vaginal vault in the first postoperative week (3rd or 4th day) after vaginal hysterectomy was done. Routine observation and clinical assessments were made by established management protocol: febrile morbidity, hemoglobin drop, need for transfusion, length of stay in hospital.
RESULTS
Of the 418 scaned patients, 103 (24.6%) had a vault hematoma. This group was compared with the 315 patients without hematoma. Significant increases in febrile morbidity (22.3% vs 7.6%), postoperative hemoglobin drop (2.39 g/dL vs 1.58 g/dL), need for blood transfusion (10.7% vs 1.3%) and length of hospital stay (8.6 days vs 6.2 days) were seen in the hematoma group.
CONCLUSION
Ultrasound detection of vault hematoma following vaginal hysterectomy is a common finding associated with increased febrile morbidity, hemoglobin drop, need for blood transfusion and longer hospital stay. Transvaginal sonography may facilitate the diagnosis of posthysterectomy vault hematoma, which are not readily detected by pelvic examination.