P18.08: Haematometra and “floppy” uterus: powerful sonographic markers of severe post‐Caesarean endometritis

we describe sonographic findings suggestive of severe post-caesarean endometritis, a potentially life-threatening complication. vaginal sonography was performed in five patients with severe post-caesarean endometritis (study group) and in 35 controls between 3 to 4 weeks after Caesarean section. Clinical and sonographic findings were collected in all cases. in the study group, 3 patients had initially uneventful postoperative course and were readmitted 15–19 days with fever and pain. One patient had leucocytosis and fever immediately after the intervention. The last patient had fever during labor associated with nonreassuring cardiotocography and had an intraoperatory haemorrage requiring blood transfusion. In all cases vaginal sonography demonstrated a large ‘floppy’ uterus associated with haematometra. Despite multi-agent antibiotic treatment, 3 patients developed sepsis and underwent hysterectomy. In all cases, pathological examination demonstrated findings suggestive of severe endometritis with diffuse inflammatory infiltration of the myometrium. Two patients recovered following antibiotic therapy. In the control group, 9/35 patients had a small amount of fluid in the endometrial cavity, but none showed the ‘floppiness’ of the uterus observed in case of severe endometritis. Demonstration of haematometra and a ‘floppy’uterus with vaginal sonography increases the likelihood of severe endometritis.