Cem Dane et al. 19.4%, 70% had small-sized hematoma and 30% had large- sized hematoma. In other studies, incidence of postopera- tive hematoma was detected 25–98% [4, 7]. Diﬀerences in surgical technique may be one explanation for this discrep- ancy, particularly the degree to which the extraperitoneal space adjacent to the vaginal vault is obliterated. In our study, no statistical diﬀerence was found in the mean duration of postoperative hospital stay in the two groups. Haines et al. support these ﬁndings [10]. The hematoma group was also prone to a greater drop in hemoglobin concentration and spent on average 2.6 days longer in hospital than those with no hematoma. The percentage of hemoglobin drop and the number of patients showing the drop in our study are in total contradiction to other studies [5, 7]. In our study, 40% in patients with vaginal vault hematoma developed postop- erative febrile morbidity. Kuhn and de Crespigny, utilizing transabdominal ultrasonography, evaluated 50 consecutive patients following vaginal hysterectomy [4]. There are ma- jor diﬀerences between their ﬁndings and the present study, most notably a claimed incidence of vaginal vault collection of 98% compared with 19.4% in the present study. In the same study, Kuhn also reported a higher incidence of postop- erative pyrexia; 70% compared with 11% in the present study [4]. Postoperative febrile morbidity was 16 times more com- mon in subjects with hematoma compared to those without hematoma. Toglia and Pearlman support these ﬁndings, in their study 69% of women with postoperative pelvic collec- tion experienced febrile morbidity compared to 12% of those with no collection [8]. In another study, incidence of febrile morbidity was 31% in patients with vaginal vault hematomas [7]. However, other recent studies of small sample popula- tions have concluded that collections of ﬂuid at the vaginal vault following hysterectomy do not contribute to postoper- ative morbidity. Although Haines and Slavotinek found no signiﬁcant relation between the detection of vault hematoma and their deﬁned parameters for postoperative morbidity, each study did show a trend towards an increase in febrile morbidity in patients with a hematoma [5, 10]. In another study, there was no correlation between the presence of a collection and indices of postoperative morbidity [8]. Ultra- sonography is helpful in detecting and delineating its exact size and location of pelvic hematomas. In the same study, 42% patients had vaginal vault hematoma on sonographic assessment. A review of recent literature reveals that other studies incorporating postoperative transvaginal ultrasound have shown a higher prevalence of vault hematoma following hysterectomy, ranging from 34% to 59% [11]. An extended morbid and complicated postoperative course can be allevi- ated if the hematoma can be drained. A small penrose drain may be inserted through the drainage tract and left in place for a day or so. If drainage cannot be achieved in this simple way, drainage with guidance of ultrasonography, or if it fails, then using computed tomography or through an abdominal incision may be necessary. If the hematoma can be drained, the patient’s recovery will be more prompt. In exceptional cases where drainage may be diﬃcult or contraindicated and infection is not a serious problem, the hematoma may be al- lowed to gradually resolve over a few months. Unfortunately 3 sometimes, a hematoma will not resolve completely but per- sists and continues to cause pain. In our study, all the post- operative large hematomas were situated in close proxim- ity to the vaginal vault; hence vaginal drainage was possi- ble. Small vaginal vault hematomas were unlikely to cause postoperative morbidity. They were left alone with watch- ful expectancy and follow-up ultrasonography for resolu- tion of the hematoma done weekly. This study suggests that asymptomatic pelvic hematomas can be recognized by early postoperative ultrasound scan which are unlikely to be detected clinically. Using postoperative ultrasound, we can identify a population of women at increased risk of post- operative morbidity following vaginal hysterectomy. Large- sized hematoma may develop postoperative morbidity and required vaginal drainage of the hematoma. All patients un- dergoing vaginal hysterectomy alone do not require under- going routine postoperative pelvic ultrasound scan. REFERENCES [1] T. F. Andersen, A. Loft, H. Bronnum-Hansen, C. Roepstorﬀ, and M. Madsen, “Complications after hysterectomy. A Danish population based study 1978–1983,” Acta Obstetricia et Gyne- cologica Scandinavica, vol. 72, no. 7, pp. 570–577, 1993. [2] W. J. 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