Hematoma (n = 20) 52.32 ± 10.7 8 (40%) 8 (83.33%) 2.32 ± 1.42 9.42 ± 2.82 95 ± 5.12 Nonhematoma (n = 83) 50.29 ± 6.51 ∗2 (2.4%) 78 (91.49%) ∗1.24 ± 1.23 ∗4.24 ± 3.16 110 ± 3.24 Table 1: Summary of results. Table 2: Relation between postoperative morbidity and size of hematoma. 2 Age (mean ± SD) Febrile morbidity (n,%) Cases with Hb drop (n,%) Hb drop (g/dl) (mean ± SD) Hosp. stay day (mean ± SD) Op. time min (mean ± SD) ∗P value signiﬁcantly. Febrile morbidity temperature was >38◦C on at least two days after operation. Preoperative anticoagulants did not ad- minister all cases. Each woman had a transabdominal ultra- sound examination by a gynecologically trained ultrasonog- rapher, on the ﬁrst or third postoperative day. The size of any vault collection (nonperistaltic complex echogenic mass) was classiﬁed small if its mean diameter was <5 cm, and large if 5 cm or more. It was possible to divide these patients into two groups according to largest diameter of hematoma, to measure the signiﬁcance of size with respect to postoper- ative morbidity. The ultrasonographers were not informed of other aspects of the women’s postoperative recovery. Staﬀ blinded to the ultrasound ﬁndings, documented nursing and medical records. Patients with detected pelvic hematomas were subject to follow-up ultrasound scan at after 7 days. Pelvic hematomas only had vaginal vault hematoma. The pa- tient of large-sized hematoma (>5 cm) was subjected to evac- uation of hematoma. Under lithotomy position, with aseptic precautions, without anaesthesia, the central two sutures of chromic catgut were removed, which was followed by digi- tal exploration and evacuation of hematoma. Patients with small-sized hematomas (<5 cm) were observed for sponta- neous resolution of the hematoma and development of any complications. All patients were assessed preoperatively for presence of any high-risk factors including hypertension, chronic intake of aspirin, ischemic heart disease, anticoagu- lant therapy, diabetes mellitus, cerebrovascular disease, coag- ulation disturbance, chronic obstructive, or restrictive lung disease. The results were subject to x2 test to assess signiﬁ- cance. But this was not possible due to lack of normal dis- tribution (e.g., hemoglobin drop), the Mann-Whitney U test was applied. All analyses were passed through SPSS software package. A P value of <.005 was considered statistically sig- niﬁcant. 3. RESULTS The 103 patients who underwent vaginal operations were as- sessed for various parameters. Twenty (19.4%) had a vaginal vault hematoma (Group 1) and 83 (80%) had no hematoma (Group 2) were detected (Table 1). The largest diameter of the hematoma varied between 2 cm and 9 cm. Mean age 52.32 ± 10.7 and 50.29 ± 6.51 was detected in two groups. No signiﬁcant diﬀerence was observed in the mean operative Infectious Diseases in Obstetrics and Gynecology Number Hb drop (g/dl) Hospital-stay (days) Febrile morbidity Small hematoma Large hematoma 14 2.8 8.5 6 1.8 14 5 (25%) 3 (50%) Nonhematoma 83 1.24 ± 1.23 4.24 4 (3.8%) time that was 95 minutes in patients with hematoma and 110 minutes in those without hematoma. The average drop in hemoglobin was, as anticipated, higher in those women with a hematoma. Eleven percent (12/103) of patients, 40% of the patients with pelvic hematomas, developed postoperative morbidity. Febrile morbidity was evident since 40% (8/20) of patients in Group 1 compared to only 2.4% (2/83) in Group 2 experienced febrile morbidity. The diﬀerence was statisti- cally signiﬁcant. Out of all women having vault hematoma, 70% (14/20) had small-sized hematoma and 30% (6/20) had large-sized hematoma (Table 2). Fifty percent of patients (3/6) with large-sized hematoma as compared to only 25% (5/14) with small-sized hematoma suﬀered from febrile mor- bidity. Largest percentage of hematomas belonged to small- sized hematoma and it was about two times larger than the subgroup. Of the 103 women, 4 required preoperative blood transfusion due to either operative bleeding or drop in hemoglobin, or both. One woman in the nonhematoma group required blood transfusion and excessive blood loss was documented at operation, estimated at >500 mL. In the group with a hematoma, three women required transfusions and only two of these had excessive operative bleeding noted. Large-sized hematomas with febril morbidity (3/6) drained vaginally. Small vaginal vault hematomas were managed by no active intervention. Follow-up scans were done weekly. A mean duration of 25 days was required for resolution of the hematoma. None of the patients in either group required readmission to the hospital for any postoperative complica- tions. 4. DISCUSSION A postoperative pelvic hematoma can cause serious mor- bidity, especially if it is large and becomes infected. Many patients may be asymptomatic; whereas some may present with postoperative bleeding per vaginum (spotting to pro- fuse bleeding per vaginum) postoperative discomfort, ab- dominal distension, paralytic ileus, continuous fever, foul smelling discharge per vaginum, abscess formation, tenes- mus, nausea, vomiting, and diarrhoea. Some authors sug- gested that the presence of sonographically diagnosed pelvic hematoma is associated with febrile morbidity [7], while oth- ers were unable to demonstrate such a relationship [5, 9, 10]. In our study, the overall incidence of vault hematoma was