Apoplexia Uteri – a Postmenopausal Bleeding into Atrophic Endometriumduring Terminal Stress

Overview

This is a detailed histological autopsy study of 47 cases of macroscopically recognisable flat intraendometrialhaemorrhage into the atrophic lining of the uterine cavity. The average age of thestudied women was 71 years.The majority of the deceased patients (61 %) had suffered from various cardiovascular diseases oracute abdomen; the rest had disseminated carcinoma, chronic lung, kidney or liver diseases. Themost common cause of death was cardiovascular failure (68 %), followed by respiratory failure,cerebrovascular accident and renal or liver failure.We have observed serious vascular changes in other organs in 22 cases (46%), many of theseaffected the gastrointestinal tract.The histological examination has always showed congestion of the endometrium and myometrium.In 38 cases there was also marked haemorrhage into the endometrial stroma which occasionallyextended into the myometrium. The intensity of the bleeding resembled a haemorrhagicinfarction in several instances. The myometrial arteries exhibited a variable degree of atherosclerosiswith narrowing of their lumen.In our opinion, apoplexia uteri is caused by the state of permanent hypoperfusion leading topassive hyperaemia, and it is related to the degree of the arterial stenosis.

Key words:
atrophic endometrium – postmenopausal bleeding – circulatory failure – passive hyperaemia– stress