Ovarian apoplexy - Causes, symptoms and treatment. MF.

In the ovaries of a sexually mature woman, follicles grow, the eggs in them mature, that is, prepare for the upcoming pregnancy. From the beginning of the menstrual cycle begins to grow a dominant follicle, which by the middle of the menstrual cycle reaches its maximum size - about 20 mm. Then the follicle envelope bursts, releasing a mature egg, - ovulation occurs. On the spot of the bursted follicle, a temporary formation is formed - the yellow body, which produces certain hormones that prepare the woman's body for pregnancy. This is the normal course of the ovarian cycle.

In dystrophic and sclerotic changes in ovarian tissue, which occur in acute and chronic inflammatory processes in the uterine appendages, in the syndrome of polycystic ovaries and some other diseases, as well as with drug stimulation of ovulation, certain disturbances occur in the process of ovulation and formation of the yellow body. As a result, blood vessels in the place of rupture of the ovary do not contract well, the intraabdominal bleeding continues and intensifies, and hemorrhage - a hematoma - is formed in the yellow body due to fragility of the vessels. All this is accompanied by pain syndrome, weakness, dizziness, nausea, vomiting, pallor of the skin, fainting condition. Without proper treatment, internal bleeding can increase, creating a real threat to the health and life of a woman. To factors provoking the rupture of the ovary factors also include abdominal trauma, excessive physical stress, violent sexual intercourse, riding, etc.

Frequency and forms of ovarian apoplexy

Ovarian apoplexy ( rupture of the ovary) - a sudden rupture( abnormality) of ovarian tissue accompanied by bleedingin the abdominal cavity and pain syndrome.

Among the causes of intra-abdominal hemorrhage, 0.5-2.5% occur on ovarian apoplexy .

There are 3 forms of ovarian apoplexy depending on the prevailing symptoms:

1. Pain when there is severe pain, but there is no sign of intraabdominal bleeding.
2. Anemic form, when symptoms of internal( intra-abdominal) bleeding come first.
3. The mixed form combines the signs of pain and anemic forms of apoplexy of the ovary.

However, according to modern data, this classification is considered inadequate, since it is impossible to break the ovary without bleeding.

Therefore, at present, this pathology is divided into several degrees of severity: mild, moderate and severe( depending on the magnitude of blood loss).

Symptoms of ovarian apoplexy

Clinical symptoms of apoplexy are associated with the main mechanism of development of this pathology:

1. Pain syndrome, which occurs primarily in the middle of the cycle or after a slight delay in menstruation( with a rupture of the yellow body cyst, for example).Pain is most often localized in the lower abdomen. Sometimes the pain can be irradiated to the rectum, to the lumbar or umbilical region.
2. Bleeding to the abdominal cavity, which can be accompanied by:

• by pressure reduction,
• by pulse increase,
• by weakness and dizziness,
• by syncopal conditions,
• chills, fever to 38 ° C,
• by single vomiting,
• dry mouth.

1. Sometimes, intermenstrual bleeding or blood discharge may occur after a delay in menstruation.

Quite often, ovarian apoplexy occurs after sexual intercourse or exercise in the gym, that is, under certain conditions, when the pressure in the abdominal cavity increases and the integrity of the ovary tissue is possibly compromised. However, the rupture of the ovary can occur and against a background of complete health.

Causes of ovarian apoplexy

Causes of ovarian apoplexy:

1. Pathological changes of vessels( varicose veins, sclerosis).
2. Previous inflammatory processes of ovarian tissue.
3. The moment of ovulation.
4. The stage of vascularization of the yellow body( middle and second phase of the cycle).

Risk factors contributing to the onset of ovarian apoplexy :

1. Injury.
2. Lifting heaviness or heavy physical activity.
3. Stormy sexual intercourse.

Diagnosis of ovarian apoplexy

According to the literature, the correct clinical diagnosis of ovarian apoplexy is only 4-5%.

Diagnostic errors are explained, first of all, by the fact that the clinic of this disease does not have a characteristic picture and develops as another acute pathology in the abdominal cavity and small pelvis.

The patient is brought to the hospital with a diagnosis of "Acute abdomen".Clarification of the cause is carried out in a hospital.

First of all, ovarian apoplexy must be differentiated from ectopic pregnancy and acute appendicitis.

As a rule, if there is a clinic for "acute abdomen", consultation of related specialists( surgeons, urologists) is also necessary.

Because ovarian apoplexy is an acute surgical pathology, the diagnosis must be made very quickly, since an increase in the time before the operation begins leads to an increase in the magnitude of blood loss and can be life threatening condition! !!

The most informative research methods are:

1. Characteristic complaints of acute abdominal pain that appeared in the middle or the second half of the menstrual cycle.
2. The examination shows a marked soreness from the affected ovary, and the symptoms of irritation of the peritoneum become positive.
3. A general blood test may indicate a decrease in hemoglobin level( with anemic and mixed forms of ovarian apoplexy).
4. Puncture of the posterior fornix, which allows confirming or refuting the presence of intra-abdominal hemorrhage.
5. An ultrasound examination that allows you to see in the affected ovary a large yellow body with signs of hemorrhage into it and / or free fluid( blood) in the abdomen.
6. Laparoscopy, which allows not only 100% to establish a diagnosis, but also to correct any pathology.

The final diagnosis of ovarian apoplexy is almost always established during surgery.

Your actions with apoplexy are necessary: ​​

1. Immediately take a horizontal position.
2. Call an ambulance urgently for hospitalization in a surgical or gynecological hospital.

Treatment of ovarian apoplexy

1. Conservative treatment is possible only in the case of a mild form of ovarian apoplexy , which is accompanied by a slight bleeding into the abdominal cavity.

Patients with mild apoplexy complain primarily of pain in the lower abdomen.

However, the data of many researchers prove that with the conservative management of such patients in 85.7% of cases in the small pelvis, spikes are formed, and 42.8% of cases are recorded infertility.

Virtually every second woman after a conservative management may have a recurrence( repeated ovarian apoplexy ).This is due to the fact that the blood and clots that accumulate in the abdominal cavity after the rupture of the ovary( of the ovarian apoplexy ) are not washed out, as in laparoscopy, remain in the abdominal cavity where they organize and promote the adhesion process in the small pelvis.

Conservative treatment can be recommended only to women who have already realized their reproductive function( that is, already having children and not planning to have them) if they have a mild form of ovarian apoplexy.

If a woman is at reproductive age and plans a pregnancy, then the tactics, even in the case of mild apoplexy of the ovary, should be reconsidered in favor of laparoscopy.

1. Surgical treatment is the main, because not only allows you to clarify the diagnosis, but also to carry out a full-fledged correction.

In all cases of apoplexy, laparoscopy is possible! !!

The only contraindication to the use of this access is hemorrhagic shock( i.e., very large loss of consciousness with loss of consciousness).

The operation should be conducted in the most gentle manner while preserving the ovary.

As a rule, removal of the capsule of the cyst, coagulation or ovarian repair is performed. In rare cases with massive hemorrhage, removal of the ovary is required.

During the operation, it is necessary to thoroughly wash the abdominal cavity, remove clots and blood, to prevent the formation of adhesions and infertility.

Rehabilitation for ovarian apoplexy

Rehabilitation after an ectopic pregnancy should be aimed at restoring reproductive function after surgery. These include: prevention of adhesions;contraception;normalization of hormonal changes in the body. To prevent the adhesive process, physiotherapy methods are widely used:

• alternating low-frequency pulsed magnetic field,
• low-frequency ultrasound,
• over-tone currents( ultratonoterapy),
• low-intensity laser therapy,
• electrostimulation of fallopian tubes;
• UHF-therapy,
• zinc electrophoresis, lidase,
• ultrasound in pulsed mode.

For the duration of the course of anti-inflammatory therapy and for 1 month after the end, contraception is recommended, and the question of its duration is decided individually, depending on the patient's age and features of her reproductive function. Undoubtedly, the desire of a woman to maintain her reproductive function should be taken into account. The duration of hormonal contraception is also strictly individual, but usually it should not be less than 6 months after the operation.

After the termination of rehabilitation measures, before recommending the patient to plan the next pregnancy, it is advisable to perform diagnostic laparoscopy, which allows to assess the status of the fallopian tube and other organs of the small pelvis. If control laparoscopy revealed no pathological changes, then the patient is allowed to plan pregnancy in the next menstrual cycle.