I am sure that many, after reading the title of the article, will go to Google, because the definition of "ovarian apoplexy" is not one that is used in everyday life. One feels that something is not good, but what exactly is hidden behind this mysteriously threatening phrase, the normal average person in most cases does not know. Well, I will not languish with anticipation, especially since the feeling of anxiety in this case is justified: apoplexy is a sudden break. Just imagine - a rupture of an internal organ ... The case is, without a doubt, the most serious, requiring urgent treatment. It cannot be said that this is a common disease: among all "female" diseases, ovarian apoplexy accounts for only 2-3%. How to recognize ovarian apoplexy, how to treat it, is surgery always indicated - you will learn about all this from our article.

Apoplexy (rupture) of the ovary: where does that come from

A symptom of ovarian apoplexy is a sharp spontaneous pain in the lower abdomen. Probably, before proceeding to the description of the symptoms, it will be useful to understand the very nature of this pathology. The fact that the female body differs from the male, like "Cayenne" from "Priora", is the "secret of Opening". That is, from a structural and technical point of view, it is a more highly organized biological unit, the functioning of which during a certain period of its life - reproductive - is strictly cyclical. All this time, the female ovaries are suppliers of vesicular tissue formations - follicles that serve as a receptacle for a maturing egg. In the initial phase of each menstrual cycle, in some way unknown to modern science, the only dominant follicle is selected: this time the egg will mature in it. By the middle of the cycle, the follicle, which has reached 20 mm by this time, ruptures, and the egg comes out. This is called ovulation. The place of the bursting ex-follicle is not empty for a long time: a new tissue structure is formed here - the corpus luteum, the role of which is the secretion of the female sex hormone progesterone, which prepares a woman for pregnancy.
Ideally, this is the case, but not always. Sometimes in this system that works like a clock, any unfavorable factors interfere, under the influence of which the ovarian tissue undergoes sclerotic and dystrophic degeneration, which negatively affects the formation of the corpus luteum. Because of this, in the area of ​​the bursting follicle, blood circulation is locally disturbed, and the ovary begins to bleed (i.e., its perforation occurs) into the abdominal cavity with the formation of a hematoma in the corpus luteum.

Causes of ovarian apoplexy

Among the causes of ovarian apoplexy are the following:

• sclerotic changes in the inner walls of the vessels of the ovary and the tissue forming it due to previous inflammatory diseases;
• long-term use of drugs that prevent blood clotting;
• external mechanical factors, which, together with the above reasons, contribute to an increased risk of ovarian apoplexy (abdominal trauma, rough sexual intercourse, horseback riding, gynecological manipulations).

Symptoms of ovarian apoplexy

The first thing that suggests ovarian apoplexy is a sharp spontaneous pain in the lower abdomen, “shooting” into the lumbar region, navel or lower extremities. Pain syndrome is associated with irritation of pain receptors of the ovary and peritoneum with opened bleeding and spasm of the ovarian artery. The time of manifestation is after a delay in menstruation or in the middle of the menstrual cycle.

If we really delve into the essence of the issue, then it should be mentioned about the existence of two forms of ovarian apoplexy: painful and hemorrhagic. In the first case, there is a distinct pain without obvious signs of bleeding, in the second - on the contrary. But if you think sensibly, then if there is no bleeding, then there is no apoplexy, therefore, each of the forms cannot exist in a single distilled genus. In this regard, it would be appropriate to distinguish not the forms of apoplexy, but various degrees of severity, depending on the amount of blood loss. Therefore, the onset of the disease is characterized by pain symptoms, and as blood loss increases, hemorrhagic (anemic) symptoms appear. What symptoms are inextricably linked to blood loss? Dizziness, weakness, nausea with vomiting, decreased blood pressure, tachycardia, dry mouth, possible fainting.

Diagnosis of ovarian apoplexy

The peculiarity of the diagnosis of ovarian apoplexy is the required promptness of the correct diagnosis due to the acute nature of this pathology. The algorithm for diagnosing ovarian apoplexy includes an initial examination, during which the doctor observes in the patient clear pain sensations caused by a ruptured ovary. In a laboratory study of blood, hemoglobin reduced due to blood loss is determined. A puncture of the posterior vaginal fornix is ​​done to confirm intraperitoneal bleeding. Blood in the abdominal cavity and hematoma of the corpus luteum are visible on ultrasound. The final confirmation of the correctness of the diagnosis is provided by a laparoscopic examination.

Ovarian apoplexy treatment

Conservative

Apoplexy of the right ovary In the initial stage, with insignificant non-progressive blood loss, it is possible to do without surgery. Conservative treatment methods include taking hemostatic ( etamsylate, dicinone) antispasmodic (no-spa, papaverine) drugs, vitamins (B1, B6, B12), physiotherapy (electrophoresis of calcium chloride solution, microwave therapy). However, as practice shows, conservative treatment is not the best choice due to possible relapses of the disease as a result. In 50% of cases, after conservative treatment, ovarian apoplexy occurs again... Blood does not go anywhere from the abdominal cavity, and in the future, against this background, the adhesion process starts. And the consequences of recurrent ovarian apoplexy are. Conclusion: conservative treatment of ovarian apoplexy is indicated only for milder forms of the disease and only for those women who do not plan offspring.

Surgical

In other cases, as well as with direct indications for surgery (the presence of more than 150 ml of blood in the abdominal cavity, repeated bouts of pain, deterioration of the general condition) surgery... It must be extremely careful in order to preserve the ovary (except in cases where this is no longer possible - with profuse hemorrhages). Coagulation of the rupture site or suturing of the ovary is performed, removal of the capsule contents after puncture of the ovarian cyst using suction. The abdominal cavity is washed from blood clots to avoid adhesions.

Patients in whom treatment for apoplexy was started in the early, painful phase, even before massive blood loss, as a rule, tolerate the disease without serious consequences. If the treatment began too late, when blood loss reached 50% of the total circulating blood volume, a fatal outcome is possible.

Ovarian apoplexy is one of the gynecological diseases that cause the appearance of the clinical picture of an acute abdomen. This dangerous pathology, in the absence of timely medical care, can lead to very serious complications. However, the occurrence of lower abdominal pain is not an uncommon symptom. Almost all women from time to time experience pain in this area associated with certain phases of the menstrual cycle. But ovarian apoplexy is exactly the disease in which it is worth paying attention to pain and seeking qualified medical help as early as possible. Knowing the symptoms of ovarian apoplexy helps to diagnose this pathology in a timely manner.

Diagnostic methods and symptoms of ovarian apoplexy

The main clinical symptom of ovarian apoplexy, like other gynecological diseases that determine the clinical picture of an acute abdomen, is sudden pain in the lower abdomen. The occurrence of pain syndrome in this case is explained by irritation of the receptor field of the ovarian tissue, the effect of outflowing blood on the peritoneum, as well as spasm in the ovarian artery basin. In addition to the pain syndrome with apoplexy, a woman is worried about weakness, nausea and vomiting, dizziness and fainting. But depending on the form of pathology, the clinical picture of ovarian apoplexy may differ slightly.

Symptoms of ovarian apoplexy:

• symptoms of ovarian apoplexy with painful form;
• symptoms of ovarian apoplexy with hemorrhagic form;
• the main methods for diagnosing ovarian apoplexy.

Symptoms of ovarian apoplexy with pain

The painful form of ovarian apoplexy is observed when hemorrhage occurs directly into the tissue of the follicle or corpus luteum. In this case, there is no bleeding into the abdominal cavity. With this form of the disease, the main symptom of ovarian apoplexy is pain in the lower abdomen, which does not radiate, and may be accompanied by nausea and vomiting. There are no signs of bleeding into the abdominal cavity. When examining the patient, the color of the skin and mucous membranes remains normal, the pulse and blood pressure do not change. On palpation, painful sensations are noted in the iliac region on the right. During a gynecological examination, the uterus is of normal size, the affected ovary may be slightly enlarged and painful on palpation.

Symptoms of ovarian apoplexy with hemorrhagic form

A mild hemorrhagic form of rupture of ovarian tissue is clinically very similar to a painful form, but in moderate and severe forms, the symptoms of ovarian apoplexy are somewhat different, since they are associated with intra-abdominal bleeding. Pain syndrome occurs acutely, often appears during physical exertion or intercourse, radiates to the rectum, leg, lower back and external genitals. The patient is also worried about weakness, dizziness, nausea and vomiting. The patient's skin and mucous membranes are pale, and cold clammy sweat may occur. Blood pressure is lowered, tachycardia occurs, which is explained by blood loss. Palpation is determined by a sharp soreness in the iliac region, with a bimanual gynecological examination on the side of apoplexy, a painful, slightly enlarged ovary is palpated.

The main methods for diagnosing ovarian apoplexy

To diagnose ovarian apoplexy, the following laboratory and instrumental research methods are used:

• complete blood count: moderate leukocytosis in painful form, decreased hemoglobin levels, leukocytosis in hemorrhagic form;
• ultrasound examination: a small amount of hypoechoic fluid with a finely dispersed suspension in the Douglas space with painful form, a significant amount of fine and medium dispersed fluid in the abdominal cavity, with hyperechoic structures of irregular shape in hemorrhagic form of ovarian apoplexy;
• laparoscopic examination: there is a stigma of ovulation - a small spot raised above the surface of the ovary with signs of bleeding, in the form of a cyst of the corpus luteum or the corpus luteum itself with a rupture or defect.

• What is Ovarian Apoplexy
• Symptoms of ovarian apoplexy
• Ovarian Apoplexy Treatment
• Which doctors should be consulted if you have ovarian apoplexy

What is Ovarian Apoplexy

Ovarian apoplexy (apoplexia ovarii) is defined as a sudden onset of hemorrhage into the ovary when the vessels of the graafian vesicle, ovarian stroma, follicular cyst or corpus luteum rupture, accompanied by a violation of the integrity of its tissue and bleeding into the abdominal cavity.

Ovarian apoplexy occurs at the age of 14 to 45 years, more often at 20-35 years. However, there are cases of ovarian hemorrhage in young girls. The incidence of ovarian apoplexy among gynecological pathologies is 1-3%. Recurrence of the disease reaches 42-69%.

What provokes ovarian apoplexy

Apoplexy has a complex pathogenesis due to physiological cyclical changes in the blood supply of the pelvic organs. Most researchers identify "critical moments" for ovarian damage. So, in 90-94% of patients, ovarian apoplexy occurs in the middle and in the second phase of the menstrual cycle. This is due to the peculiarities of the ovarian tissue, in particular with increased vascular permeability and an increase in their blood supply during ovulation and before menstruation.

Apoplexy of the right ovary occurs 2-4 times more often than the left, which is explained by the more abundant circulation of the right ovary, since the right ovarian artery departs directly from the aorta, and the left - from the renal artery.

Inflammatory processes of the pelvic organs predispose to rupture of the ovary, leading to sclerotic changes both in the ovarian tissue (sclerosis of the stroma, fibrosis of epithelial elements, perioophoritis) and in its vessels (sclerosis, hyalinosis), as well as congestive hyperemia and varicose veins of the ovarian veins. Bleeding from the ovary can be promoted by blood diseases and prolonged use of anticoagulants, leading to a violation of the blood coagulation system. These conditions create a background for exogenous and endogenous factors leading to ovarian apoplexy. Exogenous causes include abdominal trauma, physical stress, violent or interrupted intercourse, horse riding, douching, vaginal examination, etc. Endogenous causes can be abnormal position of the uterus, mechanical compression of blood vessels, which disrupts blood flow in the ovary, pressure on the ovary by a tumor, adhesions in the small pelvis, etc. In a number of patients, ovarian rupture occurs for no apparent reason at rest or during sleep.

Pathogenesis (what happens?) During ovarian apoplexy

The leading role in the pathogenesis of ovarian apoplexy is currently assigned to hormonal disorders. One of the main causes of ovarian rupture is considered an excessive increase in the amount and change in the ratio of gonadotropic hormones of the pituitary gland (FSH, LH, prolactin), which contributes to hyperemia of ovarian tissue.

An important role in the occurrence of ovarian apoplexy belongs to the dysfunction of the higher parts of the nervous system, recorded by EEG and REG. As a result of stressful situations, psychoemotional lability, the impact of environmental factors, living conditions.

Ovarian apoplexy is not only a complex of serious disorders of the reproductive system, but also a disease of the whole organism with the involvement of various levels of the nervous system.

Classification.

Allocate painful, anemic and mixed forms of ovarian apoplexy. The staff of the clinic G.M. Savelyeva proposed a classification that takes into account the severity of intra-abdominal blood loss:

• Painful form.
• Hemorrhagic form:
  • I degree - mild (intra-abdominal blood loss does not exceed 150 ml);
  • II degree - medium (blood loss 150-500 ml);
  • III degree - severe (intra-abdominal blood loss of more than 500 ml).

Symptoms of ovarian apoplexy

The main clinical symptom of ovarian apoplexy is sudden pain in the lower abdomen. The pain is associated with irritation of the receptor field of the ovarian tissue and the effect on the peritoneum of the outflowing blood, as well as with spasm in the basin of the ovarian artery.

Weakness, dizziness, nausea, vomiting, fainting are associated with intra-abdominal blood loss.

The painful form of ovarian apoplexy is observed with hemorrhage into the tissue of the follicle or corpus luteum without bleeding into the abdominal cavity. The disease manifests itself as an attack of pain in the lower abdomen without irradiation, sometimes with nausea and vomiting. There are no signs of intra-abdominal bleeding.

The clinical picture of painful and mild hemorrhagic forms of ovarian apoplexy is similar.

On examination, the skin and visible mucous membranes are of normal color. Pulse and blood pressure are within normal limits. The tongue is clean and moist. The abdomen is soft, although there may be a slight tension in the muscles of the anterior abdominal wall in the lower regions. Palpation noted soreness in the iliac region, more often on the right, no peritoneal symptoms. Percussion-free fluid in the abdominal cavity is not detected. During a gynecological examination, the uterus is normal in size, the ovary is somewhat enlarged and painful. The vaults of the vagina are deep, free. Ultrasound of the pelvic organs almost never allows to visualize directly the rupture of the ovary, but it is possible to detect the accumulation of fluid in the posterior (Douglas) space. With the painful form of ovarian apoplexy, there is a small amount of fluid in the Douglas space, it is hypoechoic with a finely dispersed suspension (follicular fluid mixed with blood). In the clinical analysis of blood, there are no pronounced changes, sometimes moderate leukocytosis is detected without a shift in the formula to the left.

In the clinical picture of moderate and severe hemorrhagic (anemic) forms of ovarian apoplexy, the main symptoms are associated with intra-abdominal bleeding. The disease begins acutely, often associated with external causes (intercourse, physical stress, trauma, etc.). Pain in the lower abdomen often radiates to the anus, leg, sacrum, external genitalia, accompanied by weakness, dizziness, nausea, vomiting, fainting. The severity of symptoms depends on the amount of intra-abdominal blood loss.

On examination, the skin and visible mucous membranes are pale, cold clammy sweat on the skin. Blood pressure is lowered, tachycardia. Tongue dry, abdomen tense, slight swelling is possible. On palpation, a sharp soreness is determined in one of the iliac regions or throughout the hypogastrium. Peritoneal symptoms are most pronounced in the lower regions. Percussion to determine the free fluid in the sloping places of the abdomen (right, left lateral canals).

Diagnosis of ovarian apoplexy

On a gynecological examination, the vaginal mucosa is normal in color or pale. Two-handed examination can be difficult due to severe pain of the anterior abdominal wall. The uterus is of normal size, painful; on the side of apoplexy, a painful, slightly enlarged ovary is palpable. The vaults of the vagina overhang, traction for the cervix is ​​sharply painful.

In the clinical analysis of blood, a decrease in the level of hemoglobin is noted, but with acute blood loss in the first hours, an increase in the level of hemoglobin is possible as a result of blood thickening. In some patients, there is a slight increase in leukocytes without a shift in the formula to the left.

With ultrasound of the internal genitals, a significant amount of free fine and medium-dispersed fluid in the abdominal cavity with structures of irregular shape, increased echogenicity (blood clots) is determined.

To diagnose the disease without pronounced violations of hemodynamic parameters, puncture of the abdominal cavity is used through the posterior fornix of the vagina. However, laparoscopy has become the method of choice in the diagnosis of ovarian apoplexy. Ovarian apoplexy during laparoscopy looks like a stigma of ovulation (a small spot 0.2-0.5 cm in diameter raised above the surface with signs of bleeding or covered with a blood clot), in the form of a corpus luteum cyst in a “collapsed” state or in the form of the corpus luteum with a linear rupture or rounded tissue defect with or without signs of bleeding.

Ovarian Apoplexy Treatment

Treatment of patients with ovarian apoplexy depends on the form of the disease and the severity of intra-abdominal bleeding. With a painful form and insignificant intra-abdominal blood loss (less than 150 ml) without signs of increased bleeding, conservative therapy can be carried out. It includes rest, ice on the lower abdomen (promotes vasospasm), hemostatic drugs (etamsylate), antispasmodics (papaverine, no-shpa), vitamins (thiamine, pyridoxia, cyanocobalamin), physiotherapeutic procedures (electrophoresis with calcium chloride, Microwave therapy).

Conservative therapy is carried out in a hospital under round-the-clock supervision. With a repeated attack of pain, deterioration of the general condition, instability of hemodynamics, an increase in the amount of blood in the abdominal cavity clinically and with ultrasound scanning, indications for surgical intervention (laparoscopy, laparotomy) appear.

Indications for laparoscopy:

• more than 150 ml of blood in the abdominal cavity, which is confirmed by physical examination and ultrasound, with stable hemodynamic parameters and a satisfactory condition of the patient;
• ineffectiveness of conservative therapy within 1 to 3 days, signs of ongoing intra-abdominal bleeding, confirmed by ultrasound;
• differential diagnosis of acute gynecological and acute surgical pathology.

Surgical intervention for ovarian apoplexy should be as gentle as possible: coagulation of the rupture site, opening or puncture of the cyst and removal of the contents using an aquapurator-suction, ovarian resection. In case of large damage and the impossibility of preserving the ovary, it is removed.

Indications for laparotomy:

• signs of intra-abdominal bleeding, leading to hemodynamic disturbances with a severe condition of the patient (hemorrhagic shock);
• impossibility of laparoscopy (due to adhesions, increased bleeding from damaged ovarian vessels).

Surgical intervention is performed with a lower midline approach or a suprapubic Pfannenstiel incision. The scope of the intervention does not differ from the laparoscopic one. With laparotomy, reinfusion of blood flowing into the abdominal cavity is possible.

Prevention of ovarian apoplexy

In patients with painful form of ovarian apoplexy, disorders of the central nervous system, hormonal profile and blood circulation in the ovary are reversible, and therefore no specific preventive measures are required. In patients who have undergone a hemorrhagic form of ovarian apoplexy, dysfunction of the higher parts of the central nervous system, changes in hormonal status and disturbances in ovarian blood flow are usually persistent. Such patients are shown complex drug therapy, breaking the vicious pathogenetic circle. Within 3 months, therapy is carried out that corrects the activity of the structures of the brain: nootropics are prescribed to improve metabolic processes in the central nervous system, drugs that improve cerebral perfusion (cavinton, tanakan, vinpocetine), tranquilizers, with intracranial hypertension - diuretics. To suppress ovulation and correct the hormonal profile for 3-6 months, combined estrogen-gestagenic monophasic low- and micro-dosed oral contraceptives (Marvelon, Regulon, Janine, Femoden, Silest, Novinet, Mersilon, Logest) are used.

Forecast. With a painful form of ovarian apoplexy, the prognosis for life is favorable. In patients with hemorrhagic form, the prognosis for life depends on the timeliness of diagnosis and treatment. Decompensated irreversible hemorrhagic shock, which occurs with blood loss of more than 50% of the BCC, can lead to death in case of rupture of the ovary.

Preventive measures help to reduce the frequency of relapses of the disease.

(other names - rupture of the ovary, rupture of the corpus luteum, ovarian infarction) is a condition characterized by a sudden rupture follicle or vascularization of the corpus luteum, formed at the site of a bursting follicle, which leads to a violation of the integrity of the ovary, and is accompanied by acute pain, hemorrhage in the ovarian tissue and internal in the peritoneum.

There are 3 forms of this disease. The classification is based on the symptoms of ovarian apoplexy.

In the first painful form of ovarian apoplexy, in which pain syndrome is expressed, the patient has:

• fever, nausea, hemorrhage in the ovarian tissue, in the absence of signs intra-abdominal bleeding ;
• anemic form of apoplexy, when the main symptom is internal bleeding ;
• a mixed form of apoplexy, in which the signs of pain and mixed forms of the disease are equally expressed.

However, the division into forms is not very legitimate, since rupture of the ovary is always accompanied by bleeding, therefore, forms of apoplexy are classified according to the severity of the disease and size, highlighting easy(when blood loss is 100-150 ml), average(150-500 ml) and severe form(with blood loss of more than 500 ml).

Ovarian rupture most often occurs during the period ovulation or during development corpus luteum , i.e. in the second half and in the middle of the menstrual cycle. Usually, the disease occurs in women of reproductive age 20-35 years.

Ovarian apoplexy is a rather dangerous condition, accounting for 17% in the structure of acute gynecological diseases and up to 2.5% among the causes of abdominal bleeding, which poses a serious threat to a woman's life, and therefore requires hospitalization and surgical intervention.

The main causes of ovarian rupture are:

• the moment of ovulation;
• period of vascularization of the corpus luteum (second phase of the cycle);
• varicose veins of the small pelvis;
• (hyalinosis , stroma ), which cause sclerotic changes in the tissues of the ovary and its vessels;
• long-term intake anticoagulants that lead to impaired blood clotting;
• hormonal disorders (a sharp increase pituitary gonadotropins resulting in increased blood filling ovarian tissue ).

Risk factors contributing to the onset of the disease include abdominal trauma, lifting weights, riding, atypical sexual intercourse (interrupted, violent), malposition of the genitals, vaginal examinations, pressure on the ovary of the tumor, adhesions and stagnant processes in the small pelvis, nervous breakdown ... The prevention of the disease can be prevention of ovarian apoplexy, timely examination by a doctor and treatment of diseases of the pelvic organs.

Usually one ovary ruptures, more often the right, which is better supplied with blood, since the right ovarian artery associated with the aorta.

Symptoms of ovarian apoplexy

Symptoms of ovarian infarction depend on the nature of the bleeding and the presence of concomitant diseases - acute ,. Symptoms of ovarian rupture include sudden pain in the lower abdomen that occurs in the middle of the cycle or after a slight delay in menstruation. The pain can be given to the lumbar region, genitals, leg, rectum. The attack can last from half an hour to several hours, and be repeated throughout the day. Bleeding into the peritoneum is accompanied by weakness, pallor, tachycardia, decreased blood pressure, fever, chills, frequent urination, dry mouth. Sometimes this condition is accompanied by fainting, nausea and vomiting are observed. When the painful side of the affected ovary. Discharge of blood from the genital tract and serous discharge from the mammary glands may also disturb.

Symptoms of ovarian apoplexy are similar to some other acute conditions. Anemic form of ovarian infarction similar to the interrupted picture, and the painful form - with acute appendicitis.

The mixed form of ovarian apoplexy is similar to painful, but with greater abdominal blood loss.

During a gynecological examination, pallor of the vaginal membrane, an enlarged and painful ovary, an increase in the size of the appendages, overhanging of the vaginal arches (with anemic form of apoplexy) are revealed.

Most often, ovarian rupture occurs after violent intercourse, intense physical exertion, i.e. in case of increased pressure in the peritoneum, however, it can also occur during rest or sleep.

Diagnosis of ovarian apoplexy

The clinical picture of ovarian apoplexy has no characteristic features, and develops in a similar pattern to other acute pathologies in the small pelvis. Most often, patients are admitted to the hospital with a diagnosis of acute abdomen, and doctors - surgeons and therapists need to quickly clarify the causes of the pain syndrome, because blood loss with ovarian apoplexy increases. First, ovarian rupture is differentiated with acute appendicitis, peritonitis, renal colic, ovarian cyst, acute.

Confirm the diagnosis of the patient's complaints about such symptoms of ovarian apoplexy as acute pain in the lower abdomen, which appeared in the second half of the menstrual cycle or in its middle. On examination, there is pallor of the skin and. On palpation, soreness from the ruptured ovary is also found.

A blood test is prescribed, in which, with anemic form of apoplexy, the level of hemoglobin ... With the help of ultrasound examination of the pelvic organs, you can see hemorrhage in the ovary and blood in stomach ... Vaginal examination can show the gynecological nature of the disease. Ancillary research methods include puncture of the posterior fornix of the vagina, which allows you to determine the presence of abdominal bleeding. However, the definitive diagnosis of ovarian rupture is made during laparoscopy .

Ovarian apoplexy treatment

Treatment for an ovarian rupture is carried out in the hospital and depends on the form of the disease and the degree of bleeding in the abdominal cavity. It is aimed at restoring the integrity of the ovary and eliminating the consequences of apoplexy. If an ovarian rupture is suspected, the patient is taken to gynecological hospital.

Conservative treatment of ovarian apoplexy is indicated in mild forms of rupture, which are accompanied by minor bleeding into the peritoneal cavity. However, studies show that with conservative treatment, 85% of women experience the formation of adhesions in the pelvis, and more than 40% develop. Relapses of the disease are also common. This is due to the fact that the blood accumulated after rupture remains in the abdominal cavity, where it contributes to the formation of adhesions in the small pelvis.

With conservative treatment, patients are assigned bed rest, complete rest, antispasmodic therapy, vitamins (, vitamin C , , ), strengthening of blood vessels, physiotherapy methods. Light candles with , apply ice to the lower abdomen, carry out douching with the addition of iodine, Bernard's currents, diathermy. However, at the slightest sign of deterioration, surgery is prescribed.

Thus, conservative treatment of ovarian apoplexy is prescribed mainly for women who already have children, and for women planning a pregnancy, laparoscopy is performed ( laparotomy ). Patients with blood diseases in violation of its coagulability are prescribed drug therapy.

Laparoscopy, as a diagnosis of ovarian apoplexy and further complications, is indicated for women with complaints of acute sudden and suspected bleeding. The operation is carried out in a gentle way while maintaining the integrity of the organs and reproductive functions of the woman. During the operation, the ovarian vessel is coagulated, the endometrium is used for bleeding from a rupture of the corpus luteum, or ovarian resection, in which only the affected part is removed. However, with massive bleeding and the presence in the ovary of a large hematomas , it is removed. During the operation, both ovaries, appendix, fallopian tubes are examined. During the operation, the abdominal cavity is thoroughly washed, blood and blood clots are removed. Faster exit from surgery, shorter hospital stay after surgery is observed. There are no significant cosmetic defects after this operation.

Contraindication to the operation is hemorrhagic shock accompanied by great blood loss and loss of consciousness.

The doctors

Medications

Prevention of ovarian apoplexy

After discharge from the hospital, it is important to prevent recurrence of the disease in the future, i.e. exclude risk factors and promptly treat diseases that provoked ovarian apoplexy. If you suspect a ruptured ovary, you need to take a horizontal position and call an ambulance for hospitalization.

List of sources

• Ed. V.I. Kulakova Gynecology // National leadership. - M .: GEOTAR-Media, 2007;
• Gasparov A.S. Emergency care in gynecology. Organ-preserving operations // Gasparov A.S., Babicheva I.A., Kosachenko A.G. - M., 2000;
• Kolgushkina T.N. Topical issues of gynecology. -Minsk: Higher School, 2000.

Ovarian apoplexy is a pathological rupture of the tissue structures of the ovary, accompanied by internal hemorrhage. The fairer sex, aged 20 to 35, is most susceptible to this pathology. Apoplexy is fraught with the development of dangerous complications, and therefore requires urgent professional medical intervention!

Note: according to statistics, about 3% of women face ovarian apoplexy.

The disease is characterized by a sharp, spontaneous onset, extremely rapid progression, which poses a serious danger not only to health, but also to the patient's life!

The main causes of ovarian apoplexy

Diseases of a gynecological nature, with concomitant pathological changes in the tissue structures of the organ, can lead to ovarian apoplexy. Gynecologists identify the following possible causes of this disease:

• with violation of the integrity of ovarian tissue;
• varicose veins of the ovarian veins, accompanied by excessive fragility and fragility of the blood vessels;
• hyalinosis;
• inflammatory processes localized in the ovarian region ();
• sclerotic changes in the connective tissue structures of the ovaries;
• long-term and uncontrolled intake of anticoagulant drugs;
• disorders of neuroendocrine origin;
• decreased blood clotting rates (thrombocytopenia);
• tumor neoplasms localized in the ovarian region;
• hormonal disorders;
• increased indicators of intra-abdominal pressure;
• adhesions localized in the pelvic region.

Note: most often in medical practice, apoplexy of the right ovary is recorded, which is due to its more intense blood supply.

The following factors can also provoke apoplexy.:

According to statistics, in 90% of cases, apoplexy is recorded during the second half of the menstrual cycle, since during this period the vessels of the ovarian tissue are most filled with blood and are highly permeable.

Another period of increased risk occurs in the days prior to the onset of menstruation. Therefore, at this time, patients are advised to be especially careful, avoid physical exertion and lifting weights!

Important! The exact causes of ovarian apoplexy have not been established to date. Alas, there are cases when tissue ruptures are observed in women who do not suffer from gynecological diseases and are in a state of absolute rest.

Symptoms of ovarian apoplexy

The main symptom of ovarian apoplexy is considered to be pronounced, localized in the lower abdomen. The pain that occurs during a rupture appears abruptly and can be given to the perineum and lumbar region.

In addition, the process is accompanied by the development of internal bleeding, which causes the patient to have symptoms such as:

The degree of manifestation of symptoms largely depends on the intensity of internal bleeding.

Important! The signs listed above may indicate not only ovarian apoplexy, but also other life-threatening pathologies! Therefore, when such symptoms appear, you need to immediately call an ambulance team!

Depending on what symptoms come to the fore, the following forms of the pathological process are distinguished:

1. Painful apoplexy of the ovary- characterized by strong and sharp pain, localized in the abdomen, nausea and vomiting.
2. Hemorrhagic- manifested by intense internal bleeding, which is accompanied by severe weakness, dizziness, fainting, signs of hypotension and bradycardia.
3. Mixed- combines the painful symptoms inherent in the above forms of apoplexy.

Why is the disease dangerous?

Tissue rupture is invariably accompanied by internal bleeding, which carries with it a number of complications:

• death from excessive blood loss;
• pain shock;
• hemorrhagic shock.

In case of ovarian apoplexy during pregnancy, the likelihood of premature birth is also high.

Important! In most cases, the above complications develop in the absence of timely, professional medical care!

Self-medication for this disease is deadly. The fact is that the use of drugs of an anesthetic or anti-inflammatory group can eliminate the pain syndrome and temporarily relieve the patient's condition, however, internal bleeding does not stop at the same time!

However, even in the case of timely medical care, apoplexy can lead to:

• problems with natural conception;
• inflammatory processes localized in the abdominal cavity and genitals;
• hormonal disorders;
• anemia;
• increased likelihood of ectopic pregnancy.

note: competent, comprehensive treatment and the implementation of all the recommendations of a qualified doctor will help you fully recover from apoplexy and reduce possible risks to a minimum!

Diagnostic methods

Diagnosis of ovarian apoplexy, first of all, consists in identifying characteristic symptoms, general clinical picture and analyzing the results of the collected anamnesis.

In order to differentiate pathology from other diseases that have similar manifestations, the following types of research can be recommended to the patient:

• laboratory blood test;
• taking a puncture of the abdominal cavity.

note: competent diagnostics allows a specialist to make an accurate diagnosis, avoiding a possible medical error, and to prescribe an optimal therapeutic course for the patient, which will significantly reduce the risks of relapses and the development of complications!

Methods for the treatment of ovarian apoplexy

Apoplexy treatment can be conservative or surgical.... Conservative therapy involves ensuring complete rest and adherence to bed rest, takes place in a hospital setting.

In most cases, a course of drug therapy is carried out, based on the use of the following groups of drugs:

• hemostatic;
• pain relievers or antispasmodics;
• vitamin and mineral complexes.

To eliminate spasmodic contractions of blood vessels, ice is applied to the lower abdomen.

Indications for surgical treatment are moderate and severe apoplexy, the development of concomitant complications, as well as the lack of effectiveness of conservative therapy.

During the operation, cystic neoplasms are removed, the blood accumulated in the peritoneal region is pumped out, which prevents the formation of adhesions. At the end of these manipulations, the torn tissues are surgically connected. During a surgical operation, doctors strive to preserve the patient's reproductive function. The ovary and tubes are removed only in especially severe cases, when there are exceptional clinical indications!

As indications for removal of the ovaries may be:

• intense intra-abdominal bleeding;
• signs of hemorrhagic shock;
• the presence of contraindications to laparoscopy.

note: basically, the surgical treatment of apoplexy is carried out by the method. This technique is as gentle and less traumatic as possible, and the recovery period after it proceeds quite quickly.

How to provide first aid?

If apoplexy is suspected, it is extremely important to provide the patient with competent first aid before the arrival of the doctors. To begin with, the victim is recommended to lay down and provide her with absolute rest. You can relieve pain and minimize internal bleeding by placing an ice heater on your lower abdomen.

Important! Before the arrival of doctors, it should not be given to the patient, as this can distort the clinical picture and complicate the process of making the correct diagnosis!

Rehabilitation period

The duration of the rehabilitation period after suffering apoplexy depends on the methods of treatment, the severity of the pathology and the individual characteristics of the patient.

Therapy during the recovery period is aimed at normalizing the functioning of the reproductive system, stabilizing the hormonal background, and preventing adhesions.