Ovarian apoplexy symptoms and treatment of apoplexy. What is apoplexy (rupture) of the right ovary

Update: October 2018

Ovarian apoplexy refers to emergency conditions and requires emergency medical care often surgical intervention. Compared with other gynecological diseases, this pathology is quite common and accounts for 17% or 3rd place in the structure of women's diseases. The causes of ovarian rupture are varied, and the consequences of untimely or inadequate treatment can be very sad (infertility as a result of a pronounced adhesive process).

Intra-abdominal bleeding, which occurs in a number of gynecological diseases, in 0.5 - 2.5% is due to ovarian apoplexy. Symptoms of ovarian rupture are most often diagnosed in young women (20-35 years), but the occurrence of pathology is also possible in other age groups (14-45 years).

Ovaries: anatomy and functions

The ovaries are gonads (female gonads) and are paired organs. They are located in the small pelvis, in which they are attached by ligaments (the mesentery and the suspensory ligament of the ovary). One of the ends faces the fallopian tube (the egg that comes out of the ovary immediately enters the tube). In appearance, the ovaries resemble peach pits and are furrowed with scars - traces of past ovulations, the formation and disappearance of corpus luteum. The organs are small in size: 20–25 mm wide and up to 35 mm long. The weight of the ovaries reaches 5 - 10 grams. Blood enters the sex glands from the ovarian arteries, and the right ovarian artery branches off immediately from the abdominal aorta, which is why its diameter is slightly larger, and the blood supply to the right organ is better. Accordingly, the right gland is larger than the left.

The functions of the sex gonads include the formation of estrogens and androgens (in a small amount), and most importantly, the production of an egg ready for fertilization.

Eggs are formed from follicles that were laid at the stage of intrauterine development of the fetus.

The female gonads are made up of:

germinal epithelium (covers the organ from above and delimits it from neighboring organs);
albuginea (consists of connective tissue and contains elastic fibers);
parenchyma, which has 2 layers: outer (cortical) and inner (cerebral).

In the cortical layer of the gland are immature follicles and maturing. Having reached the state of maturity (graafian vesicle), the follicle protrudes somewhat above the surface of the gland and breaks, from where the finished egg comes out (ovulation phase). As the egg enters and moves through the tube, a corpus luteum forms at the site of the former bursting follicle - the second stage of the cycle. The corpus luteum actively produces progesterone, which is necessary to support the onset of pregnancy. If conception does not occur, the corpus luteum undergoes a process of reverse development (involution) and becomes a white body (connective tissue), which eventually disappears completely.

The inner (brain) layer is located in the very depths of the glands, has a well-developed circulatory network and nerve endings.

Definition of pathology and classification

The term "ovarian apoplexy" means a hemorrhage into it, which happened suddenly against the background of a violation of the integrity (rupture) of the ovarian tissue. The disease is accompanied by progressive bleeding into the abdominal cavity and severe pain. Other names for the pathology are rupture of the ovary or hematoma, less often a heart attack. Hemorrhage in gonad can happen when a cyst ruptures corpus luteum, at the time of damage to the vessels of the Graafian vesicle or stroma of the organ.

The disease is divided into:

For forms:

pain form (it is also called pseudoappendicular) - characterized by a pronounced pain syndrome, which is accompanied by nausea and fever;
anemic form (or hemorrhagic) - clinically similar to rupture of the tube during ectopic pregnancy, the cardinal sign is intra-abdominal bleeding.
mixed - the signs of both forms are combined.

According to the magnitude of blood loss and manifestations of clinical signs, degrees are distinguished:

light (the volume of blood shed is 0.1 - 0.15 liters);
medium (blood loss is 0.15 - 0.5 liters);
severe (free blood in the abdomen exceeds 0.5 liters).

Anemia and pain forms are diagnosed equally often.

Causes and mechanism of development

The mechanism of the development of the disease is neuroendocrine disorders and inflammatory processes internal genital organs. As a result of these factors, sclerotic changes develop in the ovaries, and stagnation of blood in the vessels of the small pelvis, which leads to varicose veins of the ovarian veins. Due to various changes in the vessels of the genital gonads (their varicose veins, sclerosis of the vascular wall), hyperemia and inflammation of the ovarian tissue, the formation of many small cysts in the walls of the ovarian vessels become inferior, their permeability increases, which provokes further rupture of the vessel / vessels.

First, a hematoma forms in the ovary, which causes sharp pain as a result of increased pressure in the ovary. Then, due to excessive intra-ovarian pressure, the vessel / vessels burst, which leads to bleeding, often massive (even with a small rupture).

Ovarian apoplexy occurs in any phase of the cycle, but more often in the ovulatory and luteal (second). During this period, blood flow to the gonads increases, the corpus luteum flourishes, and possibly the formation of a luteal cyst. The possibility of rupture of the corpus luteum in the first trimester of pregnancy is not excluded.

It is characteristic that the right ovary ruptures more often, which is explained by its better, in comparison with the left, blood supply.

The reasons

The reasons that create a favorable background for rupture of the ovary (endogenous factors):

inflammation of the ovaries / appendages;
varicose ovarian veins (provoke heavy physical labor, repeated pregnancies, taking hormonal contraceptives, hyperestrogenia);
anomalies in the location of the genital organs (retroflection or bending of the uterus, compression of the ovary by a tumor of a neighboring organ);
adhesive process in the small pelvis, especially when constricting the ovary with adhesions;
diseases of the blood coagulation system;
sclerocystosis of the ovaries (the protein membrane becomes too dense, its rupture during ovulation "requires considerable effort from the follicle").

External causes (exogenous) that increase the risk of ovarian apoplexy:

violent sex or interrupted sexual intercourse (blood flow to the gonads increases and intraovarian pressure increases);
heavy lifting, sudden movements (tilt, turn) or heavy physical work);
trauma to the abdomen (strike, fall on the stomach);
drug stimulation of ovulation (one of the side effects clomiphene, which stimulates ovulation is the formation of luteal cysts, which is fraught with apoplexy of the ovarian cyst);
defecation (increased intra-abdominal pressure);
horseback riding (shaking);
rough gynecological examination;
visiting baths, saunas;
long-term use of anticoagulants.

Case Study

A young woman, 22 years old, was admitted to the gynecological department at night with signs of intra-abdominal bleeding. Preliminary diagnosis after examination and abdominal puncture through the posterior vaginal fornix: "Apoplexy of the left ovary, mixed form." History of sclerocystosis of the ovary, no pregnancies during the year of regular sexual activity (the patient recently married). She was put on the waiting list for paid laparoscopic surgery for ovarian sclerocystosis in regional hospital(The operation is scheduled a week after admission to our hospital). During laparotomy in abdominal cavity liquid blood with clots up to 900 ml was found, the rupture of the right ovary was about 0.5 mm. Resection of both ovaries, sanitation of the abdominal cavity and layer-by-layer suturing of the wound tightly were performed. Postoperative period without complications, discharged in a satisfactory condition.

The cause of ovarian rupture in this case was sclerocystosis. The woman happened, one might say, the first independent ovulation in her life, which led to the rupture of the gland and bleeding. On the other hand, the patient did not have to go to a paid operation (resection of both ovaries was planned).

After 5 months, the woman was registered for pregnancy in our antenatal clinic.

Clinical picture

Signs of ovarian apoplexy depend on the intensity of bleeding and concomitant (background) gynecological pathology. AT clinical picture The predominant symptoms of ovarian apoplexy are intra-abdominal bleeding and severe pain. In the case of a mixed form of pathology, signs of internal bleeding and pain syndrome are equally detected.

pain

In most cases, pain occurs suddenly, their nature is sharp, very intense, and often a painful attack is preceded by provoking factors (hypothermia, sudden movements, violent sex). The appearance of pain against the background of complete well-being, for example, in a dream, is not excluded. Occasionally, on the eve of an acute pain attack, a woman may notice a slight dull / aching pain or tingling in the left or right iliac region. Such aching pains are caused by small hemorrhages (hematoma formation) in the tissue of the ovary, or swelling or redness of the gland. The localization of the patient's pain is often determined accurately, in the lower abdomen, on the right or left, pain in the lower back is possible. Acute pain is due to irritation of nerve receptors in the ovarian tissue, as well as blood flowing into the abdominal cavity and irritation of the peritoneum. Possible irradiation of pain in the leg, under and above the collarbone, in the sacrum, anus or in the perineum.

Signs of internal bleeding

The severity of symptoms in intra-abdominal bleeding depends on the amount of blood poured into the abdominal cavity, the intensity and duration of bleeding. In moderate and severe cases (blood loss is more than 150 ml), signs of acute anemia come to the fore, and in severe cases, hemorrhagic shock. Arterial pressure falls sharply, the patient feels severe weakness, fainting is possible. The pulse becomes more frequent and weakens, the skin and mucous membranes are pale, nausea / vomiting appears, signs of peritoneal irritation (peritoneal symptoms) are added. The patient complains of dry mouth, thirst, cold skin, with perspiration.

Other symptoms

Also for this pathology is characteristic, but not always, the appearance of intermenstrual minor spotting or blood smearing against the background of a delay in menstruation. The patient complains of frequent urination and the urge to defecate (irritation of the rectum by outflowing blood).

Gynecological and general examination

A general examination confirms the picture of internal bleeding (pale, cold and moist skin, tachycardia and low blood pressure, peritoneal symptoms, bloating).

Gynecological examination reveals: pallor of the mucous membranes of the vagina and cervix, smoothed or overhanging posterior vaginal fornix (with large blood loss), painful and enlarged right or left ovary. The uterus "floats" in the small pelvis on palpation, and the displacement of the neck causes pain.

Diagnostics

Only in 4 - 5% it is possible to make a correct diagnosis, which is quite understandable. Symptoms of the disease are similar to the clinic of other pathological processes. Differential diagnosis is carried out with:

interrupted ectopic pregnancy;
acute adnexitis;
rupture of an ovarian cyst;
pyosalpinx and its rupture;
appendicitis;
renal colic;
acute pancreatitis;
perforation of a stomach ulcer;
intestinal obstruction.

Complaints are carefully collected from the patient and the anamnesis is studied, a general and gynecological examination is carried out, after which additional research methods are prescribed:

A decrease in erythrocytes and hemoglobin is determined (the degree of their decrease depends on the volume of blood loss), slight leukocytosis, and an increase in ESR.

Coagulogram
pelvic ultrasound

Examination of the ovaries and determining their size, taking into account the phase menstrual cycle and the condition of the other gland. The damaged ovary is somewhat larger; in its stroma, a hypoechoic or heterogeneous formation is determined in structure - the corpus luteum. The diameter of the corpus luteum is not larger than the size of the maturing follicle, and the follicular apparatus of the sex gland is normal (liquid inclusions up to 4–8 mm). Free fluid is visualized behind the uterus.

Culdocentesis

Puncture of the abdominal cavity through the posterior vaginal fornix confirms / refutes the presence of liquid blood in the retrouterine space, which does not clot if the apoplexy is "fresh" or contains small clots - "old" bleeding.

Laparoscopy

A minimally invasive intervention that allows not only to clarify the diagnosis, but also to carry out surgical treatment. During the inspection, the following are revealed:

blood poured into the abdominal cavity, without or with clots;
an enlarged, purplish ovary with a rupture that either bleeds or is clotted;
uterus of normal size;
inflammatory changes in the tubes (tortuosity, hyperemia, thickening, adhesions);
pelvic adhesions.

In the case of a pronounced chronic adhesive process or signs of hemorrhagic shock, laparoscopy is contraindicated and proceeds to an immediate therapeutic and diagnostic laparotomy.

Treatment

Treatment of pathology is carried out in a hospital, since all patients are admitted with symptoms of an "acute abdomen" and on an emergency basis. " Acute abdomen”requires not only careful diagnosis, but also monitoring of the patient's condition. There are 2 treatment options available.

Conservative therapy

Holding conservative treatment it is allowed for patients with small blood loss (up to 0.15 l), who have already realized their childbearing function (there are children and are no longer planned). The complex of therapeutic measures includes:

Strict bed rest

The movements of the patient can provoke and intensify the subsided bleeding from the ovary, and also increase the pain attack.

Cold

Immediately after the diagnostic measures, all patients are prescribed cold on the lower abdomen (rubber heating pad with ice), which causes vasospasm, stops bleeding and reduces pain.

Hemostatic drugs

Also, to stop bleeding, hemostatics are administered: etamsylate, ascorbic acid, vikasol, vitamins B1, B6 and B12.

Analgesics and antispasmodics

Baralgin, drotaverine, no-shpa effectively stop the pain attack.

Iron preparations

They are prescribed for anti-anemic purposes (tardiferon, sorbifer, fenyuls).

Surgery

Surgery is performed either laparoscopically or laparotomically. Preference is given to laparoscopic surgery, especially in the case of women who are planning a pregnancy in the future.
Advantages of laparoscopic access:

psychological comfort (no gross scars in the abdomen);
quick recovery from anesthesia;
early activation of the patient;
short stay in the hospital;
less use of pain medication after ovarian rupture surgery;
low risk of adhesion formation and preservation of reproductive function.

Laparotomy is performed in a serious condition of the patient (hemorrhagic shock) and in case of impossibility of performing laparoscopy (lack of equipment, significant adhesive process in the abdominal cavity).

Stages surgical intervention:

stop bleeding (hemostasis) from the damaged ovary (coagulation, suturing of the gap or wedge-shaped resection of the gland is possible);
removal of blood and clots from the abdominal cavity;
sanitation (washing) with antiseptic solutions (an aqueous solution of chlorhexidine, saline solution).

Very rarely, it is necessary to perform an oophorectomy - complete removal of the ovary (in case of massive hemorrhage in the ovarian tissues).

Rehabilitation

After surgery for ovarian apoplexy, the patient undergoes rehabilitation measures:

Prevention of adhesion formation

Physiotherapy is actively prescribed (starting from 3-4 days postoperative period):

low frequency ultrasound;
low intensity laser therapy;
electrical stimulation of the fallopian tubes;
therapeutic electrophoresis (with zinc, lidase, hydrocortisone);

Restoration of the hormonal background

Dispensary registration

All women who have had ovarian apoplexy are subject to mandatory dispensary registration in the antenatal clinic during the year. The first examination is scheduled in a month, then after 3 and 6.

Effects

The prognosis in most cases after rupture of the ovary (especially in the case of conservative treatment) is favorable. But the consequences are not excluded:

adhesive process

Conservative therapy or postponing the timing of surgery in 85% of cases leads to the formation of adhesions in the small pelvis. This is facilitated by the presence of blood and clots in the abdominal cavity, which eventually organize and cause the formation of adhesions. In addition, the duration of the operation, the open wound of the abdomen (with laparotomy), the presence of chronic inflammation of the appendages and the complicated course of the postoperative period provoke the occurrence of adhesions.

Infertility

Infertility develops in 42% of patients, which is facilitated by intense adhesion formation, hormonal imbalance and chronic inflammatory diseases ovaries and appendages. But if one healthy ovary remains after apoplexy and surgery, the chances of getting pregnant in the future are great.

Disease recurrence

Repeated apoplexy of both damaged and healthy ovaries occurs in 16% (according to some reports in 50%) of cases, which is facilitated by background diseases (hormonal imbalance, chronic adnexitis).

Ectopic pregnancy

The risk of ectopic pregnancy increases due to the formation of adhesions in the pelvis, torsion and bending of the fallopian tubes.

Question answer

How long do you stay in the hospital after the operation?

As a rule, after surgery for ovarian apoplexy, patients stay in the hospital for 7-10 days. Early discharge is carried out after laparoscopic access and a smooth course of the postoperative period.

I underwent conservative treatment for 3 days in a hospital for a painful form of ovarian apoplexy. Laparoscopy was not done, ultrasound was performed and treated with hemostatic drugs. I was discharged with improvement, but at home I again felt pain that radiated to the lower back and anus, plus the temperature rose to 37.5. What to do?

You need to urgently contact a gynecologist and possibly perform a laparoscopic operation. All signs point to continued bleeding from the ovary and associated inflammation. In case of an attack acute pain call an ambulance immediately.

When can I start having sex after surgery (ovarian rupture)?

About a month later.

How quickly can you get pregnant after surgery (ovarian apoplexy)?

In the absence of background gynecological diseases, taking COCs only for a month after surgery, ovulation and conception are possible already in the second menstrual cycle after surgical treatment.

Content

Hemorrhage in the ovary can be triggered by pathologies of the reproductive system or exposure external factors. Abundant blood loss can be the cause of death, therefore, immediate rest for the patient and medical assistance are required.

What is ovarian apoplexy

Pathology is a rupture of the vessels of the gonad, leading to bleeding. As a result, there is pain in the abdomen. Excessive blood loss can cause anemia. With a burst ovary, the patient can lose up to 500 milliliters of blood, which is a serious health hazard.

Mostly diagnosed apoplexy at the age of 20-40 years. More often there is a rupture of the right ovary, since the blood supply to the artery of this gonad is better.

Gap

The cause of the development of the pathological process is inflammation internal organs and hormonal imbalance. The impact of these factors leads to stagnation of blood in the vessels of the small pelvis, provoking varicose veins of the ovarian veins.

Increase in permeability vascular walls contributes to their breakdown. Initially, a hematoma occurs in the ovary. When it breaks, blood enters the peritoneum, which is why patients complain of severe pain. Often pathological condition observed during ovulation. There is a gap in the area of the follicle with a mature egg.

Hemorrhage

Bursting blood vessels cause profuse hemorrhage from:

follicular cysts of the gonad;
follicles during ovulation;
ovarian stroma;
corpus luteum cyst.

Classification

There are such forms:

Painful. Severe pain and bouts of nausea occur. There are no signs of hemorrhagic shock.
Anemic. There are symptoms of intra-abdominal bleeding and shock. The patient experiences weakness, dizziness, which sometimes leads to loss of consciousness.
Mixed. It combines the signs of anemic and painful apoplexy.

The classification above is conditional, since the pathological condition always provokes bleeding. Therefore, it is customary to divide ovarian apoplexy according to severity:

Light: the volume of lost blood is not more than 150 ml.
Average: from 150 to 500 ml.
Heavy: intra-abdominal hemorrhage over 500 ml.

Symptoms

The main symptom characteristic of apoplexy is a sudden cramping pain syndrome in the lower abdomen, which some confuse with appendicitis. provoked pain accumulated blood. Often the pain radiates to the lower back, lower limbs and anus. In this case, nausea with vomiting, dizziness is observed.

The cause of these symptoms is blood loss, causing a lack of oxygen.

Patients have greatly reduced blood pressure, heart rate increases. In this case, pallor of the mucous membranes and skin is observed. Some patients complain of vaginal discharge, which is similar to menstruation. There are frequent urges to go to the toilet. This is due to stretch Bladder and the pressure of the accumulated blood on the rectum.

pain

The pain syndrome develops suddenly, sometimes radiates to the navel, lower back, perineum, has a different character. There are such manifestations of pain:

stabbing;
cramping;
permanent;
paroxysmal.

With a mild course of the pathological condition, the pain is short-term, nausea is present. Ovarian apoplexy moderate becomes the cause of a severe pain syndrome that worries the patient for several hours, after which it subsides, and then again makes itself felt during the day. In this case, there are other signs of a burst ovary:

vomit;
weakness;
chills.

Pathology in severe form causes constant pain, bloating, heart rhythm disturbance.

Bleeding

With a mild course of the pathological condition, the volume of blood loss does not exceed 150 ml. In severe form, it is over 500 ml. This condition is very dangerous for a woman's life. Blood loss provokes other symptoms of ovarian apoplexy. In hemorrhagic shock of the first degree, there is:

sharp decline blood pressure;
weakness;
reduction in heart rate;
pallor of the skin.

Shock of the second and third degree provokes the following symptoms:

chills;
dry mouth;
dizziness;
loss of consciousness.

The reasons

Ovarian rupture can be triggered by such internal factors:

inflammatory processes in ovarian tissues associated with infections, hypothermia;
enlargement of the veins of the gonads, caused by increased physical activity, endometriosis, or the use of hormonal contraceptives;
polycystic;
benign or malignant tumors that press on the ovary;
blood clotting problems.

An ovarian tear can also be caused by the influence of external factors:

riding;
injuries of the peritoneum, for example, bruises;
systematic visits to the bath;
intense sex.

Diagnostics

In order not to provoke profuse blood loss, contributing to the onset of anemia, the diagnosis should be made as soon as possible. Initially, the doctor interrogates the patient, finding out such nuances:

duration of the menstrual cycle;
painful menstruation;
Are there any delays?
whether there are pathologies of the genitourinary system.

Then the following diagnostic measures are prescribed:

Palpation and gynecological examination. They allow you to determine the degree of soreness, the size of the ovaries and uterus.
Blood test for chorionic gonadotropin to detect an ectopic pregnancy.
General blood analysis- hemoglobin level.
Ultrasound examination of the pelvis. Detects the presence of fluid in the pelvis.
Puncture of the posterior fornix of the vagina. Receiving blood indicates apoplexy.
Laparoscopy. Serves to confirm the preliminary diagnosis. Using special instruments, the surgeon examines the abdominal cavity through small holes.

Treatment of ovarian apoplexy

If you suspect a burst ovary, it is important to quickly call an ambulance and lie down. After hospitalization, doctors prescribe bed rest for the patient. Medical therapy is used only in situations where intra-abdominal bleeding is minimal.

If signs of bleeding increase, surgical intervention is mandatory.

conservative

The following medicines are used:

Hemostatic. Intravenous or intramuscular injection drugs from this group. One of the most effective drugs considered Tranexam and Etamzilat.
Antispasmodic. Stop pain in the peritoneum by lowering muscle tone. The funds are used in the form of tablets or injections. Appoint No-shpu and Papaverine.
Vitamins. Help improve the general condition of the patient. Can increase blood clotting. B vitamins are used.
Antianemic. Used to prevent anemia. Often seek help Sorbifer, which restores the level of iron in the body.
Suppositories. They have antiviral and antimicrobial effects. They stop inflammatory foci, strengthen local immunity.

According to studies, conservative treatment of ovarian rupture is ineffective.

Often, patients develop adhesions in the pelvis, infertility develops. Sometimes there is repeated apoplexy of the ovary. This is related to the fact that drug therapy does not make it possible to completely clear the peritoneum of blood clots.

Surgical

Surgery is a more effective treatment technique used for moderate and severe apoplexy. Laparotomy and laparoscopy are performed. The first method of intervention involves dissection of the anterior wall of the abdomen. This helps to access the ovaries. In the process of laparoscopy, small holes are created, where special surgical instruments are inserted.

The essence of both operations is the same. The surgeon sutures the damaged vessel, then removes the blood and rinses the abdominal cavity with antiseptic solutions.

Laparotomy is performed less frequently due to the higher morbidity. After surgery, the patient is prescribed drug therapy. It is aimed at preventing infection of the operated area. Help medication to eliminate chronic inflammation, normalize hormonal levels.

Prognosis and complications

If the rupture of the ovary is accompanied by severe blood loss, the likelihood of shock is high. If timely medical care is not provided, a pathological condition can be the cause of death. If help is provided on time, the prognosis is favorable.

Pathology can cause such complications:

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One of the most dangerous gynecological diseases is ovarian apoplexy. It is characterized by a violation of the integrity of the organ itself and its vessels. In this case, hemorrhage into the ovarian tissue is observed, accompanied by an acute painful syndrome. Ovarian rupture is rare in women. The danger of the disease lies in the fact that it almost always recurs.

In a mature woman, follicles mature in the ovaries. Inside is an egg. So the body prepares for conception and gestation every 30 days.

First there is an increase dominant follicle, then - the release of a mature egg. The ovulatory phase begins. Education occurs where the follicle burst. Vulnerable tissue of the ovary can be quickly injured, then its germination with new vessels is observed. An organ tear is provoked by a hematoma. It is formed against the background of bleeding from a damaged ovarian vessel. As it grows, the hematoma puts pressure on the capsule of the organ, breaks it and pours into the pelvic cavity. More often there is damage to the organ on the right side.

The main causes of the development of pathology

Every woman should know the answer to the question of what is ovarian apoplexy and how to prevent this disease. The main precipitating factor is the progression vascular pathology. Ovarian rupture is formed for the following reasons:

Increased stress on blood vessels.
development of thrombocytopenia.
Development of Willerbrand's disease.
Prolonged use of anticoagulants that promote blood thinning.
Change in hormonal background.
ovaries and uterus.
The course of the adhesive process.

The causes of ovarian apoplexy are quite diverse. The organ can rupture due to too brutal sexual contact. Often the cause of the appearance of pathology is associated with trauma to the abdominal cavity. The ovaries can burst due to excessive strength training or carrying weights. The exact reasons why an ovarian rupture may occur are identified in the diagnosis.

Basic forms

Ovarian apoplexy can be of 3 forms:

painful;
anemic;
mixed.

The pain form is considered the most dangerous. It is characterized by the appearance of bright painful sensations, often accompanied by nausea. The syndrome can be so severe that the girl loses consciousness. The danger of this form lies in the fact that the symptoms of ovarian rupture are similar to those of appendicitis, which makes diagnosis difficult.

With an anemic form, symptoms of internal bleeding appear. The skin turns pale, the woman complains of severe weakness. Sometimes there are fainting. Painful syndrome is given in the leg, lower back, sacrum.

In a mixed form, it has signs of anemic and painful apoplexy.

How pathology manifests itself

Symptoms of apoplexy are quite specific. First, there is an acute painful syndrome. Then there are signs of internal hemorrhage. The pain accompanying the rupture of the ovary is localized in the lower abdomen. Its distribution to the perineum, rectum, lumbar or umbilical zone is noted. Painful syndrome at rupture may be paroxysmal in nature or always present. The duration of the attack varies from 30 minutes to 2-3 hours. Within 24 hours, pain may recede and return.

Hemorrhage of one of the ovaries is combined with a decrease in blood pressure. The pulse weakens skin covering turns pale. At first, the symptoms of ovarian rupture resemble signs of other diseases. There are vague dizziness, fainting, severe weakness. A woman can freeze, feel sick, vomit. The mucous membranes of the mouth become dry, urination becomes more frequent, there are false urges to defecate. A woman who is attentive to her health can discover for herself characteristic symptoms ovarian apoplexy. The first alarm signal is the appearance of bloody vaginal discharge. This symptom appears after a missed period.

If you find these signs of rupture of one of the ovaries, you should not hesitate to call a doctor. Progressive intra-abdominal bleeding can be fatal.

If the ovarian apoplexy has a mild degree, then the painful syndrome is short-lived. Shock and peritoneal effects are absent. A moderate ovarian apoplexy is characterized by a strong painful syndrome. Appears shock 1 degree, combined with peritoneal phenomena.

With a complex degree, signs of ovarian apoplexy appear, such as:

Persistent pain syndrome.
Bloating.
Collapse.
Increased heartbeat.
Cold sweat.
Shock 2-3 degrees.

Peritoneal signs are very pronounced. Hemoglobin drops to 50%.

Diagnosis

A specific answer to the question of why it develops and how this disease is treated can only be given by a doctor. The diagnosis is based on:

gynecological examination;
ultrasound examination;
blood test.

A puncture of the posterior vaginal fornix is performed, and a laparoscopy is scheduled.

Also, a specialist conducts a mandatory differential diagnosis ovarian apoplexy. This helps to exclude the presence of acute pancreatitis, torsion of the organ cyst. The doctor is obliged to differentiate this pathology with ectopic and uterine pregnancy, acute appendicitis. Diagnosis of ovarian apoplexy should be immediate. With timely intervention, the prognosis is favorable.

Features of medical care

Treatment of ovarian apoplexy is carried out in the hospital. The patient is recommended strict bed rest and complete rest. A cold compress is placed on the lower abdomen, which helps to reduce pain and narrow blood vessels.

The doctor who established the symptoms and treatment is obliged to monitor the level of hematocrit, hemoglobin and general condition. If a mild degree is diagnosed, then the specialist is taken to treat the disease in a conservative way.

First aid

If a tissue rupture of the right or left ovary is suspected, the woman should immediately call an ambulance. The patient is taken to a gynecological or surgical hospital. Before the arrival of the brigade, the patient should calm down and lie down. The range of motion should be minimal.

Even if the ruptured ovary hurts unbearably, you should not take painkillers until the doctors arrive. It is not recommended to independently apply a cold compress to the lower abdomen or install a heating pad with warm water.

Features of conservative treatment

In the acute period of ovarian apoplexy, conservative treatment involves the appointment of:

Drugs that stop bleeding.
Antispasmodics.
vitamins.
Suppositories with belladonna.

Antispasmodic drugs such as No-shpa, Papaverine are prescribed. Special attention is given to the intake of vitamins B1, B6, B12. The blood is stopped by sodium etamsylate.

When the acute period subsides, ovarian apoplexy is treated with Bernard currents, electrophoresis with calcium chloride, diathermy. Microapoplexy involves the appointment of vitamins and tonic medicines. You should refrain from sexual contact for 3-4 weeks.

Conservative treatment may be complicated by the progression of the adhesive process in the small pelvis. In 42% of cases, on the background of conservative therapy, infertility occurs. Relapse can occur in 50% of cases.

Features of surgery

The resulting rupture of the ovary is treated laparoscopically or laparotomically. The first method involves a puncture abdominal wall. During a laparotomy, the doctor makes an incision.

It is prescribed when the patient loses relatively little blood - up to 150 ml. Another indicator of this method is the ineffectiveness of conservative treatment. The general condition of the patient should be satisfactory.

It is prescribed when laparoscopy is not possible. Such an operation is not performed if an adhesive process or heavy vascular bleeding is detected in the abdominal cavity.

The treatment of a ruptured ovary involves a delicate approach. First, the doctor sutures the organ, then removes blood clots, treats the abdominal cavity with an antiseptic solution. If the ovary is damaged very badly, the specialist removes it completely. In order to stop bleeding, cauterization of the rupture site is carried out, and the bleeding vessel is tied up.

Then there is an examination of neighboring tissues and organs. The doctor must pay special attention to 2 ovaries and both fallopian tubes. Having found endometrial lesions, the surgeon removes them. When the rupture of the ovary is eliminated, the patient is prescribed antibacterial, anti-inflammatory therapy. At the second stage of the postoperative period, the doctor eliminates the symptoms of anemia. Duration recovery period varies from 5 to 7 days. Then the doctor who eliminated the rupture of the ovary discharges the woman home.

Surgical intervention does not eliminate the cause of the disease. Therefore, it is not the final stage of treatment. After the patient is discharged from the hospital, ovarian apoplexy is treated by eliminating hormonal disorders or another provocative disease.

Preventive actions

Prevention of ovarian apoplexy is prescribed to prevent relapse. But with pain, this is not necessary. After treatment, the body independently restores hormonal levels and blood supply.

Preventive therapy is needed when the rupture of the ovary has a hemorrhagic form. This is accompanied by hormonal disorders, CNS disorder. In this case, the woman is prescribed the use of drugs that stabilize the functioning nervous system. More often, the doctor prescribes the patient Nootropil, Piracetam. In order to improve the blood circulation of the brain, the patient is prescribed the use of Vinpocetine, Cavinton, Tanakan. For increase intracranial pressure The doctor prescribes diuretics. Hormonal status is normalized by contraceptives.

The doctor must explain to the woman that a disease such as apoplexy can recur even if all preventive recommendations are followed. To eliminate this risk, a woman is recommended to treat concomitant gynecological pathologies in a timely manner. Particular attention should be paid to the treatment of sexually transmitted infections, PCOS, oophoritis,. You need to visit the gynecological office 1 time in 6 months.

Opportunity to get pregnant

Rupture of an organ does not deprive a woman of the opportunity to become a mother. Usually surgery involves only partial removal organ. But even if the surgeon made a radical decision, the egg matures in the 2nd ovary. Conception becomes problematic only when an adhesive process develops in the abdominal cavity.

To prevent this from happening, a woman is prescribed a course of anti-inflammatory therapy. It involves taking antibiotics. The patient is also prescribed a physiotherapy course, which involves the passage of:

low frequency ultrasound;
electrophoresis;
laser therapy.

The first six months after surgery, the patient must protect herself during sexual intercourse. A woman is recommended to take Regulon, Logest, Novinet, Yarina. Also, the doctor may recommend the use of other potent contraceptives. These drugs stop the development of the adhesive process, help restore hormonal levels.

Very rarely, apoplexy can occur during gestation. In a woman about to become a mother, an ovary may rupture early dates. If the doctor diagnoses this disease, the patient is assigned a laparotomy. At the same time, pregnancy can be saved, but the risks of miscarriage remain quite high.

It is possible to avoid the development of this pathology. A woman should eliminate constant overwork and physical exercise. When using drugs that slow down blood clotting, you need strict control of INR, as well as coagulation parameters.

Ovarian apoplexy poses a serious threat to the health and life of a woman. The prognosis is favorable only with timely assistance and the absence of complications.

Ovarian apoplexy, what is it?

Ovarian apoplexy is an acute gynecological disease in which there is a rupture of the blood vessels and tissues of the ovary. emergency requires urgent medical care, since hemorrhage into the abdominal cavity is fraught with large blood loss (up to 2 liters) and death.

In the ovaries of women of reproductive age there are many vesicles filled with fluid - these are primordial follicles. Every month, an egg matures in one of them. She leaves the follicle (ovulates), in the place of which a corpus luteum forms a little later. Without the onset of pregnancy, it lives no longer than two weeks, regresses, and menstruation begins.

During ovulation and the development of the corpus luteum, and especially if these processes are disturbed (for example, a cyst is formed), the vessels of the ovarian tissues weaken and are easily damaged. This leads to hemorrhage.

The source of bleeding can be the vessels of the primordial follicle, ovarian stroma, cysts - corpus luteum or follicular. First, blood accumulates, forming a hematoma, and then pours into the abdominal cavity.

The disease is more often detected in girls and women aged 18-45, when the ovaries are actively functioning. If the rupture has already taken place, then the risk of re-hemorrhage is quite high.

Cases of apoplexy of the left or right ovary are more common in the second half of the cycle because the corpus luteum and the mature follicle are entwined with a large number of blood vessels. Also, the cause of the hemorrhage is seen in the action of the luteinizing hormone of the pituitary gland - it is actively produced during ovulation.

Internal factors:

Violation of the ovulation process, when when the egg is released, not only the wall of the follicle is damaged, but also nearby ovarian tissues.
Vascularization of the corpus luteum (proliferation of additional vessels) or pathologies in its development, for example, the formation of a cyst.
Abnormal location of the uterus.
Inflammatory process when the tissues of the ovary become vulnerable.
A growing tumor of the uterus or neighboring organs that puts pressure on the tissues.
Adhesions in the pelvis, for example, on the ovary after prolonged inflammation.
Poor blood clotting.
Pathologies of the ovarian vessels - thinning, sclerosis, varicose ovarian veins.

External reasons:

Increased intra-abdominal pressure due to physical overexertion, sexual intercourse, weight lifting, riding.
Gynecological examination with a mirror, especially during ovulation.
Abdominal trauma.
Taking anticoagulants - drugs that thin the blood.

Apoplexy of the right ovary is diagnosed more often than the left, since there are more blood vessels on this side and the blood supply comes from the central aorta.

Forms of pathology

The initial classification of ovarian apoplexy distinguishes three forms of the disease:

Painful form - there are no signs of internal bleeding, but pain is present.
Anemic, or hemorrhagic, - there are symptoms of intra-abdominal bleeding, pain may be absent.
Mixed, which combines the two above types.

Modern physicians consider this division inaccurate, since ovarian rupture is always accompanied by hemorrhage, and classify the condition according to severity. The amount of blood loss is defined as mild, moderate, or severe form apoplexy.

The main symptom of ovarian apoplexy is a sudden sharp pain in the abdomen, due to the outflow of blood into the abdominal cavity and often radiating to the anus, umbilical region and lower back. Bleeding, in addition to pain, may be accompanied by other symptoms:

drop in blood pressure;
dizziness and weakness;
increased heart rate;
fever and chills;
dry mouth;
vomiting, nausea;
short-term loss of consciousness with slowing of the pulse and blanching of the skin.

With apoplexy, intermenstrual bleeding from the vagina and frequent urination (up to 10 or more times a day) can be observed.

Diagnostics

After studying the complaints, the medical history (determining the phase of the menstrual cycle, the presence of concomitant pathologies) and examining the woman, diagnostic studies are carried out:

Ultrasound shows the presence of fluid in the abdominal cavity.
A general blood test reveals a decrease in hemoglobin levels, and with inflammation, an increase in leukocytes.
Puncture of the abdominal cavity from the side of the vagina, performed under general anesthesia.
Laparoscopy is both a diagnostic and surgical treatment.

Treatment of ovarian apoplexy

With ovarian apoplexy, surgery is the best method of therapy, however, some patients with mild form pathologies refuse to carry it out.

But conservative therapy is not always effective and is recommended only for those women who already have children and are not going to give birth anymore.

If pregnancy is planned, then laparoscopy is the main therapeutic measure. During the operation, the rupture is coagulated or the ovary is sutured, and in the case of a cyst, it is removed.

Contraindications to laparoscopy: critical blood loss with syncope (hemorrhagic shock), bleeding disorders, pathologies of cardio-vascular system, severe exhaustion.

Conservative treatment is carried out in a hospital under the constant supervision of medical staff and includes:

a state of complete rest;
applying cold to the lower abdomen to constrict blood vessels and reduce pain;
drugs to eliminate spasms (Papaverine, Drotaverine, No-shpa);
taking hemostatics - hemostatic agents (Tranexam, Etamzilat, Amben);
physiotherapy - electrophoresis, microwave therapy;
vitamin therapy (B1, B12, B6).

The recurrence of the pain attack is regarded as an indication for surgical treatment.

As a result of surgical treatment, the ovary retains the ability to produce eggs, since only part of it is removed during laparoscopy. Therefore, with timely assistance after ovarian apoplexy, it is possible to become pregnant.

This also applies to the complete removal of the organ - in the absence of complications, the eggs will still mature on the other side, and the possibility of conception remains.

Problems arise if adhesions form in the abdominal cavity. With a history of ovarian apoplexy, the consequences after surgery can be minimized by following all the instructions of the attending physician.

The recovery period includes:

anti-inflammatory antibiotic therapy;
physiotherapy procedures;
the use of reliable contraceptives within six months after laparoscopy.

The risk of developing an adhesive process reduces the intake hormonal drugs(Yarina, Regulon, Novinet and others).

Prevention

Ovarian tissue after apoplexy is prone to re-development of the disease, so preventive measures are important. With a pronounced hormonal imbalance and disorders in the work of the central nervous system that appear after the anemic form of the pathology, the following are prescribed:

means for improving cerebral circulation;
nootropic drugs;
hormonal contraceptives;
diuretics, if intracranial pressure is increased.

For all women, it is imperative to exclude provoking factors - inflammation of the appendages and other diseases of the pelvic organs, physical overstrain. It is especially important to take care of yourself in the second half of the cycle - during the period of ovulation, before and during menstruation.

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

Ovarian apoplexy occurs at any age (up to 45-50 years). The frequency of ovarian apoplexy among gynecological pathologies is 1-3%. The recurrence of the disease reaches 42-69%.

Apoplexy has a complex pathogenesis, due to physiological cyclic changes in the blood filling 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 characteristics 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 more abundant blood circulation in the right ovary, since the right ovarian artery departs directly from the aorta, and the left one from the renal artery.

predispose to ovarian rupture inflammatory processes pelvic organs, leading to sclerotic changes both in the ovarian tissue (stromal sclerosis, fibrosis of epithelial elements, perio-oophoritis), and in its vessels (sclerosis, hyalinosis), as well as congestive hyperemia and varicose ovarian veins. Bleeding from the ovary can be promoted by blood diseases and long-term use of anticoagulants, leading to a violation of the blood coagulation system. These conditions create the background for exogenous and endogenous factors leading to ovarian apoplexy. Among the exogenous causes, abdominal trauma, physical stress, violent or interrupted sexual intercourse, horseback riding, douching, vaginal examination, etc. are distinguished, Endogenous causes there may be an incorrect position of the uterus, mechanical compression of blood vessels that disrupts blood flow in the ovary, pressure on the ovary by a tumor, adhesive processes in the pelvis, etc. In some patients, ovarian rupture occurs without visible reasons at rest or during sleep.

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

An important role in the occurrence of ovarian apoplexy belongs to dysfunction of the higher parts of the nervous system, stressful situations, psycho-emotional lability, and environmental factors.

Allocate painful, hemorrhagic (anemic) and mixed forms of ovarian apoplexy.

Clinic and diagnostics. Main clinical symptom ovarian apoplexy is a 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 outflow of blood, as well as with spasm in the basin of the ovarian artery.

Weakness, dizziness, nausea, vomiting, fainting are determined by intra-abdominal blood loss.

pain form ovarian apoplexy is observed when hemorrhage into the tissue of the follicle or corpus luteum. The disease manifests itself with 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 pain and mild hemorrhagic form of ovarian apoplexy is similar.

In the clinical picture of moderate and severe hemorrhagic (anemic) form ovarian apoplexy the main symptoms associated with intra-abdominal bleeding. The onset is acute, often associated with external causes(sexual 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.

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

Ultrasound of the internal genitalia determines a significant amount of free fine and medium-dispersed fluid in the abdominal cavity with structures irregular shape, increased echoes (blood clots).

To diagnose the disease without pronounced violations of hemodynamic parameters, a 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 an ovulation stigma (a small spot with a diameter of 0.2-0.5 cm raised above the surface with signs of bleeding or covered with a blood clot), in the form of a cyst of the corpus luteum in a "sleeping" state, or in the form of the corpus luteum itself with a linear rupture or rounded tissue defect with or without signs of bleeding.

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 an increase in bleeding, it is possible to carry out conservative therapy. It includes rest, ice on the lower abdomen (promotes vasospasm), hemostatic drugs (etamsylate), antispasmodics (papaverine, no-shpa), vitamins (thiamine, pyridoxine, cyanocobalamin), physiotherapy 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, confirmed by physical examination and ultrasound, with stable hemodynamic parameters and a satisfactory condition of the patient;

ineffectiveness of conservative therapy within 1-3 days, signs of ongoing intra-abdominal bleeding, confirmed by ultrasound;

differential diagnosis of acute gynecological and acute surgical pathology.

Indications for laparotomy:

signs of intra-abdominal bleeding, leading to hemodynamic disturbances with a serious condition of the patient (hemorrhagic shock);

the impossibility of laparoscopy (due to adhesions, increased bleeding from damaged ovarian vessels).

Prevention. In patients with a painful form of ovarian apoplexy, CNS disorders, hormonal profile and blood circulation in the ovary are reversible, and therefore specific preventive measures not 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. For 3 months, therapy is carried out that corrects the activity of brain structures: nootropics are prescribed to improve metabolic processes in the central nervous system, drugs that improve cerebral perfusion (cavinton, tanakan, vinpocetine), tranquilizers, intracranial hypertension- diuretics. To suppress ovulation and correct the hormonal profile for 3-6 months, combined estrogen-progestin monophasic low- and microdose 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. A fatal outcome in case of ovarian rupture can be caused by decompensated irreversible hemorrhagic shock that occurs when blood loss is more than 50% of the BCC.

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