Ovarian rupture: severe pain - surgery - infertility? Which item is redundant? Ovarian apoplexy: causes, symptoms, diagnosis, treatment

Ovarian apoplexy– sudden damage to tissue and blood vessels ovary, resulting in bleeding into the abdominal cavity. This pathology is accompanied by pain and blood loss of varying degrees. In the International Classification of Diseases, Tenth Revision ( ICD-10) ovarian apoplexy is highlighted in two points. Item N83.0 corresponds to a hemorrhagic follicular ovarian cyst, and item N83.1 corresponds to a hemorrhagic corpus luteum cyst.

This pathology is usually characteristic of women of reproductive age. As a rule, women aged 25–40 years suffer from this disease. Ovarian apoplexy is more often observed in the second phase of the menstrual cycle or during ovulation ( the process in which a mature egg leaves the ovary). Often, rupture of ovarian tissue can occur during pregnancy. Relapse ( re-exacerbation) ovarian apoplexy occurs in 40–70% of cases.

Interesting Facts

• Long-term treatment with anticoagulants ( anticoagulants) increases the likelihood of ovarian apoplexy.
• Sudden rupture of ovarian tissue sometimes occurs even during sleep.
• Horseback riding can cause ovarian apoplexy.
• According to statistics, apoplexy of the left ovary occurs 3 times less often. The thing is that the left ovary is fed by a smaller artery, and blood circulation in it is less intense than in the right ovary.
• Not only women of reproductive age can suffer from this pathology. Cases of ovarian apoplexy at the age of fourteen have been described.
• Ovarian apoplexy can cause severe bleeding. The volume of blood loss in some cases is more than 1 liter. Such massive bleeding can directly threaten life.

Anatomy of the ovary

The structure of the ovary can be divided into the following components:

• coelomic epithelium;
• tunica albuginea;
• cortex;
• brain matter.

Coelomic epithelium

tunica albuginea

Cortex

The following stages of follicle development are distinguished:

• Primordial follicle. This follicle is the most immature form. On average, the primordial follicle has a size of 50 microns. It is surrounded by only one layer of follicular cells. The primordial follicle is the most numerous form of all follicle types. Each follicle contains one oocyte ( immature form of egg). At birth, there are 1–2 million primordial follicles in each ovary. Maturation of follicles occurs after puberty ( puberty).
• Primary or preantral follicle. A follicle in which the process of egg maturation has already begun due to the influence of follicle-stimulating hormone. The primary follicle is several times larger than the primordial follicle. The size of the primary follicle is approximately 150 – 200 microns. This follicle is covered by two or three layers of follicular cuboidal cells.
• Secondary or antral follicle. The secondary follicle differs from the previous ones in that a follicular cavity with fluid is formed in it. The cells of the secondary follicle are capable of producing estrogen. This hormone has a feminizing effect and leads to the development of the uterus, fallopian tubes, vagina, mammary glands, and is also involved in the formation of female secondary sexual characteristics. The secondary follicle contains granulosa cells that synthesize progestin. This hormone prepares the body for pregnancy and supports it when it occurs ( gestation). The size of the secondary follicle is 500 microns.
• Tertiary or preovular follicle. The tertiary follicle is characterized by rapid cell growth and differentiation. The tertiary follicle contains 100 times more follicular fluid than the secondary follicle. The size of a tertiary follicle is about 1 mm.
• Mature follicle or Graafian vesicle. The size of a mature follicle is 18 – 20 mm. The egg, which is part of Graaf's vesicle, is completely ready for ovulation. Before ovulation, the wall of the follicle bulges slightly. Subsequently, a rupture occurs at the site of the protrusion. The egg leaves the follicle and enters the oviduct ( ovulation). In place of Graaf's vesicle, a corpus luteum is formed, which subsequently produces progesterone. This hormone stops premature menstruation and promotes normal fertilization.
• Atretic follicle. Only one mature follicle is needed for the ovulation process. If there are two or more mature follicles, then some of them undergo atresia ( death). Under the influence of a special hormone gonadocrinin, tertiary or mature follicles can be programmed to be destroyed. In their place, an atretic body is formed, which is capable of synthesizing estrogens.

The white body is the regenerated yellow body. If fertilization does not occur, the corpus luteum is reorganized in the form of connective tissue. After some time, the white body of the ovary can completely disappear.

Brain matter

Causes of ovarian apoplexy

The most common causes of ovarian apoplexy include:

• inflammation of the ovary ( oophoritis);
• varicose veins of the ovary;
• drug stimulation of ovulation;
• polycystic ovary syndrome.

Inflammation of the ovary

Oophoritis occurs due to the entry of microorganisms into the membrane of a mature follicle after ovulation. As in any inflammatory process, oophoritis is characterized by the occurrence of pain, the appearance of hyperemia ( organ overflow), formation of pathological secretion ( exudate), the occurrence of swelling of the ovary. The same processes occur in the fallopian tubes. A painful sensation is projected at the location of the ovary and fallopian tube, in the lower abdomen. Often, salpingoophoritis can lead to acute appendicitis.

Varicose veins of the ovary

Causes of varicose veins of the ovaries:

• Difficult working conditions. Daily activities in a forced position ( sitting or standing) leads to a significant increase in pressure in the venous system of the pelvic organs and becomes a trigger for varicose veins of the ovaries. Venous hypertension is considered the main factor in the appearance of varicose veins of the ovaries.
• Repeated pregnancy and childbirth. During pregnancy, as well as during childbirth, the female body experiences enormous stress on various organs. As a rule, under these physiological conditions there is an increase in pressure in the vessels. Blood pressure increases not only in the arteries, but also in the veins. Statistics indicate that repeated pregnancy and childbirth are the main causes of varicose veins in the ovaries.
• Diseases of the female reproductive system. A number of diseases of the female genital organs can lead to the appearance of varicose veins of the ovaries. Such diseases include ovarian tumors, torsion of the broad ligament of the uterus, and endometriosis.
• Hyperestrogenism. Hyperestrogenism is characterized by an increase in the synthesis of female sex hormones - estrogens. This endocrine disorder may be a consequence of ovarian cancer. In turn, an ovarian tumor can lead to the development of varicose veins of the ovary. Hyperestrogenism also causes a number of serious diseases, from which endometriosis, the formation of uterine polyps, uterine fibroids, etc. can be distinguished.
• Hormonal contraception. This type of contraception is one of the most popular and effective. If hormonal contraception was chosen incorrectly, various side effects may occur. One of the side effects is increased pressure in the venous network of the pelvis.

Drug stimulation of ovulation

The use of various drug stimulation regimens for ovulation has a number of disadvantages. Side effects of this method include ovarian cysts, hormonal imbalance, and ovarian apoplexy.

Polycystic ovary syndrome

With this pathology, the following modifications are distinguished: bilateral enlargement of the ovaries by 2–6 times, stromal hyperplasia ( formation of an excess of new structural elements), the presence of a large number of cystic follicles ( a cyst is formed from a mature follicle), thickening of the ovarian capsule.

In the cortex of polycystic ovary syndrome there are many cystic-atretic follicles. These follicles are a pathological formation, and the body seeks to reduce their number. During reorganization ( connective tissue replacement) large cystic-atretic follicles may be destroyed, which will lead to rupture of ovarian tissue and bleeding.

Symptoms of ovarian apoplexy

Ovarian apoplexy is characterized by the following symptoms:

• pain in the lower abdomen;
• a sharp decrease in blood pressure, increased heart rate;
• general weakness;
• menstrual irregularities;
• frequent urination.

Pain in the lower abdomen

A sharp decrease in blood pressure, increased heart rate

General weakness

Menstrual irregularities

Frequent urination

In some cases, ovarian apoplexy can cause hormonal imbalance. As a result, the effect of certain hormones on the bladder can lead to stretching of its wall. As a result of excessive stretching of the bladder wall, the frequency of urination increases. Also, the collapse of massive ovarian edema may be accompanied by increased urination.

Diagnosis of ovarian apoplexy

To confirm the diagnosis of ovarian apoplexy, the following methods are used:

• gynecological examination;
• Ultrasound of the pelvic organs;
• puncture of the posterior vaginal fornix.

Gynecological examination

Next, the vaginal wall is examined. For this manipulation, special gynecological speculums are used ( an instrument that is used to widen and open the vagina). Most often, the vaginal mucosa remains the usual color. If ovarian apoplexy leads to massive bleeding, characteristic of the anemic form, then the vaginal mucosa has a pale pink color.

The next step in the gynecological examination is bimanual ( two-handed) vaginal examination. This manipulation is necessary to determine the position, condition and size of the uterus, as well as the uterine appendages ( ovaries and fallopian tubes). Quite often, bimanual examination of the vagina reveals pain at the site of projection of one of the ovaries with unilateral apoplexy. Palpation of the affected ovary causes pain. The size of the ovary remains normal or slightly enlarged.

Ultrasound of the pelvic organs

Ultrasound examination usually helps to see some structural changes in the ovary. The size of the affected ovary may be slightly enlarged or within normal limits. With apoplexy, you can notice a heterogeneous structure in the cortex. This structure is the corpus luteum. In most cases, it is the corpus luteum that causes bleeding. If there are no concomitant gynecological diseases ( polycystic ovary syndrome), then no pathologies are detected in the follicles. The main confirmation of the diagnosis of the anemic form of ovarian apoplexy is the detection of free fluid in the abdominal cavity behind the uterus.

It is worth noting that the assessment of the condition of the affected ovary should be made in comparison with the healthy ovary, and the period of the menstrual cycle should also be taken into account.

Laparoscopy

During laparoscopic diagnosis, it is almost always possible to detect some amount of blood in the pelvis. If apoplexy has occurred recently, then the blood will be of a uniform consistency without a large number of clots. The presence of clots indicates that ovarian tissue rupture and hemorrhage occurred the day or several days before laparoscopy. In the future, these clots can lead to adhesion of the abdominal organs. When examining the uterus, its size and color remain normal. Quite often one can detect chronic inflammation of the fallopian tubes, which is expressed in the presence of peritubular adhesions ( adhesions around the fallopian tubes).

When the corpus luteum ruptures, the ovary, as a rule, remains normal in size. Enlargement of the ovary is observed only when hemorrhage leads to a hematoma in the cavity of the ovary itself. If ovarian apoplexy is a consequence of rupture of a Graafian vesicle or corpus luteum cyst, then the affected ovary has a violet-purple color. Also, the presence of a cyst causes an increase in the size of the ovary.

Puncture of the posterior vaginal fornix

Conservative treatment of ovarian apoplexy

The main drugs in conservative treatment are coagulants ( hemostatic drugs), antispasmodics and vitamins. A ward ( semi-bed) mode. To stop bleeding, as a rule, apply cold to the lower abdomen.

Drug treatment includes:

• antispasmodics;
• hemostatic drugs;
• vitamins.

Antispasmodics

Antispasmodics have different forms of release. In each individual case, it is the attending physician who must select the necessary medication, dosage, and duration of use of this medication.

Antispasmodic drugs

Hemostatic drugs

Resorptive hemostatic drugs

Vitamins

B vitamins

Surgical treatment of ovarian apoplexy

Indications for surgery

Contraindications

Methods of surgery for apoplexy

Laparoscopic method
Laparoscopic surgery is a modern surgical method of operating on the abdominal organs using special equipment. The main instrument is a laparoscope with a video camera, which transmits the image to a special screen. This method has a number of advantages over abdominal surgery. It is minimally invasive and does not lead to the appearance of large scars. Within a few months after laparoscopic surgery, the sutures at the site where the incision was made become almost invisible. The postoperative period passes much faster, and the time spent in the hospital after surgery is significantly reduced. During the operation, 3 to 4 small holes less than 1.5 cm are made in the abdominal wall, through which the laparoscope and auxiliary instruments are inserted.

Laparoscopy for ovarian apoplexy is extremely gentle. In most cases, only suturing of the ovarian rupture site is performed. If apoplexy occurs during pregnancy, then in order to preserve it, no resection is performed ( excision), and suturing the corpus luteum. Cauterization of the bleeding area of ​​the tunica albuginea is performed using an electrosurgical coagulator. This occurs by delivering high-frequency current, which heats the surrounding tissue. As a result of heating, the protein that is in the tissues coagulates and the bleeding stops. If massive bleeding is observed, long-term coagulation is performed ( use of an electrosurgical coagulator).

Removal of the ovary is necessary only when apoplexy is observed together with another disease of the uterine appendages, such as when the pedicle of the fallopian tube is twisted. In any other cases, the site of ovarian rupture is sutured or part of the ovary is removed in order to preserve reproductive function and also not to disrupt hormonal levels. During laparoscopy, it is extremely important to examine both ovaries for the presence of bilateral apoplexy. It is also necessary to examine the fallopian tubes and appendix ( appendix), since apoplexy can occur in combination with an ectopic pregnancy or occur with acute appendicitis.

Endotracheal anesthesia is most often used for anesthesia. During the operation, the abdominal cavity is washed and blood clots and all blood are removed. Next, the abdominal cavity is sutured in layers. If laparoscopic surgery is not possible, laparotomy is used.

Laparotomy method
Laparotomy surgery is an operation on the abdominal organs in which a wide incision is made in the abdominal wall for access. This operation is performed if contraindications to laparoscopic surgery are identified. Laparotomy is indicated in the case of a hernia of the linea alba or if the laparoscopic method fails to stop the bleeding with an electrocoagulator. The dissection of the abdominal wall is made 8–10 cm long. The location of the incision is the suprapubic region.

For anesthesia, endotracheal anesthesia is usually used. During ovarian surgery, it is necessary to remove all accumulated blood in the abdominal cavity. At the end of the operation, the abdominal cavity is sutured in layers. In the days following surgery, it is imperative to carry out antibacterial therapy.

Recovery period after apoplexy

In dynamics, an ultrasound examination of the ovaries is performed for the presence of relapse of apoplexy. If various changes are detected in the results of blood and urine tests, they are corrected. In case of hormonal imbalance, the attending physician individually selects the necessary treatment regimen. Antibiotic therapy is prescribed in case of laparotomy surgery, as well as when indicated. During laparotomy, it is necessary to wear compression garments, as well as various abdominal bands for two months.

The gentle nature of laparoscopic surgery allows, in most cases, to preserve a woman’s reproductive function. Even if one ovary is removed, the chance of getting pregnant remains extremely high. However, with oophorectomy ( oophorectomy) the risk of ectopic pregnancy increases. Natural pregnancy is impossible only in case of inflammatory-dystrophic changes at the level of both uterine appendages or in the case of a tumor disease. It is worth noting that for 1 – 2 months after the operation it is necessary to exclude any sexual contact.

Restoration of working capacity occurs after 30–50 days. In the event of various gynecological complications, it is necessary to urgently call an ambulance or go to the hospital.

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

There are 3 forms of this disease. The basis for classification is the symptoms of ovarian apoplexy.

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

• temperature, nausea, hemorrhages 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 pronounced.

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

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

Ovarian apoplexy is a rather dangerous condition, accounting for 17% 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 reasons that contribute to the occurrence of ovarian rupture are:

• 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 use anticoagulants that lead to blood clotting disorders;
• hormonal disorders (sharp increase pituitary gonadotropins , which leads to increased blood filling ovarian tissue ).

Risk factors contributing to the onset of the disease include abdominal trauma, heavy lifting, horse riding, atypical sexual intercourse (interrupted, violent), incorrect position of the genital organs, vaginal examinations, pressure on the ovary of the tumor, adhesions and congestion in the pelvis, nervous breakdown . The disease can be prevented by the prevention of ovarian apoplexy, timely examination by a doctor and treatment of diseases of the pelvic organs.

Usually, one ovary ruptures, usually the right one, which is better supplied with blood, since the right ovarian artery connected to 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 localized in the lower abdomen, occurring in the middle of the cycle or after a slight delay in menstruation. The pain can radiate to the lumbar region, genitals, leg, rectum. An attack can last from half an hour to several hours, and repeat throughout the day. Bleeding into the peritoneum is accompanied by weakness, pallor, tachycardia, decreased blood pressure, increased body temperature, chills, frequent urination, and dry mouth. Sometimes this condition is accompanied by fainting, nausea and vomiting. When the side of the affected ovary is painful. Blood discharge from the genital tract and serous discharge from the mammary glands may also be disturbing.

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

The mixed form of ovarian apoplexy is similar to pain, 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, and overhanging vaginal vaults (with an anemic form of apoplexy) are revealed.

Most often, ovarian rupture occurs after violent sexual intercourse, intense physical activity, 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 according to a similar pattern with other acute pathologies in the 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 during ovarian apoplexy increases. First, ovarian rupture is differentiated from acute appendicitis, peritonitis, renal colic, ovarian cyst, acute.

The diagnosis is confirmed by the patient's complaints about symptoms of ovarian apoplexy such as acute pain in the lower abdomen that appeared in the second half of the menstrual cycle or in its middle. On examination, pale skin and... Palpation also reveals pain on the part of the ruptured ovary.

A blood test is prescribed, in which, in the anemic form of apoplexy, the level will be reduced hemoglobin . Using an ultrasound examination of the pelvic organs, you can see hemorrhage in the ovary and blood in stomach . A vaginal examination can reveal the gynecological nature of the disease. Ancillary research methods include puncture of the posterior vaginal vault, which allows one to determine the presence of abdominal bleeding. However, the final diagnosis of ovarian rupture is made during laparoscopy .

Treatment of ovarian apoplexy

Treatment for ovarian rupture is carried out in a 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 to 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 a rupture remains in the abdominal cavity, where it contributes to the formation of adhesions in the pelvis.

With conservative treatment, patients are prescribed bed rest, complete rest, antispasmodic therapy, vitamins ( , ascorbic acid , , ), strengthening of blood vessels, physiotherapeutic methods. Light candles with , apply ice to the lower abdomen, perform douching with the addition of iodine, Bernard currents, and diathermy. However, at the slightest sign of deterioration, surgery is prescribed.

Thus, conservative treatment of ovarian apoplexy is prescribed mainly to women who already have children, and women planning pregnancy undergo laparoscopy ( laparotomy ). Patients with blood diseases with blood clotting disorders are prescribed drug therapy.

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

A contraindication to surgery is hemorrhagic shock, accompanied by large blood loss and loss of consciousness.

The doctors

Medicines

Prevention of ovarian apoplexy

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

List of sources

• Ed. Kulakova V.I. Gynecology // National guidelines. - 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. Current issues in gynecology. -Minsk: Higher School, 2000.

Ovarian apoplexy, or ovarian rupture, is an acute condition that occurs as a result of a sudden disruption of the integrity of ovarian tissue, accompanied by intra-abdominal bleeding and pain. Ovarian apoplexy occurs in women of reproductive age, most often in the age group from 25 to 40 years. Ovarian apoplexy on the right side occurs several times more often than on the left, which is associated with a stronger blood supply to the right ovarian artery due to anatomical features.

Causes of ovarian apoplexy

The immediate cause of ovarian apoplexy is always disturbances in the vessels and tissues of the ovary, usually resulting from a chronic inflammatory process. Changed tissues of both the ovary itself and the vessels feeding it (sclerosis, scar changes, varicose veins) lead to an increased risk of rupture. On certain days of the menstrual cycle (middle and second phase of the cycle), the load on the vessels increases, which, in combination with pathological changes and provoking factors, causes ovarian apoplexy.

Factors that may serve as an additional cause of ovarian apoplexy are:

• Blood diseases in which blood clotting is impaired, as well as long-term use of anticoagulants;
• Hormonal disorders that contribute to increased blood supply to the ovarian tissue, including those caused by artificial stimulation of ovulation;
• Neuropsychic factors, stress.

All of the above prepares the ground for ovarian apoplexy to occur. When there is a combination of such factors with pathological changes in the blood vessels and the ovary itself, any physical effort that causes tension in the abdominal muscles can become the last straw, an external cause of ovarian apoplexy. Such an effort is often violent sexual intercourse (most often), playing sports, horse riding, etc. In some cases, ovarian apoplexy can occur spontaneously, during complete rest.

Types of ovarian apoplexy

Depending on the severity of certain symptoms, ovarian apoplexy is divided into the following forms:

• Painful (pseudoappendicular). The most striking symptom is severe pain accompanied by nausea, which is why this form of ovarian apoplexy is often mistaken for an attack of appendicitis;
• Hemorrhagic (anemic). The leading symptoms of ovarian apoplexy in this form are signs of internal bleeding: pallor, weakness, dizziness, even fainting;
• Mixed, combining the symptoms of ovarian apoplexy of both previous forms.

It should be taken into account that this division is quite arbitrary and superficial, since hemorrhage occurs not only with hemorrhagic, but also with the painful form of ovarian apoplexy. In this regard, a classification of ovarian apoplexy depending on the amount of blood loss is currently accepted. Thus, the following forms of ovarian apoplexy are distinguished:

• Light, the amount of blood loss does not exceed 150 ml;
• Moderate severity, blood loss from 150 to 500 ml;
• Severe, blood loss exceeds 500 ml.

The disadvantage of this classification is that usually the exact quantitative blood loss can only be determined directly during surgery.

The main symptom of ovarian apoplexy is acute, sudden pain in the lower abdomen on the affected side. The pain is intense and may be accompanied by nausea and even vomiting. In the painful form of ovarian apoplexy, the pain usually does not radiate, concentrating in the affected area. Signs of blood loss in this case are poorly expressed, which makes diagnosis very difficult.

For the hemorrhagic (anemic) form, intense pain is not typical, although pain syndrome may also be present, in a less pronounced form than with painful apoplexy of the ovary. However, in this case, the pain is radiating in nature, that is, it radiates to the lower back, sacrum, rectum and even the external genitalia. The main symptoms of ovarian apoplexy in this case are the symptoms of anemia: pale skin, bluish lips and nails, weakness, shortness of breath, dizziness and fainting.

With a mixed form of ovarian apoplexy, the symptoms characteristic of pain and anemic forms will be combined: severe pain from the affected ovary against the background of anemia.

Diagnosis of ovarian apoplexy

As already mentioned, diagnosing ovarian apoplexy presents significant difficulties due to the nonspecificity of symptoms. The patient presents with complaints characteristic of an acute abdomen in general, or sudden onset of anemia. Sometimes an ultrasound can be informative; also, if ovarian apoplexy is suspected, a puncture of the posterior vaginal vault is performed; a diagnostic sign is the presence of free blood in this area. The most reliable and error-free diagnostic method in this case remains only laparoscopy - endoscopic examination of the abdominal cavity. Laparoscopy in case of ovarian apoplexy is both a diagnostic and therapeutic method.

Treatment of ovarian apoplexy

Treatment for ovarian apoplexy must be urgent as it is a life-threatening condition. If blood loss is not stopped and reaches significant proportions, the consequence of ovarian apoplexy can even be fatal. In addition, peritonitis, which develops as a result of exposure to blood on the peritoneum, can also be a consequence of ovarian apoplexy, which is also life-threatening.

Previously it was believed that treatment of ovarian apoplexy could be either conservative or surgical. The indication for conservative treatment of ovarian apoplexy was considered to be a painful form with minor blood loss. However, as a result of many years of practical observations, it was found that conservative treatment of ovarian apoplexy, even in the case of minor bleeding, has unfavorable long-term consequences. Blood poured into the abdominal space, even in small quantities, is an active medium that causes aseptic (microbial-free) inflammation. At the site of inflammation, adhesions form, disrupting the normal structure of both the ovary itself and the surrounding structures. The consequence of ovarian apoplexy in this case is very often infertility.

Thus, the most adequate method of treating ovarian apoplexy is surgery, which in most cases (except for the most severe forms of the disease) is performed laparoscopically. The therapeutic tactics in this case consist of removing the spilled blood from the abdominal cavity and washing it with antiseptic solutions, and, if necessary, suturing the damaged vessel. In the postoperative period, complex drug treatment of ovarian apoplexy is carried out, aimed at eliminating the causes of the pathology: normalization of metabolic and hormonal processes, elimination of chronic inflammation, etc.

Video from YouTube on the topic of the article:

Apoplexy of the right ovary is a sudden hemorrhage followed by rupture of organ tissue. Occurs spontaneously and is observed more often in the second half of the cycle during or after ovulation. This pathology affects women of reproductive age, usually up to 40 years. At older ages, apoplexy occurs much less frequently.

Violation of the integrity of one of the ovaries (apoplexy)

In the middle of the cycle, when the egg matures and then leaves the dominant follicle, ovulation occurs. At the site of the burst follicle, a progesterone-producing follicle appears. In the presence of various pathologies, hemorrhage may occur in the primordial follicle, or corpus luteum cyst, this is right-sided apoplexy.

The appearance of apoplexy during or after ovulation is explained by the fact that during this period the vessels become fragile under the influence of hormones and are easily damaged. At the site of the hemorrhage in the ovary, a hematoma appears, which quickly fills with blood. The shell of this hematoma quickly collapses under pressure, blood pours into the abdominal cavity, and internal bleeding appears. This condition poses a great danger not only to a woman’s health, but even to a woman’s life, and therefore requires emergency care.

Apoplexy in the right ovary is observed much more often than in the left. This is due to the fact that large arteries are located on the right side, and in general the vascular network is more extensive, as it is connected to the aorta. the ovary is connected to the renal artery, which is smaller in size.

Doctors identify many reasons why the right ovary may rupture. It is not always possible to accurately determine what exactly played a role in the development of the pathological condition. Next, we consider the most basic causes of apoplexy of the right ovary:

Sometimes right-sided apoplexy can occur in a healthy woman in the absence of any pathologies. Such cases make diagnosis difficult.

Symptoms

With apoplexy of the right ovary, symptoms are characterized by two main signs: pain and bleeding (both external and internal). The painful form can be moderate or intense, localized in the right lower abdomen.

Bleeding may resemble menstruation; with internal bleeding, the following symptoms are observed:

• pale skin;
• chills, tremors of extremities;
• increased body temperature;
• drop in blood pressure;
• cardiopalmus;
• dizziness;
• cold sweat;
• general weakness.

With right-sided apoplexy, pain appears suddenly, usually in the second half of the cycle during or after ovulation. Often pain is felt not only in the ovary area, but also in the iliac region (right under the diaphragm), and can radiate to the buttocks, lower back, and sometimes to the leg. If the pain is intense, nausea or vomiting may be present.

If there is severe internal bleeding, there is a high risk of hemorrhagic shock.

Diagnostics

If one or more of these symptoms of this pathology are detected, as well as a sharp deterioration in health, urgent hospitalization is necessary.

Diagnostic errors arise due to the fact that right-sided apoplexy (ovarian rupture) has similar symptoms to many other diseases. These include:

• acute appendicitis (since the appendix is ​​on the right);
• interrupted tubal pregnancy (rupture of the fallopian tube);
• intestinal obstruction;
• acute gastrointestinal diseases;
• renal colic, etc.

To avoid the negative consequences of erroneous diagnosis, it must be carried out carefully and comprehensively and include the following measures:

1. Collecting symptoms, studying the patient’s medical history. At this stage, the gynecologist studies the medical history; the presence of chronic diseases is determined, which are compared with the symptoms.
2. Examination in a gynecological chair. Usually at this stage the woman experiences pain in the area where the ovarian rupture occurred, so the examination should be carried out very carefully.
3. Complete blood count to determine the degree of anemia (blood loss).
4. Blood test for hCG (to exclude interrupted ectopic tubal pregnancy).
5. Ultrasound is necessary for a more accurate picture, since right-sided apoplexy is easily confused with other pathologies. The presence of blood in the abdominal cavity is visible on the monitor as a cluster of echo structures.
6. , which is both a diagnostic and operational measure. This procedure allows you to determine the very fact of the presence of apoplexy, as well as adhesions or cysts. Also, with the help of laparoscopy, the area and nature of damage to the ovary and the presence of blood clots are clearly visible. The laparoscopic method is modern and safe, but has a number of contraindications. Thus, it cannot be used for internal bleeding to avoid the development of hemorrhagic shock, as well as for extensive adhesions. In this case, standard surgical methods are used.

Treatment

Emergency care for right-sided ovarian apoplexy can be provided by an ambulance paramedic before arriving at a medical facility. Self-administration of any medications is strictly prohibited, as this is fraught with false improvement and erroneous diagnosis.

In the case of ordinary apoplexy or if an ovarian rupture occurs, hospitalization is mandatory.

Depending on the severity of the pathological process, treatment can be conservative, surgical, or a combination of both methods.

Conservative treatment includes bed rest, antispasmodics and muscle relaxants, as well as hemostatic drugs and anti-anemia drugs (high iron). Sometimes a cold heating pad is used on the right side of the abdomen.

Drug treatment is used in cases of mild forms of the disease, but is quite risky. Without surgical intervention, there is a high risk of relapse of the disease, the development of extensive adhesions (adhesions are formed from blood clots that have not been removed) and, as a result, infertility.

Therefore, in order to avoid these complications, it is recommended to restore the outer membranes of the damaged ovary and remove blood from the abdominal cavity. The tissue where the ovary ruptured is sutured (in the case of a cyst, its contents are removed) and then cauterized (coagulation method).

Usually, after the operation, the patient is in the hospital under the supervision of doctors for 5-7 days, then she is sent home. Further recovery at home includes physical rest, taking painkillers and other medications prescribed by the attending physician.

Consequences and prevention

Surgical treatment of right-sided apoplexy is carried out using gentle methods that maximize the integrity of the ovary and its reproductive functions. Even with a rupture, permanent infertility does not always occur. Reproductive functions are lost only in particularly severe cases, when pathology is observed on both sides, or is combined with other diseases incompatible with pregnancy.

After about a month, a woman can return to normal life and even moderate physical activity. However, regular visits to the doctor are necessary to monitor possible complications from the operation.

The consequences of right-sided apoplexy boil down mainly to the development of adhesions, as well as chronic pelvic pain that is felt during ovulation. Doctors also do not exclude the possibility of relapse. To avoid this consequence, it is necessary to follow all the doctor’s recommendations, treat other gynecological diseases in a timely manner, exclude intense sports, and also undergo regular diagnostics.

Ovarian apoplexy is a sudden hemorrhage caused by a rupture, for example, of a cyst located there. In addition, a bursting Graafian vesicle - a follicle containing an egg, or a rupture of the connective tissue of an organ - the stroma, can also lead to apoplexy. Any internal bleeding is dangerous for the body and ovarian apoplexy is no exception.

Causes of the disease

Ovarian apoplexy is most often observed in teenage girls and women of childbearing age (14–45 years). This age range can be explained by the constant active maturation in the woman’s body of the follicles that contain the egg. Most often, the disease affects patients aged 20 to 35 years. In very rare cases, such hemorrhages occur in girls who have not yet reached puberty. The disease has a complex development mechanism and, unfortunately, is characterized by frequent relapses.

As is known, the female reproductive system works cyclically: first, an egg matures in the Graafian vesicle of the ovary, then the follicle ruptures, and the mature cell is sent to a possible meeting with a sperm. If such a “date” does not happen, she dies over a certain time, and menstruation occurs, renewing the uterine mucosa, which never received the fertilized egg. In this monthly repeating process, there are certain periods of increased risk of ovarian damage - these are the middle and second half of the menstrual cycle. It is during this period that the vessels feeding the uterine appendages become most permeable and are filled with blood.

Hemorrhage in the right ovary occurs several times more often than in the left, but there is no mystery here - simply in the right appendage, blood circulation occurs more intensely due to the fact that the artery feeding it branches directly from the aorta, and the bloodstream of the left appendage originates from the renal artery.

Ovarian apoplexy can occur due to the following reasons:

• acute and especially chronic inflammation of the internal organs of the female genital area;
• abnormal position of the uterus, usually congenital;
• the presence of tumors putting pressure on the ovary;
• due to postoperative adhesions in the pelvis;
• varicose veins of the ovary;
• bleeding disorders (thrombocytopenia) due to taking anticoagulant drugs or a number of diseases.

The following can cause hemorrhage:

• mechanical damage to the pelvic organs, for example, trauma;
• physical strain, too intense or rough sex;
• inept douching, rough examination by a gynecologist;
• horseback riding.

Forms and signs of ovarian apoplexy

Gynecologists use several classification options for ovarian apoplexy, the most popular among which is the division of the disease into two forms - painful (without intra-abdominal bleeding) and hemorrhagic (with intra-abdominal bleeding). The hemorrhagic form, in turn, is divided into three degrees, depending on the amount of internal blood loss. In the painful form, hemorrhage also occurs, but it is limited to blood entering the ovarian tissue - the corpus luteum or follicle; blood does not enter the abdominal cavity.

Symptoms

Both forms of ovarian apoplexy have similar symptoms. The main symptom can be considered a sharp, unexpected pain in the lower abdomen. Then the feeling of pain is accompanied by nausea and weakness, which are a consequence of blood loss.

The main symptom of ovarian apoplexy is sharp, sudden pain.

In the hemorrhagic form of the disease, if blood loss increases, these symptoms may be accompanied by signs indicating intra-abdominal bleeding:

• vomit;
• loss of consciousness;
• pallor of the mucous membranes and skin;
• sticky sweat;
• cardiopalmus;
• decrease in blood pressure.

Upon examination, the doctor detects tension in the anterior abdominal wall and bloating. Touching the abdomen is extremely painful for the patient.

Basic diagnostic methods

Ovarian apoplexy is an insidious disease that can masquerade as an ectopic pregnancy, which in many cases leads to incorrect diagnosis. Sometimes it happens that an accurate diagnosis of an illness occurs only on the operating table, during emergency care.

In order to differentiate ovarian apoplexy and ectopic pregnancy, the following differences must be taken into account:

In addition, with ovarian apoplexy, extreme pain is noted during vaginal two-handed examination.

To clarify the diagnosis, the following are usually used:

• a blood test showing a decrease in hemoglobin levels;
• an ultrasound examination to detect fluid accumulation;
• abdominal puncture, which is performed through the vagina.

It should be noted that if the patient has signs of abdominal bleeding, she will in any case need emergency surgery, regardless of what caused the bleeding. Here differential diagnosis is not of great importance.

Apoplexy of the right ovary can simulate an attack of appendicitis, however, with apoplexy, pain irradiates to the anus and right leg, while with appendicitis, pain is concentrated in the midline of the abdomen above the navel. For differential diagnosis, it is important to take into account the fact that with appendicitis, examinations through the rectum are especially painful for the patient, and with apoplexy, severe pain is caused by the impact on the uterus.

Ovarian apoplexy should also be differentiated from the following diseases:

• adnexitis (inflammation of the uterine appendage);
• torsion of the pedicle of an ovarian cyst;
• intestinal obstruction;
• perforated stomach ulcer;
• an attack of pancreatitis and colic - hepatic and renal.

How is ovarian apoplexy treated?

The treatment method will be chosen by the doctor depending on the form of the disease and the patient’s condition.

Operation

If a large amount of blood (more than 150 ml) leaks into the abdominal cavity, emergency surgery is performed.

Surgical intervention can be carried out either in a traditional way - using a scalpel incision in the suprapubic or inframedian area, or in a more gentle way - laparoscopic, using special surgical instruments inserted into the abdominal cavity through small punctures. Both methods allow you to carry out the required amount of surgical intervention - coagulate the rupture site, remove or puncture the cyst, remove blood that has entered the abdominal cavity, and even remove the damaged ovary, if necessary. The choice of surgical procedure depends on a number of factors - the presence of adhesions, the intensity of bleeding, and the severity of the patient's condition.

Carrying out surgery using the laparoscopic method

In what cases is conservative treatment prescribed?

In the absence of bleeding (painful form of apoplexy), or in case of minor bleeding, it is possible to use conservative treatment, which consists of the following:

• a heating pad with ice on the lower abdomen;
• hemostatic drugs (Vikasol, Etamzilat, etc.);
• antispasmodics (No-shpa);
• vitamins B1, B6, B12;
• electrophoresis with calcium chloride or microwave physiotherapy.

Conservative therapy is possible only in a hospital setting and under the supervision of a doctor.. If the patient's condition worsens, indications for surgery may arise.

Conservative therapy has a number of significant disadvantages, which determine the use of this type of treatment in relation to women who no longer plan to have children in the future, since such therapy often provokes infertility. After it, as a rule, adhesions form due to the impossibility of removing residual blood, and a high risk of relapse of the disease remains. If the patient is planning a pregnancy, she will most likely be offered surgery.

Folk remedies

Traditional medicine also has remedies for treating ovarian apoplexy. However, it should be emphasized here that such self-medication is possible only with a mild painful form of the disease and with an accurately established diagnosis. When resorting to popular recommendations, a woman should be aware of the high risk of such self-medication. Here are a few recipes:

1. Wrap flax seed (20 g) in several layers of gauze and put it in boiling water to steam it. Then squeeze out the bundle with the seed and apply it to the ovarian area overnight.
2. Prepare a decoction of burdock root (10 g), pour a glass of boiling water over it and leave for 12 hours. You need to take the decoction three times a day, half an hour before meals.
3. In a similar way, you can steam colza (10 g) with a glass of boiling water, infuse it and take it in the same way.
4. You can try taking one tablespoon of freshly squeezed aloe juice half an hour before meals with a small amount of water.

How to behave after treatment

The main thing a woman needs to achieve is the restoration of reproductive function, and this requires measures to prevent the formation of adhesions and establish hormonal metabolism. Most likely, the patient will be offered a course of anti-inflammatory therapy, and to optimize hormonal balance and suppress the ovulation process, combined low-dose (Regulon, Femoden) or microdose contraceptives (Mersilon, Novinet) are usually prescribed, which must be taken for at least six months. The decision on the duration of their use is made by the attending physician on an individual basis.

For the most effective rehabilitation of the patient, physiotherapeutic methods can also be used - ultrasound, laser therapy, ultratonotherapy, electrophoresis.

Menstruation can be restored within a month or a month and a half after the operation, but pregnancy can be planned only after completion of rehabilitation measures, completion of hormonal medications, a detailed examination and consultation with a gynecologist. As for the resumption of sexual activity, a doctor’s consultation is also necessary here, since this depends on the severity of the cured illness, the form of treatment and the objective condition of the woman.

Prevention

Unfortunately, patients who have suffered ovarian apoplexy often experience relapses of the disease. You should pay close attention to your health and take medications that your doctor will prescribe depending on the cause of the disease (for example, hormonal drugs, nootropics, tranquilizers, etc.), and also avoid excessively intense physical activity and heavy lifting.

Regular visits to the gynecologist are an effective method of preventing diseases of the pelvic organs

You must remember to visit a gynecologist twice a year, and also promptly treat infectious and inflammatory diseases of the pelvic organs.

Ovarian apoplexy is a serious disease that has a high risk of dangerous complications and can lead to tragic health consequences. The disease must be accurately diagnosed and treated only within the walls of a medical institution. Self-diagnosis and self-medication in this case are highly undesirable.