Ovarian apoplexy
In the small pelvis of a woman, paired organs — ovaries – are located on one and the other sides of the uterus. Ovarian dimensions: length about 3 centimeters, thickness — 1 cm, width — about 2 cm. The menstrual cycle causes these organs to change their size, so they are not permanent. Being the female sex gland, the ovaries produce female sex hormones — progesterone and estrogen. The most important part of the work of the ovaries is that once a month the egg that is formed, capable of giving new life, with the help of their ligaments has the opportunity to join the uterus.
The content of the article:
Incidence rate
Forms of ovarian apoplexy and their classification
Causes of ovarian apoplexy
Symptoms of ovarian apoplexy
Prevention of disease
Complications
Treatment for ovarian apoplexy
Forecasts
Prevention
Ovarian apoplexy
As a result of an acute gynecological disease, entailing the rupture of numerous vessels (vessels of the ovary and the resulting cyst), hemorrhage suddenly occurs in the tissues of the ovary or in the abdominal cavity. This disease is called ovarian apoplexy.
Incidence rate
At the age of 18-45, women’s bodies and ovaries work in a very active way. Therefore, the incidence of ovarian apoplexy falls precisely on the childbearing period. But women of other ages also fall into the statistics of this diagnosis. Ovarian apoplexy occupies 2% of the total number among other common gynecological diseases. It is worth noting that if a woman has suffered such a disease once, the risk of recurrence increases to 70%. Apoplexy of the right ovary occurs 3 times more often than the left one. This is a consequence of the fact that the largest number of blood vessels are located in the right ovary. In addition, the artery of the left ovary comes from the renal artery, and the right one comes directly from the aorta.
Forms of ovarian apoplexy and their classification
Specialists distinguish three main types of ovarian apoplexy:
painful view;
anemic appearance;
mixed type of ovarian apoplexy;
The classification of the disease is considered among themselves according to the pronounced pattern of blood loss.
Causes of ovarian apoplexy
Several factors can cause this disease: chronic inflammatory process (due to disorders in the tissue or vessels) — sclerosis of the stroma, fibrosis of the epithelial element, perioophoritis, hyalinosis, varicose veins of a woman, scar pathology of the organ, ovarian sclerosis.
The time of the onset of the disease has a great influence — it usually falls in the middle or second half of the phase of the menstrual cycle. Since it is during this period — the period of ovulation and immediately before the menstrual cycle, the ovaries are abundantly filled with blood. Possible rupture of ovarian tissues occurs at this time due to increased load on the vessels of the ovary.
There are provoking factors that directly affect the occurrence of ovarian apoplexy.
blood clotting is severely impaired;
long period of taking anticoagulants;
hormonal failures;
neuropsychiatric disorders and long-term stressful situations.
The factors listed above can provoke ovarian apoplexy. But it is also necessary to take into account the loads that directly affect the possibility of rupture of ovarian vessels: violent sexual intercourse, intensive physical training, general physical activity (lifting weights), horse riding, douching, abdominal injuries, etc. Ovarian apoplexy in some patients occurs during sleep, at rest and for no apparent reason.
Symptoms of ovarian apoplexy
The painful type of apoplexy is observed in those patients in whom hemorrhages in the tissues of the follicle or directly of the corpus luteum occur without hemorrhage into the abdominal cavity. The mild degree of hemorrhagic and painful types are similar to each other. Without an excessive irradiation pattern, the disease begins with a small attack of pain in the lower abdomen. The painful appearance can sometimes be accompanied by vomiting and nausea, but there are no signs of intra-abdominal hemorrhage.
Upon examination, the usual color of the mucous membranes and skin is revealed. The norm is also observed when measuring blood pressure and pulse rate. Clean and moist tongue on examination. When observed, slight rigidity is allowed in the muscles of the lower part of the anterior abdominal wall, the abdomen is soft. The peritoneal symptom does not manifest itself, only a slight discomfort in the iliac right region is possible. The presence of percussion-free fluid in the abdominal cavity is not detected. Gynecological examination shows a normal-sized uterus, a slightly enlarged ovary, painful. The arches of the patient’s vagina are also free and deep.
With ultrasound of the pelvic organs, ovarian apoplexy is very rarely visualized, a small volume fluid located in the Douglas space is more often detected, a fine—dispersed mixture – follicular fluid with blood impurities. The clinical blood test for a small leukocytosis has no shifts to the left, there are no pronounced changes.
Symptoms of intra-abdominal bleeding are observed with hemorrhagic ovarian apoplexy of moderate to severe severity. Caused by external influences, such as active sexual intercourse, trauma, strong tension, the disease begins to pass very acutely. Irradiation takes place in the anus, leg, sacrum, external genitalia, and the pain is often localized in the lower abdomen. As a rule, the accompaniment of the disease is weakness, dizziness, nausea, vomiting, fainting. The volume of intra-abdominal loss expresses this symptom.
The patient’s skin is pale, the mucous membranes are also visible. There is a sticky cold sweat. Tachycardia and a decrease in blood pressure are observed in the study of the cardiovascular system. Dry tongue, tense stomach, it is accompanied by a slight swelling. Palpation reveals a sharp pain in the entire hypogastrium or in a certain iliac region. Peritoneal symptom in the lower parts. It is possible to definitely identify free fluid in the sloping place of the abdomen (right and left lateral canal).
Gynecological examination shows the vaginal mucosa, colored in normal or pale color. The anterior abdominal wall makes it difficult to examine with a two-handed examination. The uterus is painful, of normal size, on the apoplexy side an ovary is revealed, enlarged in size, also painful. Anemia is observed in clinical blood tests. In the initial phases of the disease, the patient’s blood thickens and, as a result, the level of hemoglobin increases. White blood cells increase slightly, but the indicator does not shift to the left.
Hemorrhagic type of ovarian apoplexy is diagnosed by ultrasound. It shows the presence of a significant amount of free fluid located directly in the abdominal cavity with a pathological shape structure and blood clots.
Prevention of disease
Actions taken to prevent the disease:
It is necessary that the attending specialist prescribe oral contraceptives that can normalize the function of a woman’s ovaries;
A mandatory requirement will be the avoidance of factors that can provoke a relapse: overwork, lifting weights, intensely initiated physical exertion;
When using drugs that slow down blood clotting time, strict control over the coagulogram index, INR, is necessary.
Complications
occurrence of hemorrhagic shock;
peritonitis;
developing adhesive disease;
disorders of fertility function;
fatal outcomes.
Treatment for ovarian apoplexy
Treatment is prescribed only after the doctor diagnoses the form of the patient’s disease, the severity of intra-abdominal hemorrhage. Conservative treatment is prescribed and carried out with a painful form of apoplexy, when the bleeding is small and without increasing signs — up to 150 ml. Such treatment should include the patient’s resting state, ice should be placed on the lower abdomen (it will cause vascular spasm), ethamzylate (a hemostatic drug), antispasmodics (papaverine, no-shpa), vitamins (thiamine, pyridoxine), physiotherapy procedures (electrophoresis in combination with calcium chloride), microwave therapy.
Mandatory round-the-clock monitoring of the patient with hospital stay is required. If suddenly there is a repeated deterioration of the condition — an attack of pain, deterioration of the general condition, instability of hemodynamics, an increase in the amount of blood during ultrasound and clinically in the abdominal cavity — surgical intervention (laparoscopy, laparotomy) is prescribed.
Laparoscopy and indications for it:
stable hemodynamic parameters, the patient’s condition is satisfactory, but physical examination and ultrasound confirm the presence of more than 150 ml of blood in the abdominal cavity;
a sign of intra-abdominal hemorrhage has been established, which is confirmed by ultrasound, as a result, conservative therapy is established, the duration of which is more than 3 days;
acute gynecological and acute surgical pathology, diagnosed differentially.
The most sparing surgical intervention is prescribed for ovarian apoplexy:
the place of rupture is coagulation;
aquapurator-suction removes the contents, opens and takes a puncture of the cyst;
ovarian resection.
If the ovary is very badly damaged and there is no way to save it, a decision is made to remove it.
Laparotomy and indications for it:
severe condition of the patient (hemorrhagic shock) with signs of intra-abdominal hemorrhage;
laparoscopy due to adhesive processes, increased bleeding with damaged ovarian vessels is impossible.
Surgical intervention in this case is carried out with a low-median access or suprapubic incision according to Pfannenstiel. Laparoscopic and laparotomic interventions are the same in volume. Reinfusion of blood, which was poured out in the abdominal cavity, during laparotomy is provided.
Forecasts
After suffering a painful type of ovarian apoplexy, fairly good and favorable prognoses were revealed. In patients with a hemorrhagic type of disease, the life prognosis will depend on the rapid diagnosis and the time of the appointment of treatment. Fatal outcome from ovarian rupture occurs with decompensated irreversible hemorrhagic shock. It occurs with abundant blood loss (more than 50% of the BCC).
Various measures for the prevention of ovarian apoplexy contribute to reducing the frequency of relapses of this pathology.
Prevention
With the painful form of apoplexy, when the central nervous system, hormonal profile, blood circulation in the ovary are disturbed, their functions can be returned to normal. Therefore, no preventive measures are required. Patients with hemorrhagic ovarian apoplexy suffer persistent changes in ovarian blood flow disorders, hormone status, and dysfunction of the higher parts of the central nervous system. They are shown such drug therapy that can break the pathogenetic circle. For three months, therapy is carried out that can correct the activity of the brain structure. It is enough for them to prescribe nootropics that improve the exchange process in the central nervous system, as well as some drugs that help improve cerebral perfusion — cavinton, tanakan, vinpocetine, tranquilizers. And also in patients with intracranial hypertension — diuretic drugs. To suppress ovulation and adjust the hormonal profile for 4 months, a combined estrogen-gestagenic monophasic oral contraceptive (marvelon, janine, silest, etc.) should be used.
