Apoplexy of the ovary is a gynecological emergency, which is accompanied by a violation of the integrity of the sex gland tissues. Let's consider the pathology in more detail, identify the causes, types and signs of ovarian apoplexy, methods and methods of treatment.
Ovarian apoplexy - causes
Ovary rupture, the causes of which are different, occurs in about 1-3% of women with gynecological pathology. Most violations affect girls 20-35 years. This is due to the fact that apoplexy of the ovary is often provoked by physiological, cyclic changes, which are accompanied by an increase in blood supply to the genital organs of the small pelvis. Apoplexy of the left ovary is less common, due to less blood supply.
So, in 90% of women with this pathology, the disorder is in the middle of the cycle or the second half. Immediately at this time there is an increase in the permeability of blood vessels, filling them with blood in a larger volume. As a result, pressure on the ovarian tissue increases, which can not withstand the load, are destroyed. In addition, there are predisposing factors:
- neuroendocrine disorders;
- inflammatory diseases of the reproductive system, accompanied by sclerotic changes in the ovaries;
- stagnation in the pelvis;
- varicose veins ;
- excess physical activity in the middle of the cycle;
- anomalies of the location of the genital organs;
- tumors in the small pelvis;
- disruption of the blood coagulation system;
- vaginal examinations;
- abdominal trauma;
- violent sexual intercourse.
Ovarian apoplexy - forms
Having considered the causes of ovarian rupture in women, we note that the disease has several varieties. So, depending on the clinical manifestations, the following forms of such pathology as the rupture of the ovary are distinguished:
- painful - accompanied by pain syndrome, nausea and vomiting, fever;
- anemic - reminiscent of manifestations of a tube rupture that occurs with ectopic pregnancy, the main symptom is bleeding.
In addition, there is a classification of ovarian apoplexy in terms of blood loss. It is directly used in the compilation of the algorithm of medical care. Doctors singled out:
- mild degree - the volume of blood released from the genital organs does not exceed 100-150 ml;
- average - blood loss within the limits of 150-500 ml;
- heavy - the volume of lost blood exceeds 0.5 liters.
Apoplexy of the ovary - painful form
Apoplexy of the right ovary, painful form, is characterized by a strong, piercing pain, which is accompanied by nausea. The picture of an acute abdomen - the tension of the muscles of the abdominal press, the reduction of arterial pressure, the pallor of the skin, dagger pain, causes a diagnosis error. Often, surgeons are mistaken for appendicitis. The absence of external bleeding does not allow a woman to independently identify the disorder and seek medical attention.
Hemorrhagic form of ovarian apoplexy
Because of the peculiarities of the blood supply, a dense blood network, apoplexy of the right ovary is more common. Hemorrhagic (anemic) form is accompanied by severe bleeding from the genitals. Often it is internal - the blood is poured into the abdominal cavity. The characteristic symptomatology develops:
- weakness;
- pallor of the skin;
- dizziness;
- fainting condition;
- a sharp drop in blood pressure;
- increased heart rate;
- dry mouth of the mucous membranes;
- vomiting;
- increased frequency of micturition;
- frequent urge to defecate.
Apoplexy of the ovary - symptoms
When the ovarian rupture develops, the symptoms are so pronounced that it is difficult to miss the onset of the pathological process. Women notice a sudden, sharp pain in the lower abdomen. It is the result of irritation of the receptors of the ovarian tissue, the effect of blood on the peritoneum. This leads to spasm of the muscular structures of the lower abdomen. The pain has a clear localization, arises from the side of the damaged gland. Women note:
- severe weakness;
- dizziness;
- vomiting;
- nausea;
- loss of consciousness.
With painful form of pathology, hemorrhage to the abdominal cavity is absent. Blood is excreted in the tissues of the follicle, the yellow body. In this case, the clinical picture of mild hemorrhagic and painful forms is similar. When examining a woman in a gynecological chair, the uterus has normal dimensions, the ovary is not greatly enlarged and painful. Vagina vaults deepen, become free.
Ovarian apoplexy - diagnosis
With the help of ultrasound of the pelvic organs, it is impossible to visualize such changes. The doctor discovers only a clump of blood in the anterior space. Directly and this is the apoplexy of the ovary on ultrasound. For differential diagnosis, an examination of the woman in the chair is required. In addition, to determine the violation use:
- establishment of hemoglobin;
- puncture of the posterior vaginal vault;
- laparoscopy.
Typical signs of the violation are acute, intolerable pain in the middle or in the second half of the menstrual cycle. Monthly after apoplexy of the ovary can be displaced or absent. Immediately the pains often become indications for a comprehensive examination of the reproductive system. Early diagnosis and promptly given emergency help exclude the risk of complications, shorten the duration of the recovery period.
Ovarian apoplexy - treatment
With such a pathology as an ovarian rupture, treatment involves the provision of emergency medical care. Severe hemorrhage can lead to death. Conservative therapy is performed exclusively in mild cases, when signs of internal bleeding are absent. With the increase of symptoms, the increase in the volume of lost blood, surgical intervention is required. The algorithm of medical actions is directly related to manifestations, the severity of symptoms, the vastness of the defeat of uterine tissues.
Ovarian rupture - treatment without surgery
Conservative treatment of ovarian apoplexy is possible with an insignificant degree of lesion of the gland. This method of therapy is used if the volume of the patient's lost blood does not exceed 150 ml. In doing so, they use:
- ice on the bottom of the abdomen;
- hemostatic preparations (Etamsilate);
- antispasmodics - Papaverina hydrochloride, But-Shpa;
- vitamins - thiamine, pyridoxia, cyanocobalamin.
In the recovery phase, after the elimination of the acute period, physiotherapy is prescribed for a speedy recovery:
- electrophoresis with calcium chloride;
- Microwave therapy;
- currents of Bernard ;
- diathermy.
Conservative treatment is carried out exclusively in the hospital, under the constant supervision of physicians. With the development of a repeated attack of pain, deterioration of the condition, instability of hemodynamic parameters, an increase in the volume of blood accumulated in the cavity of the peritoneum, ovarian apoplexy requires surgical intervention. It is carried out by laparoscopy, which accelerates the recovery period.
Apoplexy of the ovary - operation
This method of therapy is the main method for apoplexy. During the operation, doctors examine the area of the lesion, extract blood from the abdominal cavity, and cover the ovary. With extensive lesion of the gland, the question arises of how to remove it. When the rupture of the ovary develops, the operation is mandatory under the following conditions:
- In the abdominal cavity more than 150 ml of blood accumulated, which is subject to ultrasound;
- conducted conservative therapy did not bring the expected result within 2-3 days;
- There is a need for differential diagnosis of acute gynecological and surgical pathology.
Ovarian rupture - consequences
After apoplexy of the ovary, with untimely medical care, the following complications are possible:
- hemorrhagic shock ;
- adhesive process in the small pelvis;
- repeated rupture of the gland;
- secondary infertility;
- death.
Can I get pregnant after my ovarian apoplexy?
Pregnancy after apoplexy of the ovary is possible. If the iron has not been removed during therapy, the woman has a chance to become a mother. However, conception is possible with 1 working gland. A great concern of doctors when planning pregnancy are caused by spikes in the small pelvis. These formations prevent normal ovulatory processes. To normalize them, many patients are forced to use hormonal drugs, anti-inflammatory drugs. Pregnancy becomes impossible when both glands are removed during surgical treatment.