How ovarian apoplexy can be dangerous for a woman's health. Bleeding with cystic formations

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Dysfunction of the ovaries or adrenal cortex leads to various disorders in the structure of the ovarian tissue - this causes cysts, the absence of ovulation. In most cases, deterioration in health occurs gradually.

A small percentage of women may develop ovarian apoplexy, which requires emergency hospitalization. Such a situation cannot be predicted in advance, so it takes you by surprise.

Ovarian apoplexy is a rupture of the ovarian tissue as a result of hemorrhages from various kinds of cysts or a mature dominant follicle ready for ovulation.

Why is ovarian apoplexy dangerous?

Apoplexy has several forms, each of which is characterized by a different degree of pain. Rupture of the ovary is accompanied by hemorrhage into the abdominal cavity. Mild types of hemorrhage can be treated with medication and are not life-threatening.

More severe forms require emergency medical care in the form of surgical intervention. If the patient is not operated on in time, then there is a high risk of death.

There are cases when apoplexy occurs simultaneously with development. Both of these conditions are dangerous to life and health.

Causes of ovarian apoplexy

Rupture of ovarian tissue is spontaneous, but there are factors that contribute to this:

Follicular cysts
Cysts of the corpus luteum
Stimulation of superovulation with medications
Excessive exercise during ovulation
Inflammation of the ovary
Dysfunction of the veins adjacent to the pelvic organs

Most often, a rupture of the ovarian tissue occurs during the period of ovulation, due to heavy loads or due to a follicular cyst. According to the observations of specialists, in most cases, apoplexy of the right ovary occurs, since it is best supplied with blood.

Signs and symptoms of ovarian apoplexy

Rupture of the ovarian tissue never goes unnoticed, however, mild forms of this condition can be confused with pain during ovulation. To understand that it was a hemorrhage that occurred, it is necessary to pay attention to the presence of the following symptoms characteristic of ovarian rupture in women:

Cutting pains in the lower abdomen. During ovulation, pain, as a rule, is expressed in the form of lumbago.
Sudden drop in pressure
Paleness of the skin
Fainting
Intoxication of the body: nausea, vomiting, diarrhea
Frequent urge to empty the bladder
Pain is long lasting

The doctor during hospitalization conducts an ultrasound examination, which reveals the characteristic signs of apoplexy:

Slightly enlarged uterine body
Accumulation of fluid in the retrouterine space
Dense consistency of uterine tissue

Ultrasound will show only indirect signs of ovarian rupture. The results of the study should be evaluated taking into account the bimanual gynecological examination of the patient on the chair, during which the following will be noted:

On palpation of the cervix and its displacement to the right or left, there is a sharp pain.
The posterior fornix of the vagina is enlarged (typical of severe hemorrhage)
The size of the ovary is greatly enlarged
Ovarian mobility is limited
Slight bleeding from the genital tract

As additional diagnostic measures, a puncture of the posterior fornix of the vagina and a complete blood count are performed.

pain form

Hemorrhage occurs directly in the ovarian tissue, or in the tissue of the dominant follicle or cyst of the corpus luteum. No blood clots were found in the abdominal cavity. This type of disease is characterized by severe cutting pains in the lower abdomen.

Hemorrhagic form

It is characterized by the fact that hemorrhage occurs in the abdominal cavity. This provokes pain that radiates to the anus and lower back. The more extensive the bleeding, the brighter the symptoms, and the worse the patient feels.

mixed form

Combines the features of the two above forms. It is difficult to tolerate, often leads to fainting and intoxication of the body.

When making a diagnosis, doctors are guided by the severity of the hemorrhage - this determines the course of subsequent treatment and resolves the issue of the need for surgical intervention.

Treatment of ovarian apoplexy, drugs and surgery

Ovarian apoplexy is treated both medically and surgically - everything will depend on the form of the disease, as well as on the presence or absence of peritonitis and sepsis. The doctor will make a decision on how to eliminate the consequences of hemorrhage on the basis of a hardware and bimanual examination, as well as blood tests and the results that a puncture will show.

Medical treatment

Therapy should be carried out in a hospital, so that the patient is under round-the-clock supervision of doctors and, if her condition worsens, she can immediately undergo an operation. The course of treatment should consist of hemostatic drugs, so the doctor may prescribe Tranexam or Etamzilat in the form of injections.

Another task of conservative treatment is the need to relieve pain and pain in the lower abdomen, which is accompanied by a rupture of the ovary or cyst in women. Drotaverine, No-shpa, Papaverine can be prescribed as analgesics. In addition to relieving pain, they help reduce the tone of the pelvic floor muscles.

As an addition to the main treatment regimen, B vitamins are recommended, which have a positive effect on the recovery of the body and strengthen the walls of blood vessels.

Types of operations for ovarian apoplexy, features

In most cases, ovarian apoplexy requires surgery, which can be performed in two ways: laparoscopic (through punctures in the abdominal cavity) and laparotomy (normal abdominal surgery).

The first method is used for minor bleeding, since it is impossible to clear the abdominal cavity from a large number of blood clots through punctures. The second method is more traumatic, but it allows for a thorough treatment of the pelvic organs and intestines.

Laparoscopy

Three punctures are made in the anterior abdominal wall to insert the camera and necessary surgical instruments. The surgeon locates the site of ovarian rupture and performs suturing. Bleeding is stopped with a coagulator.

In more complex cases, a resection of a part of the ovary is indicated, but after a while it will recover and function normally.

After performing surgical procedures, the doctor examines other organs of the abdominal cavity and small pelvis: the second ovary, appendix and fallopian tubes in order to detect an inflammatory process in them, which could be triggered by apoplexy.

This type of surgical intervention is considered sparing, therefore, after the operation, the ovary retains the ability to ovulate and produce hormones.

Laparotomy

The abdominal wall in the suprapubic area is dissected with a wide incision, which provides the surgeon with full access to the organs of the small pelvis and abdominal cavity. The accumulated blood clots are removed, the ovary is sutured, resected or oophorectomy is performed, and then, after a control examination of neighboring organs, layer-by-layer suturing of the peritoneum begins.

The laparotomy method is quite traumatic, often leading to the formation of an inflammatory process in the small pelvis, therefore, after surgery, a course of antibiotics is usually prescribed.

The consequences after surgery for ovarian apoplexy can be expressed in an extensive adhesive process in the fallopian tubes, therefore, before planning a pregnancy in the future, it will be necessary to undergo an HSG procedure.

Conceiving a child after treatment for ruptured ovarian tissue will depend on whether whether the operation was organ-sparing or not.

If one ovary was amputated, then ovulation will occur in the second. This will somewhat slow down the process of pregnancy and increase the frequency of anovulatory cycles.

In most cases, doctors try to perform an organ-preserving operation, so women are often interested in whether it is possible to get pregnant after ovarian apoplexy?

If the gap was sutured without resection, then soon the ovary will fully restore its reproductive function. If there was a resection, then it will take him some time to recover.

Patients who have undergone apoplexy require increased attention of the gynecologist during the management of pregnancy, since the hormones responsible for its preservation may be produced in insufficient quantities.

Apoplexy is a rare disease that occurs in people 15-45 years old, but more often 20-35 year old women suffer from this ailment. In practice, cases of this pathology in girls are known. This pathology occurs due to an increase in pressure in the peritoneal cavity (although there are cases when the rupture occurs at rest), which leads to damage to the ovarian tissue.

More often, apoplexy of the right ovary is planned, due to the speed of blood circulation occurring in it, and the fact that its blood supply is carried out from the aorta. The reasons are very different and are divided into exogenous and endogenous.

What it is?

Ovarian apoplexy is a rupture of tissues and vessels of an organ, which is characterized by sudden acute pain in the abdomen. Very often it can be complicated by significant blood loss and, as a result, the development of a severe form of anemia. When an ovary ruptures, a woman can lose up to 0.5 liters of blood, which is a danger to her life.

Causes of ovarian apoplexy

The immediate cause of ovarian apoplexy is always disorders in the vessels and tissues of the ovary, usually resulting from a chronic inflammatory process.

Altered tissues of both the ovary itself and the vessels that feed it (sclerosis, cicatricial changes, varicose veins) lead to an increased risk of rupture. On certain days of the menstrual cycle (the 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 can serve as an additional cause of ovarian apoplexy are:

Blood diseases in which its clotting is disturbed, 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;
Neuro-psychic factors, stress.

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

Symptoms of ovarian apoplexy

The main symptom is a sudden sharp pain in the lower abdomen. Pain is complicated by severe spasms, dizziness, nausea, vomiting and general weakness of the body.

The cause of severe pain is the pressure of the accumulated blood on the pain receptors of the surrounding tissues. They can give to the navel, lower back, anus, leg. Severe blood loss causes general poor health, as the body experiences an acute lack of oxygen.

Ovarian apoplexy is also characterized by the presence of such symptoms:

Bloody discharge from the vagina, reminiscent of menstruation, but not as abundant and occurs in the middle of the cycle. Sometimes the gap is preceded by a delay in menstruation.
A sharp decrease in blood pressure, increased heart rate, strong heartbeat, blanching of the skin. The patient notes a strong thirst, the skin is covered with a cold sweat.
Frequent urination and false urge to defecate. This is due to the stretching of the walls of the bladder under the influence of certain hormones, as well as due to the pressure of the blood mass on the rectum.

Diagnostics

If there is a suspicion that the ovary has burst, the following diagnostics are carried out:

An ultrasound examination of all internal female organs is carried out.
Blood is taken for general analysis. With apoplexy, a decrease in hemoglobin or its increase (occurs if the blood begins to thicken) is possible. Leukocytes may also increase.
The level of chorionic gonadotropic hormone in the blood is determined (to exclude an ectopic pregnancy). Often, bleeding occurs due to a rupture of the fallopian tube as a result of improper attachment of the fetal egg or after an abortion on the eve of the abortion and severe consequences that have arisen.
Complete examination and examination of the skin, mucous membranes. A gynecological examination reveals the normal color of the genitals and the inside of the vagina. Sometimes it may differ slightly, becoming paler with pathology. It is often not possible to conduct a bimanual examination due to increased pain symptoms. When examining the uterus, it is usually normal, and as for the appendages, one of them (in which the pathology occurred) will be increased in size.
Take a puncture of the contents of the abdominal cavity through the posterior fornix of the vaginal wall.

Laparoscopy is prescribed to confirm the diagnosis and possible correction of the pathology that has arisen. Laparoscopy is both a diagnostic procedure for ovarian apoplexy and a therapeutic one. It is she who confirms the violation with 100% probability.

Treatment of ovarian apoplexy

Conservative tactics of treatment is possible only in mild cases of ovarian apoplexy in the absence of obvious signs of internal bleeding.

Conservative measures for ovarian apoplexy include the appointment of strict rest, cold on the stomach, suppositories with belladonna, antispasmodics, vitamins, hemostatic drugs. After the acute period subsides, diathermy, electrophoresis with calcium chloride, Bernard currents are performed. If signs of increased bleeding appear, immediate surgery is indicated.

In recent years, gynecology, as a rule, conducts surgical treatment of ovarian apoplexy. Conservative treatment is prescribed only for patients with a mild form of pathology and realized reproductive function. If a woman is planning a pregnancy, then preference is given to surgical treatment of ovarian apoplexy.

Surgical treatment

The use of video endoscopic equipment is not only the most accurate diagnostic method, but also one of the most relevant methods of treating diseases.

Operation with laparoscopic access has a number of significant advantages:

the most gentle surgical method of treatment;
absence of pain syndrome;
preservation of reproductive functions;
reduction of the rehabilitation period;
the absence of a pronounced postoperative cosmetic defect.

The operation is performed in the main, organ-preserving direction, the removal of the ovary is performed only with massive bleeding and complete tissue damage. The scope of the operation depends on the severity of the patient's condition and may include the following surgical procedures:

suturing the site of rupture of ovarian tissues;
coagulation of the rupture of the affected tissue;
wedge-shaped resection of the ovary, in addition to excision of damaged tissues, allows you to eliminate possible factors of infertility;
oophorectomy (removal of the ovaries).

Vascular coagulation is carried out as carefully as possible, using a bipolar coagulator. At the end of the surgical procedures, all blood clots are removed, and the peritoneum is thoroughly washed. Due to the high risk of spontaneous abortion, if pregnancy is detected, labor induction is prescribed.

In the postoperative period, measures are taken to prevent the formation of adhesions, normalize hormonal processes, and restore reproductive capabilities. During the recovery period after ovarian apoplexy, patients are given a competent selection of contraception, physiotherapy is prescribed (magnetotherapy, ultrasound, laser therapy, electrophoresis with zinc, lidase, electrical stimulation of the fallopian tubes).

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:

Infertility. It develops in 42% of patients, which is facilitated by intense adhesion formation, hormonal imbalance and chronic inflammatory diseases of the ovaries and appendages. But if one healthy ovary remains after apoplexy and surgery, the chances of getting pregnant in the future are great.
Soldering 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.
Ectopic pregnancy. The risk of ectopic pregnancy increases due to the formation of adhesions in the pelvis, torsion and bending of the fallopian tubes.
Disease relapse. 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).

Prevention

Patients who have had an ovarian rupture and have completed a full course of rehabilitation are recommended to undergo a laparoscopic examination before planning a pregnancy.

In view of the possible risk of developing the disease in healthy women, it is recommended to take some precautions:

regular visits to the gynecologist (2 times a year);
timely treatment of infectious and inflammatory diseases of the reproductive organs;
control and correction of hormonal levels;
exclusion of heavy physical exertion;
proper selection of contraceptives.

Taking care of your reproductive health will protect every woman from unpleasant and dangerous diseases. In the event of a pathology, timely seeking help from specialists is a guarantee of a successful cure and preservation of the reproductive functions of the body of each patient.

Forecast

Timely detection and emergency treatment methods have a favorable prognosis with preservation of reproductive function. However, the pregnancy of a woman in the future requires increased attention from doctors. Untimely medical care and severe blood loss can lead to death.

The ovaries are a paired organ, up to 3 cm long and 2 cm wide. The weight of the ovary of an adult woman is about 5-6 grams, with age it decreases to 3 grams. Organs are responsible for the production of special hormones that stimulate the maturation of eggs necessary for successful conception.

Ovarian rupture most often occurs between the ages of 20 and 40. The disease is dangerously high probability of recurrence (more than 50% of cases). It is not uncommon for apoplexy to occur during childbearing.

Mostly, the pathology, which is accompanied by a strong loss of blood, occurs in the middle of the menstrual cycle when a mature egg moves into the fallopian tube.

Etiology of the disease

The causes of ovarian rupture are quite diverse, but most of them are associated with pathologies that occur in the structure of the organ. Among the most common reasons are:

the presence of inflammation of the ovarian tissues, the cause of which can be sexually transmitted infections, microflora disorders, severe hypothermia;
varicose veins of the ovary - occurs due to hard physical work, repeated pregnancy, elevated estrogen levels, long-term use of hormonal contraceptives;
- a pathology that disrupts the course of the menstrual cycle and causes infertility;
stimulation of egg maturation by medication - organ rupture occurs as a side effect of this procedure;
anomalies in the structure of neighboring organs, the presence of tumors that put pressure on the ovary;
the presence of adhesions;
disorders in the blood coagulation system.

The disease is caused by a strong blood flow to the gonads, which provokes a rupture. More intense blood supply to the right ovary leads to the fact that it ruptures more often than the left. The disease is usually acute, it can be provoked by various external factors, such as:

intense sexual intercourse;
unnecessarily heavy physical activity associated with lifting weights;
horseback riding;
bruises and injuries of the abdomen;
prolonged stay in the sauna or bath;
rough gynecological examination.

In some cases, ovarian apoplexy can occur without the participation of provoking factors, when a woman is in a state of physical inactivity.

Symptoms of ovarian apoplexy

The main symptom is a sudden sharp pain in the lower abdomen. Pain is complicated by severe spasms, dizziness, nausea, vomiting and general weakness of the body.

Ovarian apoplexy is also characterized by:

A sharp decrease in blood pressure, increased heart rate, strong heartbeat, blanching of the skin. The patient notes a strong thirst, the skin is covered with a cold sweat.
Bloody discharge from the vagina, reminiscent of menstruation, but not as abundant and occurs in the middle of the cycle. Sometimes a break is preceded by.
Frequent urination and false urge to defecate. This is due to the stretching of the walls of the bladder under the influence of certain hormones, as well as due to the pressure of the blood mass on the rectum.

Forms of the development of the disease

The disease can take several forms. Allocate painful, anemic and mixed forms.

Painful form of ovarian apoplexy is accompanied by severe pain, nausea and vomiting. The patient has no signs of internal bleeding and anemia. It is not uncommon for an ovarian rupture without bleeding to be mistaken for appendicitis due to similar symptoms of the disease.

In the anemic form, the patient has all the signs of internal bleeding. Large blood loss leads to the development of signs of anemia. This weakness, pallor of the skin, the presence of dark circles under the eyes, dry mouth, dizziness and fainting.

The degree of blood loss can be different. It is classified as:

mild (the amount of blood lost does not exceed 150 ml);
medium (the body loses up to 300 ml of blood);
severe (blood loss reaches 500 ml and above).

With the development of a mixed form, the presence of signs of both forms of the disease is noted: abdominal pain and symptoms of anemia.

Diagnostics

After hospitalization of the patient, for an accurate diagnosis, examinations by a surgeon, gynecologist and urologist are prescribed. It is extremely important to make a diagnosis as soon as possible in order to exclude the development of a severe form of anemia.

Differential diagnosis includes:

gynecological examination to determine the degree of pain, determine the size and consistency of the uterus and ovary;
general examination and palpation;
survey of the patient, analysis of her menstrual function (duration of menstruation, their intensity and soreness);
analysis of data on previous gynecological diseases, sexually transmitted diseases, the number of previous pregnancies and childbirth;
a blood test to determine the level of hemoglobin and the number of leukocytes;
a blood test for hCG to exclude the possibility of an ectopic pregnancy;
puncture of the posterior fornix of the vagina;
laparoscopy.

When evaluating a diseased ovary, the state of the second healthy organ is taken into account, and it also takes into account on which day of the cycle the rupture occurred.

Laparoscopy for ovarian apoplexy is one of the most reliable diagnostic methods. The reliability of the result reaches 98%. It provides for endoscopic examination of the abdominal cavity and at the same time acts as a method of treatment.

Signs of ovarian rupture are similar to the symptoms of a number of other diseases, which are also characterized by the presence of an "acute abdomen". All diagnostic measures should be aimed at differentiating the disease from:

acute form of appendicitis;
inflammation of the pancreas;
renal colic;
stomach ulcer;
intestinal obstruction.

Most often, it is necessary to differentiate ovarian apoplexy with diseases such as ectopic pregnancy and appendicitis. These diseases also pose a certain danger to a woman's health and require immediate treatment. They have similar symptoms, so diagnosis can be significantly difficult.

For the correct diagnosis, consider:

The onset of the disease relative to the phase of the menstrual cycle. Apoplexy usually occurs in the middle of the cycle, appendicitis does not depend on it, and with an ectopic pregnancy, a delay in menstruation is noted.
Anus puncture. With ovarian apoplexy, light-colored blood is released, with ectopic pregnancy, dark-colored blood with clots, with appendicitis, there is no blood discharge.
Analysis of the state of the internal genital organs. At rupture, a dense consistency of the uterine appendages, an increase in the ovaries are noted. An ectopic pregnancy leads to an increase in the uterus, and with appendicitis, changes in the state of the internal genital organs are not observed.
Palpation of the abdomen. The rupture causes pain throughout the lower abdomen, with appendicitis, the pain is localized in the right iliac region, with an ectopic pregnancy, pain is noted in the inguinal region.
Presence of signs of pregnancy. They can only be with an ectopic pregnancy; with rupture and appendicitis, such signs are not noted.

Often, the final diagnosis is possible only during the operation.

Treatment

With the appearance of severe pain in the abdomen, a woman should be urgently hospitalized. Before the arrival of the ambulance, she must be in a prone position. It is forbidden to take painkillers or anti-inflammatory drugs, which can make diagnosis difficult.

Emergency care for ovarian apoplexy consists in providing the patient with a state of rest and urgent hospitalization with delivery on a stretcher. In the presence of bleeding, the introduction of blood-substituting solutions is necessary.

In no case should the treatment of the disease be delayed or delayed, at the same time it should be gentle and aim at maintaining the ability to bear children. When choosing methods of treatment, they are guided by data on the volume of blood lost and the form of the course of the disease.

Conservative therapy

Conservative treatment of ovarian apoplexy is prescribed when there is no internal bleeding at rupture or when its volume is small (up to 150 ml). The patient must observe bed rest, she is forbidden even the slightest physical activity. To stabilize the condition, eliminate pain and general strengthening of the body, hemostatic therapy, antispasmodics and vitamins are prescribed.

The task of antispasmodics is to eliminate spasms in the muscles and relieve pain in the abdomen. Means are released in the form of intramuscular injections or tablets for oral administration. They reduce the increased muscle tone, relax the muscles of the internal organs, accelerate the supply of oxygen to the tissues. Buscopan, Papaverine, No-shpa are effective.

Hemostatic or hemostatic drugs can reduce the amount of blood lost and speed up the formation of platelets. They are administered intramuscularly and intravenously. The preparations Etamzilat, Tranexam, Amben should be singled out.

Vitamin therapy is necessary to normalize the vital activity of the body, reduce the intensity of bleeding, and normalize the functioning of individual internal organs. They increase the ability of blood clotting. The appointment of vitamins B1, B6, B12 is shown.

Medical research data show that the treatment of apoplexy without surgery is often not effective enough and leads to the formation of adhesions in the pelvis or the development of secondary infertility. There are frequent cases of repeated ruptures, since conservative methods do not completely rid the abdominal cavity of accumulated blood and clots.

Operative methods of treatment

Given all the risk factors, doctors generally prescribe conservative treatment for women who have already given birth. Laparoscopy is indicated for patients who are just planning a pregnancy.

The advantages are obvious: this is an innovative and at the same time gentle technique that allows you to completely clear the abdominal cavity from accumulated blood clots and blood clots. It is aimed at preserving the ovary. This is especially important for those women who are just planning to become mothers in the future.

Other advantages of the method:

gentle operation;
the absence of intense pain and gross cosmetic defects at the incision site;
little use of painkillers;
minimal risk of adhesions and other complications;
short recovery period after surgery;
psychological comfort;
maintaining the full functioning of the body.

Surgery for ovarian apoplexy involves the careful restoration of damaged tissues. Removal of the ovary is carried out only in the presence of excessive blood loss, when it is impossible to maintain the integrity of damaged tissues and blood vessels. The amount of blood accumulated in the abdominal cavity, allows you to determine the time of organ rupture.

Laparoscopy for ovarian apoplexy

If the rupture occurred while the woman was carrying a child, surgery will prevent miscarriage and keep the pregnancy.

There are a number of contraindications for which laparoscopy is not performed:

hypertension;
severe pathologies of the liver and kidneys;
bronchial asthma;
myocardial infarction or stroke;
the presence of large tumors (more than 10 cm in diameter);
obesity, which prevents the procedure;
the presence of a purulent process (peritonitis);
disturbances in the work of the blood coagulation system;
abdominal hernia;
significant loss of blood and severe exhaustion of the body.

Laparoscopy is undesirable if the patient has inflammation of the abdominal cavity or a malignant tumor of the genital organs. The procedure is not recommended for allergies to drugs, as well as in the second half of pregnancy.

If there are contraindications to laparoscopy, a laparothymic operation is performed. During it, an incision up to 10 cm long is made in the area of the suprapubic region. After surgery, additional antibiotic therapy is necessary.

Period after surgery

After laparoscopy, the recovery period lasts from several weeks to one to two months. Within a week after surgery, the patient must be in the hospital. After discharge, she needs to regularly undergo examinations by a gynecologist and a therapist. All women who have had ovarian apoplexy should be registered in a special women's clinic for a period of up to one year. Preventive examinations are carried out every three months.

Successful recovery after suffering apoplexy excludes the development of negative consequences. With a preventive purpose, in order to avoid the development of an adhesive process, physiotherapy is prescribed (ultrasound, electrophoresis, UHF).

Approximately 5-6 days after the operation, menstruation should begin. It takes place in the usual mode, sometimes the discharge is poorer than usual. If there are no periods, this must be reported to the attending physician in order to avoid the risk of complications.

After laparotomy, it is necessary to wear a special compression garment or bandage for two months. Sexual life throughout the recovery period should be completely excluded.

Pregnancy planning

Most women are concerned about the question, when will their body regain the ability to bear a child, and when is pregnancy possible after ovarian apoplexy?

After timely surgical intervention, the ability to fertilize and give birth to a child is preserved. Even if the ovary was completely removed, this should not sound like a sentence. The eggs will mature in another organ, and the woman will be able to realize her dream of becoming a mother.

However, when planning a pregnancy after surgery, you must follow some rules. So, conception should not occur earlier than six months after surgery, when the course of full recovery has not yet been completed. Preventive measures are needed to prevent the development of the adhesive process, since it is the presence of adhesions that can become the main obstacle to the occurrence of pregnancy.

In addition to regular physiotherapy sessions, hormonal contraceptives are prescribed. They not only prevent conception too early after surgery, but also help the body restore hormonal levels and minimize the risk of complications. Recommended drugs - Novinet, Regulon, Yarina. Since there are a number of contraindications, they can only be taken after a doctor's prescription.

Consequences and complications

The consequences of ovarian apoplexy are conditionally divided into early and remote. Early complications include complications that occur during treatment and directly during the rehabilitation period.

It should be remembered that ovarian rupture is a very dangerous disease. If the patient is not provided with medical care in time, with large blood loss, it can lead to death. Self-treatment or the use of folk remedies is strictly prohibited. A late call for an ambulance is fraught with the development of hemorrhagic shock.

Late complications occur after a certain time after the operation or complex treatment.

Main complications:

. They occur as a result of incomplete cleansing of the abdominal cavity from accumulated blood clots and blood clots. They can also be formed when a woman refuses to undergo surgery, when treatment is limited only to complex therapy methods.
. Usually observed after removal of the ovary. Although the likelihood of getting pregnant is quite high, such consequences can occur if there are adhesions or the development of hormonal dysfunction.
Ectopic pregnancy. The resulting adhesions prevent the free movement of a fertilized egg into the uterus. The egg gets stuck in the thickness of the fallopian tube, forming an ectopic pregnancy.
risk of re-rupture. It can be caused by pathological changes in the hormonal background. The risk of recurrence increases if the treatment is limited to conservative methods.

Complications after surgery can be avoided if a woman follows all the doctor's instructions and regularly undergoes examinations by a gynecologist.

Physical activity

The transferred operation does not mean at all that the patient cannot lead her usual way of life. Moderate physical activity has a positive effect on the recovery process of the body during the rehabilitation period.

After laparoscopy, you can get up and move around the ward a little at the end of the first day. In the first days, special exercises designed for people who have undergone gynecological operations are shown.

Such exercises help prevent the adhesive process, strengthen the abdominal wall, and gradually restore the normal functioning of the ovary. In addition, they help improve the functioning of the endocrine and digestive systems, and have a positive effect on the overall psycho-emotional state.

Successful recovery is facilitated by ordinary walking with a gradual increase in distance, breathing exercises, exercises for turning the body and imitation of walking in the prone position.

Caution should be exercised in the presence of the following diseases:

increased risk of blood clots;
severe anemia;
malfunctions of the cardiovascular system, respiratory disorders;
the presence of malignant tumors;
development of postoperative complications.

How justified are sports after ovarian apoplexy?

You can return to regular exercises in the gym after the completion of the recovery period, that is, not earlier than after 2-3 months. In this case, it is necessary to take into account the individual characteristics of the body and general well-being.

Prevention

Unfortunately, even properly performed treatment does not give a full guarantee that ovarian rupture will not recur. Therefore, all doctors recommend following certain rules that will help avoid relapse.

Prevention of ovarian apoplexy should begin immediately after surgical treatment. Its main task is to prevent the development of the adhesive process and gradually normalize the disturbed menstrual cycle. The patient was recommended physiotherapy and hormone therapy.

Preventive measures are developed individually and should take into account the age of the woman, the general state of health, the conditions in which the treatment was carried out, the presence of complications in the postoperative period.

The development of a set of preventive measures should take into account:

volume of surgical intervention;
the presence of previous ruptures and other gynecological diseases;
the state of the hormonal background;
conditions for the recovery period.

timely treatment of various infections and inflammations;
regular examination by a gynecologist;
taking hormonal contraceptives between pregnancies;
ultrasound examination at least once a year;
avoid hypothermia, heavy physical labor, weight lifting;
monitor nutrition, fight excess weight;
lead an active healthy lifestyle.

Ovarian apoplexy is a serious disease not only of one organ, but of the entire reproductive system. Its diagnosis and treatment should take place exclusively in a hospital under the supervision of experienced doctors. Compliance with all the rules of treatment will preserve the woman's ability to bear children and exclude the possibility of a recurrence of the disease.

The rupture is a violation of the integrity of the shell of the appendage or the capsule of the formation, with further outpouring of blood.

Normally, minor damage to the epididymis is observed monthly in the middle part of the cycle. An abnormal ovarian rupture or cyst is an emergency that threatens the life and health of the patient.

A sudden rupture of the ovary in girls under 35 occurs in the middle or second part of the cycle and is caused by hormonal disruptions. Moreover, the paired organ is damaged not outside, but inside.

After ovulation, a wound appears on the outer part of the ovary, and a small amount of blood flows into the pelvic area, which leads to pain in the lower abdomen. Deviations from the norm are eliminated due to the characteristics of the female body. In place of the follicle appears, which is responsible for the production of progesterone, intended for the course of pregnancy. When conception does not occur, the temporary gland gradually regresses.

The cause of hemorrhage in ovarian apoplexy is almost always the corpus luteum or follicle. Rupture of the follicle in the middle of the cycle is not considered a pathology. The right side of the pelvic region has a more intense blood circulation than the left, so it "suffers" more often.

Before determining what sensations occur with ovarian apoplexy or cysts, it is necessary to understand that the symptoms depend on the degree of blood loss. With insignificant bleeding, the clinical picture is not bright, but with severe pathology, the signs intensify.

Features of treatment

Apoplexy (hemorrhage) is an emergency. Without medical assistance, it can lead to bad consequences, the most dangerous of which is hemorrhagic shock, which occurs against the background of intense blood loss. With pathology, the patient is hospitalized.

Before the arrival of the ambulance, the use of painkillers is prohibited, because this creates a false sense of improvement, and internal bleeding continues.

Conservative therapy is used only for a mild form of ovarian rupture, because it has long-term consequences.

Therapy of bleeding in ovarian apoplexy

If the affected area is extensive, then the paired organ itself is excised. However, the woman retains a second ovary, so she can become pregnant. When during the operation it is not possible to remove all the blood, adhesions of the pelvic region also develop over time. This is fraught with ectopic pregnancy. Failure to eliminate the cause of deviations often leads to relapse.

The scale of surgical intervention is determined by the degree of damage to the tissues of the appendage. If the gap is small, then the damaged areas are sutured. With an extensive hematoma, resection is indicated. If it is impossible to save the appendage, then it is removed. During the operation, pathologies of the reproductive system are often detected. All of them are subject to liquidation.

After surgery, measures are taken to prevent complications. The patient is prescribed anti-inflammatory drugs and antibiotics. Recovery in the hospital lasts a week.

Elimination of hemorrhage in the rupture of the cyst

With normal health of the patient and stable hemodynamic parameters, if there are no pronounced manifestations of intra-abdominal bleeding, and the absence of liquid content is determined by ultrasound, conservative therapy is performed, which implies:

the use of analgesics, hemostatic agents;
application of cold to the lower abdomen.

If the patient has an ovarian cyst with hemorrhage, then the operation is performed when the condition worsens or bleeding provokes a moderate or severe condition.

Surgery is usually performed laparoscopically. Manipulations come down to stopping bleeding by cauterizing the vessels or suturing the affected area. If necessary, the formation is exfoliated, or the complete removal of the paired organ. Any type of treatment (conservative or surgical) is carried out in a hospital.

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

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

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

fever, 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, so the forms of apoplexy are classified according to the severity of the disease and the magnitude, highlighting light(when blood loss is 100-150 ml), middle(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 occurs in women of reproductive age 20-35 years.

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

The main reasons that contribute to the occurrence of ovarian rupture are:

the moment of ovulation;
the period of vascularization of the corpus luteum (the 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 , which lead to a violation of blood clotting;
hormonal disorders (a sharp increase pituitary gonadotropins , resulting in increased blood filling ovarian tissue ).

Risk factors contributing to the onset of the disease include abdominal trauma, weight lifting, horseback riding, atypical sexual intercourse (interrupted, violent), incorrect position of the genitals, vaginal examinations, pressure on the ovary of the tumor, adhesive and congestive processes in the pelvis, nervous breakdown . The prevention of ovarian apoplexy, timely examination by a doctor and treatment of diseases of the pelvic organs can prevent the disease.

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

Symptoms of ovarian apoplexy

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

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

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

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

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

Diagnosis of ovarian apoplexy

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

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

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

Treatment of ovarian apoplexy

Treatment of 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 with a small pelvis, and more than 40% develop. There are also frequent recurrences of the disease. This is due to the fact that the blood accumulated after the rupture remains in the abdominal cavity, where it contributes to the formation of adhesive processes in the small pelvis.

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

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

Laparoscopy, as a diagnosis of ovarian apoplexy and further complications, is indicated for women with complaints of acute sudden and suspected bleeding. The operation is carried out in a gentle way while maintaining the integrity of the organs and reproductive functions of the woman. During the operation, coagulation of the ovarian vessel is carried out, 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, fallopian tubes are examined. During the operation, the abdominal cavity is thoroughly washed, blood and blood clots are removed. There is a faster exit from, a shorter stay in the hospital after surgery. After this operation, there are no significant cosmetic defects.

A contraindication for surgery is hemorrhagic shock accompanied by great blood loss and loss of consciousness.

The doctors

Medications

Prevention of ovarian apoplexy

After discharge from the hospital, it is important to prevent the recurrence of the disease in the future, i.e. exclude risk factors and timely treat diseases that provoked 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 leadership. - M.: GEOTAR-Media, 2007;
Gasparov A.S. Emergency assistance in gynecology. Organ-preserving operations // Gasparov A.S., Babicheva I.A., Kosachenko A.G. - M., 2000;
Kolgushkina T.N. Topical issues of gynecology. -Minsk: Higher school, 2000.