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Ovarian Apoplexy

Apoplexy ovary (ovarian rupture) - a sudden break (tampering) ovarian tissue, accompanied by bleeding into the abdominal cavity and the pain.

In the ovaries of mature women going on follicle growth, oocyte maturation in them, it is a preparation for the upcoming pregnancy. Since menstrual dominant follicle starts to grow, which is the middle of the menstrual cycle reaches its maximum size - about 20 mm. The shell then the follicle ruptures, releasing himself from the ripened egg - ovulation occurs. At the site of the ruptured follicle is formed temporary education - the corpus luteum, which produces certain hormones that prepare the woman's body for pregnancy. This is the normal cycle for ovarian.

In dystrophic and sclerotic changes of ovarian tissue that occur in acute and chronic inflammation of the uterine appendages, in polycystic ovary syndrome and other diseases, as well as medication to stimulate ovulation there are certain irregularities in the process of ovulation and corpus luteum formation. As a result, the blood vessels rupture in the ovary badly cut, and continuing increases intra-abdominal bleeding, and in the corpus luteum is formed due to the fragility of vessels bleeding - bruising. All this is accompanied by pain, weakness, dizziness, nausea, vomiting, pale skin, fainting. If left untreated, internal bleeding may increase, creating a real threat to the health and lives of women. By provoking a break ovarian factors also include abdominal trauma, excessive physical exertion, rapid sexual intercourse, horseback riding, etc.

The frequency and form of ovarian apoplexy

Apoplexy ovary (ovarian rupture) sudden break (tampering) ovarian tissue, accompanied by bleeding into the abdominal cavity and the pain.

Among the causes of intra-abdominal bleeding 0.5-2.5% are ovarian apoplexy.

There are three forms of ovarian apoplexy, depending on the predominant symptoms:

Pain form when there is severe pain, but no signs of intra-abdominal bleeding.
Anemic form, when in the first place there are signs of internal (intra-abdominal) bleeding.
Mixed form combines symptoms of pain and anemic forms of ovarian apoplexy.

However, according to recent data, this classification is incomplete, since the gap is not possible without ovarian bleeding.

Therefore, at present, this pathology is divided into several levels of severity: mild, moderate and severe (depending upon the amount of blood loss).

The symptoms of ovarian apoplexy

The clinical symptoms of apoplexy associated with the primary mechanism of this disease:

Pain that occurs primarily in the middle of the cycle or after a minor delay of menstruation (at break luteum cyst, for example). Pain is most often localized in the lower abdomen. Sometimes the pain can radiate to the rectum, in the lumbar or umbilical region.
Bleeding into the abdominal cavity, which can be accompanied by:

Reduction in pressure
Increase in heart rate
Weakness and vertigo
Chills, fever up to 38 degrees,
Single vomiting
Dry mouth.

Occasionally you may experience intermenstrual vaginal bleeding or vaginal bleeding after a missed period.

Quite often, ovarian apoplexy occurs after sexual intercourse or training in the gym, that is, under certain conditions, when increased pressure in the abdomen and possibly a violation of the integrity of the ovarian tissue. However, the gap cysts can occur on the background of good health.

Causes ovarian apoplexy

Causes that contribute to ovarian apoplexy:

Pathological changes in blood vessels (varicose, sclerosis).
The previous ovarian tissue inflammation.
The moment of ovulation. Step vascularization of the corpus luteum (the middle and the second phase of the cycle).

The risk factors that contribute to ovarian apoplexy:

Weight lifting or heavy exercise.
Rapid intercourse.

Diagnosis of ovarian apoplexy

According to the literature the correct clinical diagnosis of ovarian apoplexy is only 4-5%.

Diagnostic errors due primarily to the fact that the clinic of the disease has a characteristic pattern and is developing in a different type of acute pathology in the abdomen and pelvis.

The patient was brought to the hospital with a diagnosis of "acute abdomen". Clarifying the reasons is carried out in a hospital.

First of all ovarian apoplexy must be differentiated from ectopic pregnancy and acute appendicitis.

As a general rule, in case of the clinic "acute abdomen" is also required consultation related professionals (surgeons, urologists).

Because ovarian apoplexy is an acute surgical pathology, diagnosis must be set very quickly, because the increase in the time prior to surgery increases the amount of blood loss and can be life threatening condition!

The most informative methods of research are:

Typical complaints of acute abdominal pain, which appeared in the middle or second half of the menstrual cycle.
On examination, there is soreness of the affected ovary, and become positive symptoms of peritoneal irritation.
In general, the blood test can be marked decrease in hemoglobin (at anemic and mixed forms of ovarian apoplexy)
Puncture the posterior fornix, allowing to confirm or deny the presence of intra-abdominal bleeding.
Ultrasound, which allows you to see the affected ovary large yellow body with signs of hemorrhage in and / or free fluid (blood) in the abdomen.
Laparoscopy, which not only allows 100% diagnosis, but also make a correction of any disease.

Definitive diagnosis of ovarian apoplexy almost always installed during surgery.

Your actions in apoplexy:

Immediately take a horizontal position.
Urgent call "911" for admission to a surgical or gynecological hospitals.

Treatment of ovarian apoplexy

Conservative treatment is possible only in the case of mild ovarian apoplexy, which is accompanied by slight bleeding into the abdominal cavity.

Patients with mild apoplexy complain primarily of pain in the abdomen.

However, the findings of many researchers argue that the conservative management of such patients in 85.7% of cases of pelvic adhesions are formed, and 42.8% of cases, infertility is registered.

Almost every second woman after conservative management may relapse (re ovarian apoplexy). This is due to the fact that blood clots and which accumulate in the abdominal cavity after the gap ovary (ovarian apoplexy) not washed as laparoscopy remain in the abdominal cavity, which organizes and promote the formation of adhesions in the pelvis.

Conservative treatment can be recommended only for women who have already implemented their reproductive function (ie already have children and do not expect to have them) if they detect mild ovarian apoplexy.

If a woman is of childbearing age, and is planning a pregnancy, the tactics even in the case of mild ovarian apoplexy should be revised in favor of laparoscopy.

Surgical treatment is fundamental, because it only allows you to specify the diagnosis, but also hold full correction.

In all cases of apoplexy may laparoscopy!

The only contraindication to the use of this access is hemorrhagic shock (ie very large hemorrhage with loss of consciousness).

The operation should be carried out as gentle way while preserving ovarian.

As a rule, carried out the removal capsule cysts, coagulation or suture of the ovary. In rare cases, massive hemorrhage required to perform removal of the ovary.

During the operation should be carefully washed the abdominal cavity to remove blood clots and to prevent the formation of adhesions and infertility.

Rehabilitation measures for ovarian apoplexy

Rehabilitation measures after an ectopic pregnancy should be focused on reproductive function after surgery. These are: prevention of adhesions; contraception; normalization of hormonal changes in the body. To prevent adhesions are widely used physical therapy techniques:

AC pulsed magnetic field of low frequency
Low-frequency ultrasound
Supersonic frequency currents (ultratonotherapy)
Low-level laser erapiyu,
Electrostimulation fallopian tubes
Electrophoresis zinc, hyaluronidase,
Ultrasound pulsed.

In the course of anti-inflammatory therapy and yet within 1 month after the recommended contraception, the question of its duration decided individually depending on the age of the patient and the features of its reproductive function. Certainly, it should be a woman's desire to preserve reproductive function. Duration of hormonal contraception as a purely individual, but normally it should not be less than 6 months after the surgery.

After rehabilitation, the patient before recommending to plan next pregnancy, it is advisable to perform a diagnostic laparoscopy to evaluate the state of the fallopian tube and other pelvic organs.