Apoplexy ovary - Causes, Symptoms and Treatment .MF .
The ovaries mature women going follicular growth, maturation of the egg in them, that is the preparation for the forthcoming pregnancy.Since the beginning of the menstrual cycle dominant follicle starts to grow, which is the middle of the menstrual cycle reaches its maximum size - about 20 mm.Then, the shell of the follicle ruptures, releasing himself from ripened egg - ovulation occurs.In place of the ruptured follicle forms a temporary formation - corpus luteum, which produces certain hormones that prepare a woman's body for pregnancy.This is normal during the ovarian cycle.
In dystrophic and sclerotic changes in ovarian tissue, found in acute and chronic inflammatory processes in the uterus, in polycystic ovary syndrome, and other diseases, as well as medication to stimulate ovulation, there are certain irregularities in the process of ovulation and formation of the corpus luteum.As a result, the blood vessels at the site of ovarian rupture badly reduced, continues and intensifies abdominal bleeding
frequency and form of ovarian apoplekii
apoplexy ovary (ovarian rupture) - a sudden break (breach of integrity) of ovarian tissueaccompanied by bleeding into the abdominal cavity and pain.
Among the causes of intra-abdominal bleeding 0.5-2.5% is apoplexy ovary.
There are 3 forms of apoplexy ovary depending on the predominant symptoms:
- painful form when there is severe pain, but no signs of intra-abdominal bleeding.
- Anemic form when come first symptoms of internal (intra-abdominal) bleeding.
- mixed form combines the signs of pain and anemic forms of ovarian apoplexy.
However, according to recent data, this classification is considered to be defective, as the gap is not possible without bleeding of the ovary.
So now this pathology is divided into several degrees of severity: mild, moderate and severe (depending on the amount of blood loss).
Symptoms of ovarian apoplexy apoplexy
Clinical symptoms are related to the basic mechanism of development of this pathology:
- pain syndrome, which occurs primarily in the middle of a cycle or after a minor delay menstruation (at rupture of the corpus luteum cyst, for example).Pain is most often localized in the lower abdomen.Sometimes the pain may radiate into the rectum, in the lumbar region or the umbilical.
- bleeding into the abdominal cavity, which can be accompanied by:
- pressure reduction,
- increase in heart rate,
- weakness and dizziness,
- chills, fever up to 38 ° C,
- single vomiting,
- dry mouth.
- Occasionally you may experience intermenstrual vaginal bleeding or bloody discharge after menstruation.
Quite often, ovarian apoplexy occurs after intercourse or training in the gym, that is, under certain conditions, when increased pressure in the abdomen and possible violation of the integrity of ovarian tissue.However, ovarian rupture can occur against the background of full health.
Causes of ovarian apoplexy
reasons that contribute to ovarian apoplexy:
- pathological changes of vessels (varicose, multiple sclerosis).
- Previous inflammation of ovarian tissue.
- moment of ovulation.
- Stage corpus luteum vascularization (the middle and the second phase of the cycle).
risk factors that contribute to ovarian apoplexy:
- heavy lifting or heavy physical activity.
- Rapid intercourse.
Diagnosing 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 this disease has a characteristic pattern and develops a different type of acute pathology in the abdomen and pelvis.
The patient was brought to the hospital with a diagnosis of "acute abdomen".Clarification of the reasons is carried out in a hospital.
First apoplexy ovary must be differentiated from ectopic pregnancy and acute appendicitis.
As a rule, in case of "acute abdomen" clinic also needed counseling related professionals (surgeons, urologists).
Since ovarian apoplexy is an acute surgical pathology, the diagnosis is necessary to deliver very fast, because the increase in the time before the operation leads to an increase in the magnitude of blood loss and can be life-threatening condition !!!
most informative methods of research are:
- Typical complaints of acute pain in the abdomen, which appeared in the middle or second half of the menstrual cycle.
- On examination, a marked tenderness on the part of the affected ovary and become positive symptoms of irritation of the peritoneum.
- The general analysis of blood can be observed decrease in the level of hemoglobin (at anemic and mixed forms of ovarian apoplexy)
- Puncture of the posterior fornix, allowing to confirm or deny the presence of intra-abdominal bleeding.
- ultrasound, which allows you to see a lot in the affected ovary yellow body with signs of hemorrhage in and / or free fluid (blood) in the abdomen.
- Laparoscopy, which allows not only the diagnosis of 100%, but also make a correction of any pathology.
final diagnosis ovarian apoplexy almost always installed during surgery.
your actions when necessary apoplexy:
- immediately take a horizontal position.
- Urgent call "ambulance" for hospitalization in a surgical or gynecological hospitals.
Treatment of ovarian apoplexy
- Conservative treatment is possible only in the case of mild apoplexy ovary, which is accompanied by minor bleeding into the abdominal cavity.
Patients with mild apoplexy complain primarily of pain in the abdomen.
However, the data 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 the cases registered infertility.
Almost every second woman after conservative management may relapse (re apoplexy ovary).This is due to the fact that the blood and clots that accumulate in the abdominal cavity after ovarian rupture ( ovarian apoplexy ), not washed, as in laparoscopy, remain in the abdominal cavity, where the organized and contribute to 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) in the case of their mild form of ovarian apoplexy.
If a woman is of reproductive age and is planning a pregnancy, the tactic even in the case of a mild form of ovarian apoplexy should be revised in favor of laparoscopy.
- Surgical treatment is fundamental, because not only allows you to specify the diagnosis, but also to complete the correction.
In all cases of apoplexy may laparoscopy !!!
only contraindication to the use of this access is hemorrhagic shock (ie a very large hemorrhage with loss of consciousness).
operation is necessary to move the most gentle way to the conservation of the ovary.
As a rule, carried out the removal of the cyst capsule, coagulation or suturing of the ovary.In rare cases, massive hemorrhage required to perform the removal of the ovary.
During the operation, you must thoroughly wash the abdominal cavity, to remove clots and blood, for the prevention of adhesions and infertility.
Rehabilitation actions during ovarian apoplexy
Rehabilitation actions after an ectopic pregnancy should be aimed at the restoration of reproductive function following surgery.These include: the prevention of adhesions;contraception;normalization hormonal changes.For the prevention of adhesions is widely used physiotherapy methods:
- AC pulsed magnetic field of low frequency,
- low-frequency ultrasound,
- supersonic frequency currents (ultratonotherapy),
- low-level laser therapy,
- electrical stimulation of the fallopian tubes;
- electrophoresis zinc lidazy,
- ultrasound in a pulsed mode.
In the course of anti-inflammatory therapy, and even within 1 month after the end of contraception is recommended, and the question of its duration is decided individually, depending on the age of the patient and the features of its reproductive function.Of course, one should consider a woman's desire to preserve reproductive function.The duration of hormonal contraception and especially individual, but usually it should not be less than 6 months after surgery.
After rehabilitation, before recommending the patient to schedule the next pregnancy, it is advisable to perform a diagnostic laparoscopy to assess the condition of the fallopian tubes and other pelvic organs.If the control laparoscopy revealed no pathological changes allow the patient to schedule the next pregnancy menstrual cycle.