What is ovarian apoplexy and what is its danger for a woman?

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• Causes and mechanism of ovarian apoplexy
• Symptoms of ovarian apoplexy
• Diagnosis of ovarian apoplexy
• Treatment of ovarian apoplexy

Ovarian apoplexy is a hemorrhage in the ovary that can rupture the ovary and cause internal bleeding. Ovarian apoplexy is an acute, often life-threatening condition that requires immediate medical intervention.

Types of apoplexy

Previously, doctors diagnosed the disease according to one of three types - painful form, anemic and mixed. At the moment, the classification has been finalized, and according to the modern classification, ovarian apoplexy is:

• painful;
• hemorrhagic.

The painful form of apoplexy is diagnosed when the ovary ruptures without intra-abdominal bleeding. Such hemorrhage can be internal, i.e. into the tissue of the organ itself or the corpus luteum maturing inside it. Typically, the woman will have severe pain and may vomit and feel nauseated, but there will be no signs of bleeding into the abdomen.

Ovarian apoplexy of the hemorrhagic type is associated with a significant release of a certain volume of blood. When bleeding up to 150 ml, the disease is assigned a mild degree, from 150 to 500 ml - moderate severity, over 500 ml - severe severity. Typically, the hemorrhagic form begins acutely and is associated with serious physical overexertion. The pain radiates to different parts of the body: to the leg, to the lower back, and even fainting is possible. Symptoms directly depend on the amount of blood loss.

Why does ovarian tissue rupture?

This pathology occurs when the permeability of ovarian vessels is impaired. The reason may lie in the specific characteristics of the ovarian tissue itself. If the patient suffers from inflammation of the appendages, polycystic ovary syndrome, or has had abortions, sclerotic or degenerative changes in the tissue occur. This is the kind of disease that may appear. Ovarian apoplexy often occurs:

• if the woman had abdominal injuries;
• she was fond of horse riding;
• if the patient has experienced excessive physical activity;
• did douching;
• had an active sexual relationship with a partner.

Sometimes rupture of ovarian tissue is associated with a congenital pathology of the location of the uterus. Even ordinary squeezing of blood vessels can disrupt blood flow to the ovary. Quite often, rupture of organ tissue occurs spontaneously. Such an incident can occur while a woman is sleeping.

Inflammatory processes of the abdominal organs, blood diseases of various types, too long use of anticoagulants that disrupt the clotting process can provoke the onset of the disease.

Data from statistical studies show that ovarian apoplexy occurs at a certain period of the menstrual cycle. Usually this is the middle or second half. It is at this time that the level of vascular permeability in the ovarian tissue is very high. They undergo increased blood supply. Most often, the pathology is inherent in the right ovary. After all, the degree of blood circulation in it occurs much more intensely in comparison with its left counterpart. The reason is that the right ovarian artery arises from the aorta, and the left from the main vessel of the kidney.

Causes

Ovarian rupture can be provoked by both pathologies of the organ itself and other dysfunctions in the functioning of the body. Doctors identify the following reasons:

• polycystic ovary syndrome;
• blood coagulation pathologies with long-term use of anticoagulants;
• acute and chronic adnexitis;
• pathologies of blood vessels - varicose veins, atherosclerotic changes;
• stimulation of ovulation with medications;
• abnormal position of the uterus, compression of the ovaries;
• the presence of adhesions;
• abdominal injuries;
• increased pressure in the peritoneum as a result of physical stress;
• hormonal disorders;
• emotional instability, stress.

Possible consequences and complications

Ovarian apoplexy requires emergency care. In its absence, hemorrhagic shock may develop. This is the name of a condition caused by large blood loss. It is accompanied by multisystem and multiple organ failure. Its outcome is death in 15% of cases. Hemorrhage into the ovary and peritoneum can also cause peritonitis.

Untimely assistance often becomes the cause of adhesions. In 50% of cases, women's fertility decreases. Possible development of infertility.

Symptoms

The disease develops rapidly. A sharp pain occurs in the lower abdomen in the projection to the ovary; it can have a pulling and aching character. The symptom appears when the peritoneum is irritated by blood, so the pain is directly proportional to the volume of blood released.

In addition to abdominal discomfort, women experience characteristic signs of internal bleeding - weakness, nausea, dizziness. Blood pressure drops, cold sweat appears, and in some cases fainting is possible.

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At what size does an ovarian cyst rupture?

A cyst whose diameter exceeds 2 centimeters is considered potentially dangerous. Without proper treatment and constant monitoring, it can lead to a number of serious complications: hemorrhage, suppuration, torsion.

The size of the formations can vary from 20 mm to 22 cm in diameter. Small formations up to 1 cm most often are not treated and resolve on their own within 1-3 cycles. Capsules with a diameter of 4 centimeters or more pose a serious health hazard. When they rupture they cause severe bleeding.

Rupture of an ovarian cyst in women

Apoplexy can happen at any time, but most often it is provoked by a combination of several factors. Cysts are particularly affected by:

• Pregnancy. During pregnancy, the possibility of apoplexy remains due to excess pressure on the uterus or possible hormonal imbalance. Therefore, if a pregnant woman is diagnosed with a capsule measuring 8 cm or more, surgical intervention is prescribed.
• Menstruation. At this stage, the formation is prone to resorption, but with regular exercise or intense sexual relations, a rupture may occur.
• Disruptions in the production of hormones. If there are disruptions in the menstrual cycle or lack of ovulation, multiple neoplasms may occur that tend to rupture under the influence of external factors.
• Poor blood clotting. The rupture of a cyst in combination with this feature of a woman can provoke severe bleeding.

When diagnosing a cyst, it is important to follow the doctor’s instructions to prevent new problems with the body.

Conservative treatment

Drug treatment of ovarian apoplexy is acceptable for mild cases of the disease, when the volume of blood entering the abdominal cavity does not exceed 150 ml. In this case, the patient should have no signs of progressive bleeding. In this case, doctors are inclined to organ-preserving treatment.

Conservative therapy involves applying cold to the lower abdomen to constrict blood vessels. The patient is prescribed hemostatic (hemostatic) medications, vitamins, and during the period of improvement in health, physical therapy (microwave, electrophoresis) is indicated.

An important place is given to rehabilitation after ovarian apoplexy.

Postoperative period

Upon completion of the operation, the patient is prescribed anti-inflammatory drugs, antibiotics, painkillers, vitamin complexes, as well as drugs for postoperative treatment of ovarian cysts. Additionally, you must adhere to a diet. You will only be able to eat:

• Liquid soups.
• Porridge.
• Freshly squeezed juices.
• Steamed vegetables and fruits.

Over time, restrictions are lifted.

To speed up the healing of sutures, the doctor prescribes wearing a special bandage. Full recovery of the body after surgery takes about 3-4 weeks. During this period, intimacy, as well as heavy lifting and physical activity, are contraindicated.

Surgery

Specialists resort to surgical treatment as a last resort if the ovary ruptures with significant hemorrhage and disruption of integrity. For small ruptures, surgery can be avoided, and thanks to natural methods of repair, the rupture heals on its own.

Indications for surgical intervention are:

• hemorrhagic form of the disease;
• deterioration of the patient's general condition;
• repeated attacks of pain;
• unstable hemodynamics, accumulation of large amounts of blood in the abdominal cavity.

The operation today is performed without a large abdominal incision, allowing the aesthetics of the tissue to be preserved. The laparoscopic method provides the gynecologist with access to the ovaries thanks to three punctures in the abdominal cavity, which do not exceed one centimeter, and subsequently the scars from the operation are practically invisible. Simultaneously with the surgical intervention, a blood transfusion is performed to replace the volume of fluid circulating in the circulatory system. Cardiovascular drugs are administered according to indications.

Diagnostics

Diagnosis of ovarian cyst rupture is based on the following algorithm:

• collecting complaints and studying anamnesis;
• gynecological analysis;
• additional examination.

Among the additional examination methods for suspected apoplexy of an ovarian cyst, the following are used:

• general blood analysis;
• general urine analysis;
• blood test for hCG;
• biochemical blood screening;
• ultrasonography;
• puncture of the posterior vaginal fornix;
• diagnostic laparoscopy.

Diagnosis of cyst rupture

In a general blood test with a cyst, a decrease in hemoglobin and hematocrit levels is noted. In a general urine test, the protein level increases, and red blood cells may appear. A blood test for human chorionic gonadotropin allows you to exclude ectopic pregnancy and rupture of the fallopian tube - a pathological condition, the clinical picture is extremely similar to a ruptured ovarian cyst. Biochemical screening indicates damage to kidney function.

Using an ultrasound examination, the doctor can see the accumulation of fluid in the pelvis. The doctor will also notice that one of the ovaries is enlarged in size, this will make it possible to suspect a cyst. In order for OMT ultrasound to provide more information, it is recommended to perform it transvaginally. In this case, the gynecologist can much better assess the condition of the female genital organs, in particular the damaged ovary.

Puncture of the posterior vaginal vault is a minimally invasive manipulation that is necessary to examine the contents of the pelvic cavity. The procedure is performed in a manipulation room, with strict adherence to the rules of asepsis and antiseptics. In emergency cases, the puncture is performed without prior preparation. If necessary, the woman should empty her bladder and rectum. Since the procedure is quite painful, it is performed under local anesthesia or general anesthesia.

The patient is placed in a gynecological chair, and the external genitalia are treated with an antiseptic solution. The cervix is ​​shifted towards the pubis, and the posterior vaginal vault is stretched. Then the gynecologist makes a puncture and sucks out the contents of the pelvic cavity using a syringe. The resulting liquid is sent to the laboratory for testing. As a rule, the doctor is able to obtain blood, which confirms the fact of internal bleeding. However, with a pronounced adhesive process in the pelvis, provided that the adhesions impede the free flow of blood, the procedure may not be informative.

Diagnostic laparoscopy is an endoscopic examination that allows you to directly examine the pelvic and abdominal organs and see the ruptured cyst. Instruments are inserted into the body through small punctures in the anterior abdominal wall, after which the abdominal cavity is filled with a special gas, and the doctor begins the examination. Using magnifying optics, a gynecologist can examine the uterus, fallopian tubes and ovaries in detail, assess the contents of the pelvic cavity and draw final conclusions about the woman’s health. The manipulation is carried out only under general anesthesia.

Rehabilitation

After ovarian apoplexy, patients are shown rehabilitation to restore normal blood flow in the pelvic organs, as well as correct hormonal levels. The doctor will pay special attention to the central nervous system; you may need to consult a specialist.

Patients are prescribed Laennec therapy, massage, mud therapy, and gynecological massage. All these methods of postoperative recovery will help normalize blood circulation in the genital organs.

In the absence of contraindications, sanatorium-resort treatment is possible, where the above methods of rehabilitation of patients with gynecological diseases are practiced. With high-quality rehabilitation, women will be able to recover quickly enough both after surgery and after conservative treatment of the disease.

What kind of prevention should be carried out?

In order for a woman not to suffer the sad fate associated with this pathology, it is necessary to take care of her health. Even if you feel excellent, go to the gynecologist for an examination every six months. If there are gynecological problems, be observed regularly. Patients with adnexitis, oophoritis, polyendocrine syndrome or STDs must definitely treat their disease.

Women who have suffered from ovarian apoplexy should take care to ensure that there is no relapse. One of the preventive measures is complex treatment to normalize the menstrual cycle and improve blood supply.

Patients who have undergone surgery are required to monitor the restoration of hormonal levels and the normalization of blood circulation. They are advised to take nootropics and tranquilizers. Under no circumstances should you refuse such drugs. The use of multiphase oral contraceptives will ensure normalization of hormonal levels and help prevent ovulation. It is better not to plan pregnancy during this period. It is necessary to wait for the body to fully recover and become stronger. Then you can confidently hope for a successful pregnancy and birth of a healthy baby.

Observation by a doctor is considered mandatory.

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