The apoplexy of the right ovary is a sharp hemorrhage with the subsequent rupture of the body tissue. It occurs spontaneously and is observed more often in the second half of the cycle during or after ovulation. This pathology is subject to women of reproductive age, usually up to 40 years. At the older age, the apoplexy happens much less frequently.

Violation of the integrity of one of the ovary (apoplexy)

In the middle of the cycle, when the egg ripens, then comes out of the dominant follicle, ovulation occurs. At the site of the burst follicle appears, generating progesterone. In the presence of various pathologies, hemorrhage can occur in the prioritial follicle, or a yellow body cyst, this is a right-sided apochia.

The appearance of apoplexy during or after ovulation is explained by the fact that during this period, the vessels become fragile under the influence of hormones and are easily damaged. At the scene of hemorrhage in the ovary appears hematoma, which is quickly filled with blood. The shell of this hematoma under pressure is rapidly destroyed, the blood is poured into the abdominal cavity, internal bleeding appears. This condition is a greater danger not only for health, but even for the life of a woman, therefore requires emergency care.

Apoplex in the right ovary is observed much more often than in the left. This is due to the fact that it is from the right side of large artery, and in general the vascular network is more extensive, as it is associated with the aorta. The ovarian is associated with the renal artery, which is less in size.

Doctors distinguish many reasons why the right ovary can occur. It is not always possible to determine accuracy that it was played by the role in the development of a pathological condition. Next, consider the most basic reasons for the applement of the right ovary:

Sometimes right-sided apoplexy can occur at a healthy woman in the absence of any pathologies. Such cases make it difficult to diagnose.

Symptomatics

In the apoplexy of the right ovarian, the symptoms are characterized by two main signs: pain and bleeding (both external and internal). The painful form is moderate or intense, localized to the right at the bottom of the abdomen.

Bleeding can resemble menstruation, with internal bleeding, the following features are observed:

• pallor skin;
• chills, tremor limbs;
• increasing body temperature;
• drop in blood pressure;
• heart palpitations;
• dizziness;
• cold sweat;
• total weakness.

With right-sided apoplexy, pain appears suddenly, it usually happens in the second half of the cycle during or after the onset of ovulation. Often painfulness is felt not only in the ovarian area, but also in the ivoid region (right under the diaphragm), can irradiate to the buttocks, lower back, sometimes in foot. With intensive pains may be nausea or vomiting.

In the presence of strong internal bleeding, the danger of the occurrence of hemorrhagic shock.

Diagnostics

When one or more specified symptoms of this pathology are found, as well as with a sharp deterioration of well-being, urgent hospitalization is necessary.

Diagnostic errors arise due to the fact that the right-sided apoplexy (ovarian break) has similar symptoms with many other diseases. These include:

• acute appendicitis (as appendix is \u200b\u200bright);
• interrupted pipe pregnancy (phallopyye tube breaking);
• intestinal obstruction;
• acute gastrointestinal diseases;
• renal colic, etc.

To avoid negative consequences of erroneous diagnostics, it should be carried out carefully and comprehensively and include the following activities:

1. Collect symptoms, examination of the patient's history. At this stage, the gynecologist studies the history of the disease, it is necessary to find out the presence of chronic diseases that are compared with symptoms.
2. Inspection in the gynecological chair. Usually at this stage, a woman experiences pain in the area where the ovary rupture occurred, so the inspection should be carried out very carefully.
3. General blood test for determining the degree of anemia (blood loss).
4. Blood test for hCG (to eliminate the interrupted ectopic tubular pregnancy).
5. Ultrasound is necessary for a more accurate picture, as the right-sided apoplexy is easy to confuse with other pathologies. The presence of blood in the abdominal cavity is visible on the monitor as a cluster of echo structures.
6. which is at the same time a diagnostic measure and operational. This procedure allows you to determine the very fact of the presence of apoplexy, as well as spikes or cysts. Also, with the help of laparoscopy, the region and the nature of the ovary damage is clearly visible, the presence of blood clots. The laparoscopic method is modern and safe, but has a number of contraindications. So, it cannot be used with internal bleeding to avoid the development of hemorrhagic shock, as well as with an extensive adhesive process. In this case, standard surgical methods apply.

Treatment

Emergency assistance in the right-sided apoplexy of the ovary can be provided by the Ambulance of ambulance before arriving at the medical institution. An independent reception of any drugs is strictly prohibited, since it is fraught with a false improvement and erroneous diagnosis.

In the case of conventional apoplexy, or if the ovary rupture occurred, the hospitalization is carried out at mandatory.

Depending on the severity of the pathological process, treatment can be conservative, operational or combine both methods.

Conservative treatment includes bed regime, taking antispasmodics and muscle relaxants, as well as hemostatic drugs and means against anemia (with a high content of iron). Sometimes it uses a cold heater on the right side of the abdomen.

The drug treatment method is applied in the event of a light form of the disease, but is rather risky. Without surgical intervention, the risk of recurrence of the disease, the development of an extensive adhesion process (spikes are formed from blood clots, which were not removed) and as a result - infertility.

Therefore, in order to avoid these complications, it is recommended to restore the external shells of the damaged ovary and remove the blood from the abdominal cavity. Fabrics, on the site of which the ovarian break occurred, stroke (at a cyst, its contents are removed), and then cavities (coagulation method).

Usually after the operation, the patient is in the hospital under the supervision of doctors for 5-7 days, then it is released home. Further restoration at home includes physical peace, the reception of painkillers and other drugs that appoint the attending physician.

Consequences and prevention

Operational treatment of right-handed apoplexy is carried out by gentle methods, which maximize the system to preserve the integrity of the ovary and its reproductive functions. Even with a break, persistent infertility does not always occur. Reproductive functions are lost only in particularly severe cases when pathology is observed on both sides, or is combined with other diseases that are incompatible with pregnancy.

About a month later, a woman can return to normal life and even to moderate physical exertion. However, a regular visit to the doctor is necessary to monitor possible complications of the operation.

The consequences of right-side apoplexy are mainly reduced to the development of adhesions, as well as chronic pelvic pains that are felt during ovulation. Doctors also do not exclude recurrence. To avoid this consequence, it is necessary to comply with all the recommendations of the doctor, in time to treat other gynecological diseases, eliminate intensive sports, as well as undergo regular diagnostics.

The consequence of inflammatory diseases of the uterus's appendages, as well as hormonal disorders in the body, may become irreversible changes in the ovaries tissues. The spikes and cysts formed during inflammation impede normal blood circulation, the permeability of the vessels increases. This can provoke a sudden tissue and vessels, the appearance of bleeding. There is a so-called apoplexy of the ovary, in which the woman feels acute pain. This condition is dangerous for life. A woman needs urgent medical care.

Content:

Types of apoplexy

The apoplexy of the ovary is called a sudden violation of its integrity. At the same time, a woman has a sharp strong pain in the lower abdomen. If a large vessel is damaged, then hemorrhage in the peritoneum. In a different way, this disease is called an ovarian infarction.

Depending on the specific manifestations, such pathology is divided into the following types:

1. Pained apoplexy of the ovary. In this form of the disease, bleeding in the peritoneum does not occur. There is a pain syndrome, there are no signs of blood loss.
2. Anemic (hemorrhagic). There is intra-painted bleeding. The mains are signs of increasing blood loss, the pain is not so strong.
3. Mixed. Broken fabrics, small and large vessels. Combined signs of both species.

With anemic apoplexy ovarian bleeding can be weak and strong. Depending on the volume of lost blood, 3 forms of such pathology are distinguished.

Easy - The loss of blood is not more than 150 ml (the first degree of hemorrhage).

Average - Volume of lost blood from 150 ml to 0.5 liters (second degree).

Heavy - more than 0.5 liters of blood (third degree) is lost.

Bleeding during the apoplexy of the ovary is caused by damage to the follicle vessels (grapham bubble) - the shell in which the egg generation develops. The reason is the gap of the follicular cyst (it can form inside the follicle, if for some reason the egg did not come out of it, that is, no ovulation occurred). Such anomaly is caused by hormonal violations.

At the same time, the connective tissue is rupture, as well as the cysts of a yellow body. Such a cyst is formed from the burst follicle after the exit of the egg. It is filled with blood.

Video: types of apoplections of ovary

Symptoms of apoplexy

The pain is a symptom of apoplexy of the ovary of any variety. It occurs suddenly, localizes in the lower abdomen. The pain can be permanent or appear in the form of attacks that continue from half an hour to 2-3 hours. Attacks after a small break can be returned. At the same time, colic or spasms like contractions.

If painful apoplexy arises, then the causes of pain are irritation of nervous endings in the tissues during the breaking of the fibers, as well as the spasms of the ovarian artery. With such a kind of apoplexy of the ovarian, the pain is sometimes felt in the field of rectum, navel, loin. The appearance of nausea and vomiting.

With anemic form, besides the bouts of pain, there are signs of bleeding: general weakness, dizziness, severe thirst, nausea, vomiting, headache, decrease in blood pressure, frequent pulse, fainting, pallor skin, cold sweat. It is possible to increase body temperature. The pain spreads to the leg, the crushes, the crotch area and the rear pass. The stronger the blood loss, the more pronounced symptoms.

With the mixed apoplexy of the ovary, all the symptoms are combined, besides, the appearance of blood secretions from the genital tract. Strong pain is felt during the feeling of the ileal abdomen. At the place of the break is formed by hematoma.

For the light stage of the apoplexy of the ovary, the periodic repetition of pain attacks is characterized, but they are short. With moderate severity, the bouts of pain cause loss of consciousness. If the disease occurs in severe form, the pain is permanently permanently, the abdomen (the so-called "sharp belly") occurs), heart failure appears, death can come.

The blood supply to the right ovary is carried out through the ovarily artery, which is directly connected to a large vessel - aorta. The left is supplied with blood through the ovarian artery extending from the renal artery. Due to the best blood supply, the right ovary has a larger size, mass, he has a more developed vascular network. Therefore, the apoplexy of the ovary is 2-4 times more likely arises from the right side.

According to symptoms, the apoplexy can be confused with ectopic pregnancy, acute appendicitis, renal colic, inflammation of the pancreas, cure ovary or its twist. Therefore, it is important to accurately determine the cause of pain in order to provide a woman in a timely manner.

Video: Ovarian apoplexy symptoms

Causes of rupture

The apoplexy of the ovary can occur at any woman of the childbearing age (about 12 to 50 years). Risk (40-60%) is quite large that the disease will repeat.

The following factors can provoke a break:

1. The presence of polycystic - the formation of a multitude of follicular cyst. At the same time, a woman has an impossibility of pregnancy, as there is no ovulation. Such a disease arises due to violation of the work of endocrine bodies.
2. Diseases associated with violation of blood coagulation or reception of drugs that dilute blood (anticoagulants).
3. Vascular diseases (narrowing of the lumen of vessels - atherosclerosis, expansion of the ovary vein).
4. Inflammation of ovaries and uterine pipes.
5. Reception of drugs that stimulate ovulation.
6. Blood impairment in the ovary due to the unusual arrangement of the uterus, the presence of adhesions, squeezing vessels with tumors in the organs of the small pelvis.
7. Traumatic damage to tissues and vessels in the abdomen.
8. Increased intra-abdominal pressure when lifting weights, enhanced sports activities, during sexual intercourse.

However, sometimes it happens that the apoplexy of the ovary arises in the absence of such factors in a woman who does not have any deviations in a state of health. The gap can occur even during sleep.

It is believed that the main reason is the imbalance of hormones, namely the increased production of the lactotropic hormone of prolactin and gonadotropic hormones - FSH (follicularity) and LH (luteinizing). FSH and LH regulate the work of the ovaries, the formation of eggs in follicles. Prolactin affects the ratio of sex hormones responsible for all the processes of the menstrual cycle.

The cause of the apoplexy of the ovary can also be strong experiences, nervous breakdowns, neuropsychiatric diseases. The state of the nervous system has a direct connection with hormonal processes in the body.

The greatest probability of the break is created at the time of ovulation (the middle of the menstrual cycle), as well as during the formation of a yellow body and its vascular system (the second phase of the cycle).

Possible complications

A large loss of blood caused by a rupture of large vessels can lead to hemorrhagic shock - a sharp drop in blood pressure. If the help is not rendered on time, death can come.

After the treatment of apoplexy of the ovarian, the formation of adhesions in the ovary becomes complications, the repetition of breaking subsequently, as well as infertility. Especially likely to appear such complications after conservative treatment. With laparoscopic timely treatment, the patient's reproductive health is possible.

A warning: When acute pain in the lower abdomen occurs, especially in the middle or in the second half of the menstrual cycle, the woman must necessarily take a stay. It is necessary to immediately call "ambulance".

With intra-abdominal bleeding in women, about 2-3% of cases, the cause of the ovarian apoplexy is.

Diagnostics

Such a sign like a "acute belly" is also characteristic of other serious pathologies in the bodies of the small pelvis. The purpose of the diagnosis is to confirm that the ovarian rupture (apoplexy) has occurred, and not damage to the phallopyheological pipe due to ectopic pregnancy. It is also necessary to exclude suspicion of appendicitis.

The prehistory of the disease is studied to understand whether it has a connection with the phases of the menstrual cycle. Methods are used that allow you to quickly understand the nature of the pathology, to detect an increase in the size of the ovary.

General blood analysis Shows the content of hemoglobin and the speed of its coagulation. This suggests the presence of anemic or mixed apoplexy of the ovary. Increased concentration of leukocytes indicates the appearance of the inflammatory process.

Puncture of the rear vessel of the vagina. In the peritoneum between the uterus and the rectum there is a deepening in which the liquid accumulates. The study of its composition makes it possible to establish the presence of intra-abdominal bleeding. To take the trial of this fluid, it is necessary to pierce the rear wall of the vagina using a special needle. The presence in fluid of blood and pus is determined.

Ultrasound - To study the structure of the yellow body, the formation of hemorrhage in it.

Laparoscopy. An optical instrument (endoscope) is introduced into the abdominal cavity through the puncture. The method allows you to accurately determine the cause of the bleeding and the nature of the apoplexy of the ovary. If necessary, this method can be immediately eliminated by pathology.

Video: Treatment of apoplexy ovarian

Treatment

There are two methods of treatment: conservative and surgical.

Conservative treatment of apoplexy of ovaries includes the reception of antispasmodic drugs, weakening pain, and hemostatic (preparations that strengthen vessels). At the same time, the woman prescribes full rest, ice is laid on the bottom of the belly. Appointments of vitamins B1, B6, B12, as well as subsequent physiotherapy are prescribed.

There is a round-the-clock observation of the state of a woman. When repetition of a painful attack and deterioration of well-being operations.

This method of treatment can be used only with a light form of pain apoplexy of the ovary in the absence of bleeding into the abdominal cavity. About 50% of cases in women there is a repetition of such a disease. In the ovary and cavity of the peritoneum remains blood clot, spikes. The likelihood of infertility is great. Therefore, this method is not applied to the treatment of born women or planning other children subsequently.

Surgical treatment is the main way to eliminate such pathology. Most often, even with a light form of apoplections of the ovary, endovidoscopic treatment (laparoscopy) is used. At the same time, the worshicle of the cyst is removed, coagulation (soldering) of vessels and ovarian sewing is made. After stopping bleeding, it is washing the cavity of the peritoneum by a disinfectant solution, removal of blood clots. Thanks to such a gentle operation, a woman maintains the opportunity to conceive a child subsequently, since the lack of adhesions on the ovaries guarantees their normal functioning.

With severe forms of apoplexy of the ovary with strong bleeding and a large area of \u200b\u200brupture, laparotomy is carried out. In this case, an incision on the pureth wall is made. The ovary is usually trying to save. If the gap is very large, it is removed.

Video: How laparoscopy is performed. Condition after surgery

Ovarian break during pregnancy

The emergence of apoplexy of the ovary is possible during pregnancy. In this case, only the surgical method of suturing of the ovary is used. Maximum efforts are applied to preserve pregnancy. At the same time, accuracy and speed of diagnosis becomes even more important. Different profile doctors are attracted: urologist, gynecologist, surgeon.

Rehabilitation after treatment

After surgery, rehabilitation treatment is carried out to prevent the inflammatory process in the abdominal cavity, as a result of which spikes may form. Scars and spikes provoke the occurrence of repeated apoplexy of the ovary. The methods of physiotherapy are used:

• electrophoresis with zinc solutions, copper, calcium chloride and drugs, contributing to the restoration of the structure of the ovarian tissues, resorbing scars and hematomas (lidase, for example);
• laser therapy;
• Microwave therapy (exposure to ultra-high frequency current);
• ultrasound treatment.

In this case, it is necessary to use hormonal contraception to complete restoration of the ovarian functioning (at least 6 months after the operation to eliminate the apoplexy of the ovary). Planning a pregnancy after rehabilitation is recommended only after the diagnostic examination by the method of laparoscopy and confirm the full healing and the absence of the inflammatory process.

Prevention of repeated apoplexy

If the patient has an apoplexy of the ovary in a light form and arose against the background of hormonal disorder, then special preventive measures are not required, since after restoring the functioning of the ovary, the hormonal background comes back to normal.

If the disease occurs as a result of vascular disorders and vegetative disorders (increased tone of muscles, neurosis and others), accompanied by hemorrhagic bleeding, treatment is carried out. It is prophylactic, continues for 3 months. Preparations are prescribed to improve the blood supply of the brain, income into it oxygen (Cavinton, Tanakan), psychotropic drugs. In addition, diuretic drugs are used to eliminate internal edema.

To restore the hormonal background after the treatment of the ovarian apoplexy for 3-6 months, it is necessary to take microdosted contraceptive pills with estrogen and progesterone (Marvelon, Zhanin, Femoden).

The gap of the ovary or the medical terminology "Apoplexia" (Apoplexia Ovarii) is defined as suddenly occurring hemorrhage into the body when the vessels of the vessels of the grapple bubble, the stroma of the ovary, follicular cyst or the cyst of the yellow body, accompanied by a disorder of the integrity of the ovarian tissue and bleeding in the abdominal cavity.

More often the ovarian breaks are between the ages of 14 and 40, usually in 20-35 years. However, there are cases of hemorrhage among young girls and adolescents. Its frequency among gynecological pathology is 1-3%, recurrence with the disappearance of adequate rehabilitation reaches 40-70%.

How does the ovarian apoplexy arises

In the ovaries of a hawk woman there are growing follicles, ripening eggs in them, that is, preparation for the upcoming pregnancy. From the beginning of the menstrual cycle, the dominant follicle begins to grow, which by the middle of the menstrual cycle reaches its maximum size - about 20 mm. Then the follicle shell is broken, producing ripened eggs, - ovulation occurs. A temporary formation is formed on the site of the follicle, a yellow body, which produces certain hormones, prepare the body of a woman to pregnancy. This is the normal course of the ovarian cycle.

In the dystrophic and sclerotic changes in the ovarian tissue, occurring during acute and chronic inflammatory processes in the apparatus of the uterus, with polycystic ovary syndrome, adhesive process and some other diseases, as well as during the drug stimulation of ovulation, there are certain disorders in the process of ovulation and the formation of a yellow body. As a result, blood vessels at the site of the ovarian break point are poorly reduced, international bleeding continues and enhanced, and in the yellow body, hematoma hematoma is formed due to the fragility of the vessels. All this is accompanied by pain syndrome, weakness, dizziness, nausea, vomiting, pallor of skin, fainted condition. Without the appropriate treatment, internal bleeding when the ovarian break can increase, creating a real threat to the health and life of a woman.

Causes of ovarian breaking

Most doctors allocate "critical moments" for damage to the ovary. So, in 90-95% of patients the apoplexy of the ovary occurs in the middle and in the second phase of the menstrual cycle. This is due to the features of the ovarian tissue, in particular with the increased permeability of the vessels and the increase in their blood flow during the period of ovulation and before menstruation.

The apoplexy of the right ovary is found at 2 - 4 times more often than the left, which is explained by its more abundant blood circulation, since the right ovarian artery is directly from the aorta, and the left - from the renal artery.

In women, the inflammatory processes of the small pelvis are predisted in women, leading to adhesive processes and, as a result of this, sclerotic changes both in the ovarian tissue (sclerosis of stroma, fibrosis of epithelial elements, periophores) and in its vessels (sclerosis, hyaline ), as well as stagnant hyperemia and varicose veins of a small pelvic organs.

Apoplexes of ovary can contribute blood disease and long-term intake of anticoagulants, leading to a violation of the coagulation system of blood.

Among other reasons, abdominal injury, physical stress, stormy or interrupted sexual intercourse, horse riding, dying, vaginal research, etc. They may be the wrong position of the uterus, mechanical compression of vessels, adhesions in a small pelvis, etc. Sometimes occurs without visible reasons at rest or during sleep.

The leading role in the development of this state is currently allocated disorders of hormonal status. One of the main reasons for the ovarian break is considered an excessive increase in the number and changes in the ratio of gonadotropic hormones of pituitary glands (FSH, LH, Prolactin), which contributes to ovarian tissue hyperemia.

The main forms of apoplexy in the ovary

Eliminate pain, anemic and mixed form of apoplexy of the ovary. Currently, the classification is most often used (Savelyeva G.M.), taking into account the severity of intraperous blood loss:

1. painful form.

2. Hemorrhagic form:

I degree - light (intra-abdominal blood loss does not exceed 150 ml);
. II degree - average (blood loss 150-500 ml);
. III degree - severe (intraperous blood loss more than 500 ml).

Symptoms of ovarian break

The main complaint with the ovarian breaking in women is a sudden pain in the lower departments of the abdomen. The pain is associated with irritation of the receptor field of the ovarian fabric and the impact on the abutant blood, as well as with a spasm in the ovarian artery pool. Such signs as weakness, dizziness, nausea, vomiting, a fainting condition are associated with intra-abdominal blood loss.

The painful form of apoplexy is observed with hemorrhage into the ovary or yellow body fabric without bleeding into the abdominal cavity. The disease is manifested by the attack of pain at the bottom of the abdomen without irradiation, sometimes with nausea and vomiting. There are no signs of intra-abdominal bleeding. Clinical symptoms of pain and light hemorrhagic shape are similar.

In the clinical picture of the middle and heavy hemorrhagic (anemic) form of the apoplexy of the ovarian, the main symptoms are associated with intra-abdominal bleeding. The disease begins acutely, often associated with external causes (sexual intercourse, physical stress, injury, etc.). Pain in the lower sections of the abdomen often irradiates to the rear pass, leg, crushes, outdoor genitals, accompanied by weakness, dizziness, nausea, vomiting, fainting. The severity of symptoms depends on the value of intra-abdominal blood loss.

DIAGNOSTICS

With an ultrasound of a small pelvis, a significant amount of free fine and medium-part fluid in the abdominal cavity is determined with the structures of irregular shape, increased echogenicity (blood clots). To diagnose the apoplexy of ovaries without pronounced disorders of general well-being, the puncture of the abdominal cavity through the rear arch of the vagina. However, the method of choice is optimally diagnostic laparoscopy.

Treatment of apoplexy ovarian

The approach to the treatment of patients with apoplexy of the ovary depends on the form of the disease and severity of intra-painting bleeding. With pain and insignificant intra-abdominal blood loss (less than 150 ml) without signs of increments of bleeding, you can conduct conservative therapy. Medical treatment of the apoplexy of the ovary includes peace, ice to the bottom of the abdomen (contributes to the vessels of the vessels), the preparations of hemostatic action, antispasmodic agents, vitamins, physiotherapeutic procedures (electrophoresis with calcium chloride, microwave therapy), especially during the rehabilitation period.

Conservative therapy for the ovarian breaks is carried out in the hospital under round-the-clock supervision. With a positive dynamics from conservative therapy, the patient is issued under the supervision of the doctor a gynecologist of an outpatient institution for further treatment and prevention of relapses and complications.

With hemorrhagic form, re-attack pain, deterioration of the general condition, instability of hemodynamics, increasing the amount of blood in the abdominal cavity clinically and when ultrasound of a small pelvis appear to indicate operational intervention(laparoscopy, laparotomy). At the same time, it is necessary to refund blood loss (repentance, transfusion of donor blood, blood substitutes), if necessary, administer cardiovascular drugs.

The apoplexy of the ovary occurs infrequently, but its consequences and complications can stay in a woman for life. Therefore, it is essential in the preservation of women's health and reproductive function in particular, a reducing stage and recurrence prevention is given. Preventive measures are aimed at reducing the likelihood of repeated ovarian break. In order to prevent the repetition of the status and restoration of hormonal status, the patient is prescribed oral contraceptives. Women and girls gynecologists recommend avoiding the factors that provoke this condition, to pass inspections every six months and in time to contact a specialist for help. Timely treatment of diseases of the uterus and its appendages contributes to the healthy functioning of the entire sexual system.

The site provides reference information solely to familiarize yourself. Diagnosis and treatment of diseases must be under the supervision of a specialist. All drugs have contraindications. Consultation of a specialist is obligatory!

Anatomy and ovarian physiology

Disease prevalence

The reasons

Against the background of these reasons, there are external and internal factors that can provoke an apoplexy of the ovary.

Internal factors:

• Spikes in a small pelvis.
• The pressure on the ovary located next to the tumor (this may be the mioma of the uterus or tumors who are not related to female genital organs).
• Violation of blood flow in the ovary and feeding it vessels.
• Incorrect position of the uterus.

External factors:

• Excessive physical overvoltage.
• Abdominal injury.
• Sexual intercourse (especially in the middle of the menstrual cycle).
• Act of defecation.
• Horseback riding.
• Examination at the gynecologist with mirrors.

Basic symptoms

Forms of the disease

Hemorrhagic, or anemic form. The disease is developing sharp, and is often associated with external provoking factors - sexual intercourse, exercise, trauma. The main symptoms at this form of apoplexy are associated with intra-painted bleeding. The pain is felt in the lower departments of the abdomen, often pulls out the rectum, exterior genitals, seats and back. There is almost always weakness, dizziness, nausea, vomiting. With severe internal bleeding, the pulse is increased, reduced pressure and loss of consciousness.

Mixed form. Signs of apoplexy of the ovary in this form begin with pain syndrome, but with abundant bleeding, manifestations of anemic version of the apoplexy are joined.

Diagnostics

I. Complaints: Pain, nausea, vomiting, signs of internal bleeding.

II. History of the disease. In 90-95% of women, the apoplexy of the ovary occurs in the middle or in the second phase of the menstrual cycle (after 14-21 days from the beginning of the monthly). These are the so-called "critical moments", because during the period of ovulation (exit of the egg) and before menstruation, the blood vessels become more permeable and crowded, which contributes to their rupture.

III. Inspection of the patient. The general condition will depend on the form of apoplexy. With pain, the general condition will be satisfactory. The skin of the usual color, pulse and pressure will be located within the normal range. The stomach remains soft, painful above the pubic, more often on the right. In the hemorrhagic form of the apoplexy of the ovary, the pallor of the skin and mucous membranes will be observed, there may be a cold sticky sweat. Blood pressure in the patient will be lowered, and the pulse is rapidly. There is a bloating of the abdomen and sharp pain in the lower departments.

IV. Generally clinical analyzes. In general blood test, the hemoglobin rate is reduced (but with acute strong blood loss due to blood thickening, it may remain normal), the level of leukocytes (inflammation cells) can be elevated.

V. Instrumental research. The ultrasound during the apoplexy of the ovary will determine the liquid (blood) in the abdominal cavity. For accurate diagnosis of the character of the fluid, medical manipulation is performed - puncture (puncture) of the abdominal cavity through the vagina. This intervention is performed under anesthesia. If this study did not help to make a diagnosis, operation is carried out - diagnostic laparoscopy.

Conservative treatment

Treatment should be carried out only in the hospital, under the clock observation of medical personnel. In the event of a repetition of a painful attack, with a worsening of the general condition and indicators of analyzes, the issue of conducting an operation.

Surgery

• Lack of effect from imperative treatment conducted within 1-3 days.
• Continuing internal bleeding confirmed by ultrasound data.
• Differential diagnosis of the apoplexy of the ovary and other acute gynecological or surgical pathology.
• With a satisfactory condition of the patient, normal indicators of analyzes and presence in the abdominal cavity no more than 150 ml of blood.

• If for any reason it is impossible to carry out laparoscopy (spikes in the abdominal cavity, abundant bleeding from vessels located on the surface of the ovary).
• Emergency assistance in apoplections of ovary with strong internal bleeding with a common state impaired (low pressure leading to a shock state with loss of consciousness).

Differential diagnostics during the apoplexy of the ovary

Pregnancy after the apoplexy of the ovary

Difficulties with conception may occur in the formation of adhesions in the abdominal cavity. To minimize the consequences of the apoplexy of the ovary, it is necessary to comply with all the recommendations of the doctor in the rehabilitation (recovery) period:
After the transferred operation about the apoplexy of the ovary, the need for prevention is determined by the form of the disease. If there was a painful form of apoplexy, special preventive measures to prevent re-apoplexy is not required, since all changes in the level of hormones and blood supply in the ovary will soon come to normal.

Prevention is necessary for the patients who transferred the hemorrhagic form of the apoplexy, since they have resistant disorders of the hormonal background and the work of the central nervous system.
In such a situation, a set of events is appointed, which includes the application:

• Drugs that improve the activity of the nervous system (the so-called nootropic drugs - piracetam, nootropyl).
• Preparations that improve cerebral circulation (Tanakan, Cavinton, Vinpocetin).
• Diuretics with increasing intracranial pressure.
• Drugs normalizing the hormonal status of the body (

Apoplex ovarian - sudden damage to fabric and vessels ovarian, as a result of which bleeding in the abdominal cavity. This pathology is accompanied by painful sensations and blood loss of varying degrees. In the international classification of diseases of the tenth revision ( MKB-10) The apoplexy of the ovary is highlighted in two points. Point N83.0 corresponds to a hemorrhagic follicular ovarian cyst, and paragraph N83.1 is a hemorrhagic yellow body cycle.

This pathology is usually characteristic of women in reproductive age. As a rule, women are suffering from this disease 25 to 40 years. The apoplexy of the ovary is more often observed in the second phase of the menstrual cycle or during the period of ovulation ( the process in which the mature egg leaving the ovary). Often, the rupture of the ovarian tissue can occur during pregnancy. Recurry ( re-exacerbation) Apoplexes of the ovary occurs in 40 - 70% of cases.

Interesting Facts

• Prolonged anticoagulant treatment ( antoslude funds) Increases the likelihood of apoplections of the ovary.
• Sudden rupture of the ovarian tissue sometimes occurs even during sleep.
• Horse riding can cause an apoplexy of the ovary.
• According to statistics, the apoplexy of the left ovary occurs 3 times less frequently. The thing is that the left ovary feeds the smallest artery, and the blood circulation in it is less intense than in the right ovary.
• Not only women of reproductive age can suffer from this pathology. Cases of appearances of ovaries at the age of fourteen were described.
• Apoplex ovarian can cause strong bleeding. The volume of blood loss in some cases is more than 1 liter. Such massive bleeding can directly threaten life.

Anatomy of ovarian

In the structure of the ovary, the following components can be distinguished:

• nominal epithelium;
• bell shell;
• cortical substance;
• brainstuff.

Non-epithelium

Skin shell

Cork substance

The following stages of the development of the follicle are distinguished:

• Primordial follicle.This follicle is the most immature form. On average, the primordial follicle has a size of 50 microns. It is surrounded by only one layer of follicular cells. Primordial follicle is the most numerous form of all types of follicles. In each follicle there is one oocyte ( unripe shape of eggs). At the time of birth there are 1 - 2 million primbradial follicles in each ovary. Ripening of follicles is carried out after a pubertal period ( period of puberty).
• Primary or prehane follicle.Follicle, in which the process of ripening eggs has already begun due to the impact of the follicularity immuling hormone. Primary follicle several times more than the priority follicle. The size of the primary follicle is approximately 150-200 microns. This follicle is coated in two or three layers of follicular cubic cells.
• Secondary or antral follicle.The secondary follicle differs from the previous ones that a follicular cavity with liquid is formed. The cells of the secondary follicle are able to produce estrogen. This hormone has a feminizing effect and leads to the development of uterus, uterine pipes, vagina, mammary glands, and also participates in the formation of female secondary sexual signs. The secondary follicle includes granular cells that are synthesized progressin. This hormone prepares the body to pregnancy and is supported by it ( gestration). The size of the secondary follicle is 500 microns.
• Tertiary or prevail follicle.For the tertiary follicle, the rapid growth and differentiation of cells is characteristic. The tertiary follicle contains 100 times more follicular fluid than the secondary follicle. The size of the tertiary follicle is about 1 mm.
• Mature follicle or grappes bubble.The size of the mature follicle is 18 - 20 mm. The egg cell, which is part of the graon bubble, is fully ready for ovulation. Before ovulation, the wall of the follicle is distinguished slightly. Subsequent on the place of the protrusion takes place. The egg leaves the follicle and falls into the ovage ( ovulation). On the site of the graon bubble, a yellow body is formed, producing progesterone further. This hormone stops premature menstruation and promotes normal fertilization.
• Atrettic follicle. For the ovulation process, only one mature follicle is needed. In case there are two and more mature follicles, some of them are subjected to atresia ( death). Under the action of a special hormone of gonadakroninine, tertiary or mature follicles can be programmed destroyed. In their place, an atrethic body is formed, which is capable of synthesize estrogens.

White body is a reborn yellow body. In the event that fertilization did not happen, the yellow body is reorganized in the form of a connective tissue. After some time, the white body of the ovary can completely disappear.

Brainstuff

The reasons for the apoplexy of the ovarian

To the most frequent reasons for the apoplexy of ovaries can be attributed:

• ovarian inflammation ( ooforit);
• varicose veins of the ovarian veins;
• medical stimulation of ovulation;
• polycystic ovarian.

Inflammation of the ovary

The ooforite arises due to microorganisms in the shell of the mature follicle after ovulation. As in any inflammatory process, the ooforite is characterized by the emergence of the painful sensation, the appearance of hyperemia ( overflow of blood organ), the formation of the pathological secret ( exudate), the occurrence of the edema of the ovary. The same processes occur in the uterine tubes. The painful sensation is projected at the location of the ovary and the uterine tube, at the bottom of the abdomen. Often, SalpingOforite can lead to acute appendicitis.

Varicose veins of ovarian veins

The reasons for the emergence of varicose extensions of the ovarian veins:

• Heavy working conditions.Daily activities in a forced pose ( sitting or standing) Leads to a significant increase in pressure in the venous system of the small pelvis organs and becomes a starting mechanism for varicose expansion of the ovarian veins. Venous hypertension is considered to be the main factor in the emergence of varicose expansion of the ovarian veins.
• Repeated pregnancy and childbirth.During pregnancy, as well as during childbirth, the female organism is experiencing a colossal load on various organs. As a rule, in these physiological conditions, pressure increases in vessels. Blood pressure rises not only in the arteries, but also in the veins. Statistics indicate that it is re-pregnancy and childbirth that is the main cause of the varicose veins of the ovarian veins.
• Diseases of the women's reproductive system.A number of female genital diseases can lead to the appearance of varicose expansion of the ovarian veins. Such diseases include the ovarian tumors, twisting a wide bundle of uterus, endometriosis.
• Hyperastroy.Hypereresses are characterized by an increase in the synthesis of female sex hormones - estrogen. This endocrine violation may be a consequence of an oncological disease of the ovary. In turn, the ovarian tumor is able to entail the emergence of varicose expansion of the ovarian veins. Also, hyperacters also cause for a number of serious diseases, from which endometriosis can be distinguished, the formation of uterine polyps, fibromyoma of the uterus, etc.
• Hormonal contraception.This type of contraception is one of the most popular and efficient. If the hormonal contraception was incorrectly selected, various side effects may occur. One of the side effects is the increased pressure in the venous pelvis network.

Medical stimulation ovulation

The use of various diagnostic stimulation schemes has a number of disadvantages. The side effects of this method include the cysts of ovarian, violation of the hormonal background, the apoplexy of the ovary.

Polycystic ovarian

With this pathology, the following modifications are allocated: a bilateral increase in ovaries at 2 - 6 times, stroma hyperplasia ( education in the excess of new structural elements), the presence of a large number of cystic follicles ( the cyst is formed from a mature follicle), thickening of the ovarian capsule.

In the cortical matter, with polycystic ovaries, there are many cystic atretic follicles. These follicles are pathological formation, and the body seeks to reduce their number. When reorganized ( connective tissue) The major cystic atrethic follicles can occur their destruction, which will lead the tear of the ovarian tissue and the appearance of bleeding.

Symptoms of apoplexy ovarian

The apoplexy of the ovary is characterized by the following symptoms:

• pain at the bottom of the abdomen;
• a sharp decrease in blood pressure, the increase in the pulse;
• general weakness;
• impairment of the menstrual cycle;
• student urination.

Pains at the bottom of the belly

Sharp reduction in blood pressure, pulse

Total weakness

Disruption of menstrual cycles

Student urination

In some cases, the apoplexy of the ovary can cause a violation of the hormonal background. As a result, the impact of some hormones on the bladder can lead to the stretching of its wall. As a result of excessive stretching of the bladder wall, an increase in urination frequency increases. Also, the convergence of massive edema of the ovary can be accompanied by the participation of urination.

Diagnosis of apoplections of ovarian

To confirm the diagnosis of ovarian apoplexy, the following methods are used:

• gynecological examination;
• Uzi small pelvis organs;
• puncture of the rear vessel of the vagina.

Gynecological examination

Next inspects the wall of the vagina. For this manipulation uses special gynecological mirrors ( a tool that is used to expand and reveal the vagina). Most often, the mucous vaginal remains ordinary color. If the apoplexy of the ovary leads to massive bleeding, characteristic of anemic form, then the mucous membrane of the vagina has a pale pink color.

The next stage in the gynecological examination is bimanual ( two-handed) Vaginal research. This manipulation is necessary to determine the position, state and size of the uterus, as well as the appendages of the uterus ( ovaries and uterine pipes). Quite often, the bimanual study of the vagina reveals pain in the place of projection of one of the ovaries with one-sided apoplexy. Palpation of the affected ovary delivers painful sensations. The size of the ovary remains normal or slightly increased.

Uzi small pelvis organs

Ultrasound examination, as a rule, helps to see some structural changes in the ovary. The dimensions of the affected ovary can be slightly increased or located within the normal range. In apoplections, you can see the inhomogeneous structure in the cortical matter. This structure is a yellow body. In most cases, it is the yellow body that causes bleeding. If there are no accompanying gynecological diseases ( polycystic ovarian), In the follicles, no pathologies are detected. The main confirmation of the diagnosis of the anemic form of the apoplexy of the ovarian is the detection of free fluid in the abdominal cavity behind the uterus.

It is worth noting that the assessment of the state of the affected ovary should be carried out in comparison with a healthy ovary, and the period of the menstrual cycle must also be taken into account.

Laparoscopy

With laparoscopic diagnostics, it is almost always possible to detect a certain amount of blood in a small pelvis. If the apoplexy occurred recently, the blood will be homogeneous consistency without a large number of clots. The presence of bunches suggests that the rupture of the ovarian tissue and hemorrhage occurred in a day or a few days before laparoscopy. In the future, these bunches can lead to the spike of the abdominal organs. When examining the uterus, its size and color remains normal. Quite often, it is possible to detect chronic inflammation of the uterine pipes, which is expressed in the presence of near-robber adhesions ( spikes around uterine pipes).

When the yellow body is ruptured, the ovary, as a rule, retains normal sizes. An increase in the ovary is observed only when hemorrhage leads to the hematoma in the cavity of the ovary itself. If the apoplexy of the ovary is a consequence of the rupture of the cyst of the grappa of a bubble or a yellow body, then the affected ovary has a purple-crimson color. Also, the presence of cyst causes an increase in the size of the ovary.

Vagina rear axle

Conservative ovarian apoplexy

The main drugs in conservative treatment are coagulants ( heal standing drugs), antispasmodics and vitamins. Also needed a chamber ( semiating) Mode. To achieve a stop of bleeding, as a rule, use the applying of cold to the lower part of the abdomen.

Medicia treatment includes:

• spasmolytics;
• hemostatic drugs;
• vitamins.

Spasmolytiki

Antispasmodics have a different form of release. In each case, it is precisely the doctor who must choose the necessary medical preparation, dosage, as well as the duration of the use of this medication.

Antispasmodic drugs

Heal standing drugs

Hemostatic resorbative preparations

Vitamins

Vitamins Group B.

Surgical treatment of apoplexy ovarian

Indications for the operation

Contraindications

Techniques for apoplexy

Laparoscopic method
Laparoscopic operation is a modern surgical method of operating the abdominal organs using special equipment. The main tool is a laparoscope with a video camera that transmits an image to a special screen. This method has a number of advantages over long-term operations. He is minimally invasive and does not lead to the appearance of large scars and scars. Within a few months after the laparoscopic operation of the seams in place, where the incision was carried out, become almost invisible. The postoperative period is much faster, and the time of finding the hospital after the operation is significantly reduced. During the operation in the abdominal wall, 3-4 small holes are less than 1.5 cm, through which laparoscope and auxiliary tools are introduced.

Laparoscopy during apoplexy of the ovary is extremely gentle. In most cases, only the exposure of the ovarian break site is produced. If the apoplexy occurred during pregnancy, it is not replaying for its preservation ( excision), and earsing the yellow body. The ignition of the region of bleeding of the protein shell is produced using an electrosurgical coagulator. This is due to the supply of high-frequency current, which heats the surrounding tissues. As a result of heating the protein, which is in the tissues, is coagulated, and bleeding stops. If massive bleeding is observed, a long coagulation is produced ( the use of electrosurgical coagulator).

The removal of the ovary is a necessity only when the apoplexy is observed along with another disease of the uterus's appendages, such as, for example, when twisting the legs of the uterine tube. In any other cases, the exposure of the ovarian breakdown or the removal of the ovarian part of the ovary is to maintain a childbearing function, as well as not to break the hormonal background. During laparoscopy, it is extremely important to inspect both ovaries for the presence of bilateral apoplexy. It is also necessary to inspect the uterine pipes and a worm-shaped process ( appendix) Since apoplexy can proceed in combination with ectopic pregnancy or to meet with acute appendicitis.

Endotracheal anesthesia is most often used for anesthesia. In the course of the operation, the abdominal cavity was washed and blood clots and all blood remove. Further, the abdominal cavity is in layers. In case of impossibility of holding a laparoscopic operation, resort to laparotomy.

Laparotomic method
Laparotomic operation - an operation on the abdominal organs, at which a wide section of the abdominal wall is made for access. This operation is carried out in the event of a detection of contraindications to the laparoscopic operation. Lapotomy is shown in the case of hernia of the white lines of the abdomen or if the laparoscopic method fails to stop the bleeding with an electrocoagulator. The dissection of the abdominal wall makes a long 8 - 10 cm. The velocity of the cut is the suggestion area.

For anesthesia, endotracheal anesthesia is used. During the operation on the ovary it is necessary to remove all the bloodflow in the abdominal cavity. At the end of the operation, the abdominal cavity layers in layers. In the following days after the operation, it is necessary to carry out antibacterial therapy.

Recovery after apoplexy

The dynamics produces an ultrasound study of the ovaries for the presence of recurrence of apoplexy. If various changes are revealed in the results of blood and urine test results, then their correction is carried out. In violation of the hormonal background, the attending physician individually selects the necessary treatment regimen. Antibiotic therapy is prescribed in the case of a laparotomic operation, as well as the indication. With laparotomy, it is necessary to wear compression linen, as well as various bandages on the belly for two months.

The gentle nature of the laparoscopic operation allows in most cases to preserve the female function of the woman. Even when removing one ovarian, the chance to get pregnant remains extremely high. However, with ovariectomy ( oophorectomy) Risk of ectopic pregnancy increases. Natural pregnancy is not possible only with inflammatory and dystrophic changes at the level of both the uterine appendages or in the case of a tumor disease. It is worth noting that within 1 - 2 months after surgery, you must eliminate any sex contacts.

Disability occurs after 30 - 50 days. In the event of various gynecological complications, it is necessary to urgently cause ambulance or contact the hospital.