September 4, 2011

Ovarian apoplexy   (other names - the gap ovarian corpus luteum rupture, myocardial ovary) - a condition characterized by sudden rupture follicle   or vascularization of the corpus luteum, formed at the site of the ruptured follicle, which leads to the violation of the integrity of the ovary, and is accompanied by severe pain, bleeding into the tissues of the ovary and the inner bleeding   into the peritoneum.

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

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

• fever, nausea, bleeding in ovarian tissue, in the absence of intra-abdominal bleeding ;
• anemic form of apoplexy, when the main symptom is internal bleeding ;
• mixed form of apoplexy, in which expressed the same symptoms of pain and mixed forms of the disease.

However, the division into shape is not very legitimate, because rupture of the ovary is always accompanied by bleeding, so the form of apoplexy are classified according to the severity of the disease and the amount of blood loss, highlighting light   (when the blood loss is 100-150 ml) average   (150-500 ml) severe   (blood loss of over 500 ml).

Rupture of ovarian most often occurs in the period Ovulation   or developing luteum Ie in the second half in the middle of the menstrual cycle. Typically, the disease occurs in women in the reproductive age of 20-35 years.

Ovarian apoplexy - quite a dangerous condition is 17% of the acute gynecological diseases and up to 2, 5% - among the causes of abdominal bleeding, which poses a serious threat to a woman's life, therefore, requires hospitalization and surgery.

The main causes that contribute to the rupture of the ovary are:

• time of ovulation;
• during the vascularization of the corpus luteum (the second phase of the cycle);
• varicose veins of small pelvis;
• pelvic inflammatory disease   ( hyalinosis . sclerosis of the stroma ) That cause sclerotic changes in the tissues of the ovary and its receptacles;
• long-term use anticoagulants That lead to blood clotting;
• hormonal disorders (a sharp increase pituitary gonadotropins , Resulting in an increased blood filling ovarian tissue ).

Risk factors contributing to the emergence of the disease include abdominal trauma, weight lifting, horseback riding, atypical sexual intercourse (interrupted, explosive), incorrect position of the genitals, vaginal examination, the pressure on the ovary tumor, adhesions, and stagnation in the pelvis, nervous breakdown . Prevention can prevent disease ovarian apoplexy, timely medical examination and treatment of diseases of the pelvic organs.

Usually there is a rupture of the ovary, usually right, which is better supplied with blood, since the right ovarian artery   It is connected to the aorta.

Symptoms of ovarian apoplexy

Symptoms of a heart attack depends on the nature of the ovary and bleeding associated diseases - acute appendicitis . pregnancy . The symptoms include sudden discontinuity ovary pain is localized in the lower abdomen occurring in mid-cycle or after a small delay of menstruation. Pain can give to the lumbar region, genitals, leg rectum. An attack can last from an hour to several hours, and repeated during the day. Bleeding into the peritoneum it is accompanied by weakness, pallor, dizziness , Tachycardia, lowering blood pressure, fever, chills, frequent urination, dry mouth. Sometimes this condition is accompanied by fainting, nausea, and vomiting occurs. On palpation of the painful side of the affected ovary. They can also disturb blood discharge from the genital tract and serous - from mammary glands.

Symptoms of ovarian apoplexy similar to some other acute diseases. Anemic form of myocardial ovary   similar to the picture interrupted ectopic pregnancy And painful form - with acute appendicitis.

Mixed form of ovarian apoplexy is similar to the pain, but with greater abdominal hemorrhage.

During a pelvic examination revealed pallor of membranes of the vagina, increased and painful ovary, an increase in the size of the appendages, the overhang of the vaginal vault (with anemic form of apoplexy).

The most common ovarian rupture occurs after violent sexual intercourse, intense exercise, ie in the case of pressure increase in the peritoneum, but it can happen and just rest or sleep.

Diagnosis of ovarian apoplexy

The clinical picture of apoplexy of the ovary does not have the characteristics and develops a similar pattern with other acute abnormalities in the pelvis. Most often, patients come to the hospital with a diagnosis of "acute abdomen", and doctors - surgeons and physicians need to quickly clarify the causes of pain, as blood loss increases ovarian apoplexy. Please differentiate ovarian rupture with acute appendicitis, peritonitis, ectopic pregnancy, renal colic, ovarian cysts, acute pancreatitis .

Confirms the diagnosis of the patient's complaints, such as the symptoms of ovarian apoplexy acute pain in the lower abdomen, which appeared in the second half of the menstrual cycle or in the middle. On examination, there is pallor of the skin and tachycardia . On palpation detected abdominal distention   and pain from a ruptured ovary.

Appointed by a blood test, which form when anemic apoplexy level will be lowered Hemoglobin . With the help of ultrasound of the pelvic organs can be seen in the ovary and bleeding blood stomach . Vaginal examination may reveal the nature of gynecological diseases. Auxiliary research methods include puncture posterior vaginal fornix, which allows you to determine the presence of abdominal bleeding. However, a definitive diagnosis of ovarian rupture is put at laparoscopy .

Treatment of ovarian apoplexy

Treatment of ovarian gap in hospital and dependent form of the disease and the degree of bleeding in the abdominal cavity. It aims to restore the integrity of the ovary and the elimination of the consequences of apoplexy. If you suspect a rupture of the ovary delivered to the patient gynecological hospital .

Conservative treatment of ovarian apoplexy shown in the milder forms of rupture that are accompanied by slight bleeding in the peritoneal cavity. However, studies show that conservative treatment in 85% of women, the formation of adhesions with the pelvis, while more than 40% developed infertility . Also often relapse. This is due to the fact that the blood collected after the gap remains in the abdominal cavity, where promotes the formation of adhesions in the pelvis.

When conservative treatment of patients assigned bed rest, complete rest, antispasmodic therapy Vitamins ( drotaverine . ascorbic acid . vitamins B1, B6, B12 ), Strengthen blood vessels, physiotherapy techniques. Put candles with antipyrine, apply ice to the lower abdomen, carry douching with the addition of iodine, Bernard currents, diathermy. However, at the slightest sign of deterioration prescribe surgery.

Therefore, conservative treatment of ovarian apoplexy prescribed mainly to women who already have children, and women planning pregnancy, laparoscopy is performed ( laparotomy ). Patients with diseases of the blood in violation of its clotting prescribe medication.

Laparoscopy as a diagnostic ovarian apoplexy and further complications show women with complaints of sudden acute abdominal pain and suspected bleeding. The operation is performed gentle manner while maintaining the integrity of organs and reproductive functions of women. During the operation, carried out coagulation vessel ovary, endometrium used in bleeding from rupture of the corpus luteum, or resection of the ovary, which removes only the affected part. However, massive bleeding, and the presence of a large ovarian hematoma , It is removed. During the operation, carried out inspection of both ovaries, appendix, fallopian tubes. During surgery, the abdomen is thoroughly washed, blood, and blood clots are removed. There is a faster way out anesthesia Less long stay in the hospital after surgery. After this operation, no significant cosmetic defect.

Contraindications to surgery is hemorrhagic shock Accompanied by a large loss of blood and loss of consciousness.

Prevention of ovarian apoplexy

After discharge from the hospital is important to prevent a recurrence of the disease in the future, ie, eliminate risk factors and promptly treat diseases provoked apoplexy ovary. If you have any suspicion of ovarian rupture, need to take a horizontal position and call an ambulance to hospital.