Ovarian apoplexy: characteristics of the pathology, symptoms and consequences
Ovarian apoplexy is an acute gynecological pathology, which is a sudden, spontaneous, rapidly progressive bleeding into the ovary with the further flow of blood beyond this internal organ directly into the abdominal cavity. In other words, ovarian apoplexy is a sudden rupture of the vessels, violation of the integrity of tissues of the female reproductive organ, which is accompanied by a pronounced pain syndrome. Ovarian apoplexy in most cases is very hard and provides serious risks to a woman’s life. Therefore, the sudden rupture of the ovary is a major indication for emergency surgical intervention.
Before you can understand the basic causes and symptoms of apoplexy should be more details to highlight some of the anatomical peculiarities of the female body. As you know, the ovaries are the paired internal organs located in the pelvis, on either side of the uterus. The average size of ovary is approximately 3 cm in length, width of body, about 2-3 cm and a thickness of 1-1,5 cm depending on the phase of the menstrual cycle the size of the ovary can vary significantly upwards.
The ovaries perform an extremely important function in these paired organs develop into female sex hormones, estrogen and progesterone. Each ovary contains special follicles, which are located inside the egg, ready for further fertilization. For a time equal to the duration of the menstrual cycle, the egg fully Matures, the follicle bursts and the egg comes out.
Apoplexy of the ovaries is found in virtually any age, but the main risk group are women aged 18 to 35 years. This period is considered the peak of the reproductive function, accompanied by active functioning ovaries and a full production of female hormones. Modern gynecological practice shows that the gap of the ovary is approximately 2-3% of all gynaecological diseases. It should be noted that apoplexy of the ovary has an extremely high tendency to relapse. For example, if a woman had ovarian rupture, it is safe to say that in 70-75% of cases the gap again.
At the same time, is much more common apoplexy of the right ovary is due to the fact that the right ovary has a better blood supply with a large quantity of blood vessels. As a result of such anatomical features apoplexy of the left ovary occurs approximately in 3 times less.
Causes of ovarian apoplexy
Causes sudden rupture of the ovary can be of various types. Among the main causes of acute gynecological pathology are the following:
- Varicose veins, multiple sclerosis and other pathological changes of the blood vessels. Subsequently, thinning of walls of blood vessels circulation is disturbed, blood can’t circulate and becomes stagnant, which can lead to the rupture of a certain portion of the blood vessels.
- The rapid increase in the level of intra-abdominal pressure, which can result from excessive physical exertion or violent sexual contact. It is especially dangerous to do power sports or riding directly in the period of menstruation.
- The causes of the disease can be of inflammatory nature – in this case, various inflammatory processes affecting the tissue of the ovary, or tumors in the pelvic organs lead to apoplexy reproductive organ.
- Mechanical trauma to the abdomen can cause rupture of the ovary.
- Serious hormonal imbalance in the female body.
- Disrupted blood clotting, prolonged use of drugs from the group of anticoagulants, the effect of which is aimed on the change of indicators of blood coagulation.
- In some cases, apoplexy of the ovary could result in different pathologies of the Central nervous system, strong nervous shock, a long stay in a stressful condition.
- Improperly performed vaginal examination, which was conducted before menstruation or during menstruation.
- Very often, ovarian apoplexy occurs directly at the time of ovulation or immediately thereafter. This is due to the fact that the rupture of the Mature follicle leads to the appearance on the surface of ovarian trauma, which under favorable conditions may lead to apoplexy.
- Oophoritis or polycystic ovarian syndrome, drug stimulation of ovulation the special drugs – common causes of the disease.
- Women should remember that the interrupted sexual intercourse, as well as improperly performed douching can cause ovarian apoplexy.
The characteristic feature of the pathology is considered to be a pronounced pain syndrome. Most often, the pain localized in the lower abdomen, sometimes the pain can «give» in the belly or lower back. Depending on the type of pain syndrome in apoplexy is allocated the following form:
- painful form, which is characterized by acute pain similar to the pain during appendicitis. Hemorrhage takes place inside the ovary and is accompanied by a sharp, rapid pain in the abdomen.
- anemic form – the symptoms of this variety is reminiscent of the unauthorized interruption of tubal pregnancy and is characterized by profuse bleeding.
- combined form has the symptoms of both previous species.
Allocate following basic signs of ovarian apoplexy:
- As mentioned above, one of the first signs of rupture of the ovary is the sharp, acute pain in the pelvis. Pain – the main symptoms of the disease.
- In addition, the development of this pathology is in most cases accompanied by sharp and severe headaches that can go on the dizzy. In some cases, subsequently, excessive bleeding, a woman may feel weak and lose consciousness. This is a characteristic symptoms of apoplexy.
- Some of the symptoms of apoplexy of the ovary are the disorders stool, nausea, vomiting.
- Ovarian apoplexy is characterized by a sharp palpitations, rapid rise in blood pressure.
- The symptoms of worsening overall health a woman may be concerned about increased dryness and mucosal pallor, weakness and fatigue, increased urination and defecation.
Diagnosis and treatment of ovarian apoplexy
Treatment of apoplexy of the reproductive organs starts with emergency hospitalization of women in specialized medical institution. The patient must be under the supervision of medical staff, because when you break the blood vessels a very high risk of major blood loss, which ultimately can lead to death. Treatment of ovarian apoplexy should begin immediately after diagnosis.
It should be noted that according to medical statistics in the majority of cases, the correct diagnosis of the disease is not more than 5-8% of all cases pathologists. Wrong diagnosis is that the symptoms of rupture of the reproductive organ is very similar to the symptoms of other pathologies, e.g. acute appendicitis or interruption of ectopic pregnancy, which treatment is quite different.
Diagnosis of ovarian apoplexy should be as accurate and quick as this is an extremely serious condition, which, under the condition of profuse bleeding, has a serious danger to the life of the patient. The consequences can be very sad. Diagnosis of pathology is made by a variety of methods – is a common blood test, palpation of ovaries, puncture the posterior fornix. Also is made mandatory ultrasound and laparoscopy of the pelvic organs. It should be noted that laparoscopy reproductive organs is an innovative diagnostic technique. To date, laparoscopy is used not only as a method of surgical treatment, but also as an effective method of diagnosis.
Treatment of ovarian apoplexy are often combined and consists of conservative and surgical intervention. The exclusive use of drug therapy without surgery is possible only in cases of slight rupture of blood vessels, which is not accompanied by profuse bleeding. Most often this treatment is the conservative method is used only in relation to already parous women, who are not planning a subsequent pregnancy.
But the traditional treatment has many disadvantages: it in the abdominal cavity remain the particles of blood clots and blood clots that may eventually lead to the development of pronounced adhesions. In addition, if the treatment of apoplexy is made exclusively of drugs, very high risk of re-ruptures. Approximately 80% of all cases recorded recurrence of apoplexy. That is why the best option most experts believe all the same transaction in which it becomes possible the complete removal of all accumulated blood clots.
As the methods of operation most often used laparoscopy, in which thoroughly washed the abdominal cavity, removes all the blood clots and thrombi, is a necessary correction of the pelvic organs. Laparoscopy refers to the most gentle, organ-preserving surgery techniques, because during such an operation the surgeons are able to retain the ovary. This is particularly important if the woman has not yet fulfilled her reproductive function, and plans the replenishment of the family in the future.
Treatment of ovarian apoplexy requires instant reaction. During the operation, the cauterization is open or tying a ruptured blood vessel. If a woman has a cyst, simultaneously made and her treatment, she also removed, and its cavity during the operation, carefully trimmed.
The effects of ovarian apoplexy
The consequences of gynecological pathology is directly dependent on the severity of the disease and the abundance of blood loss. So, when a significant blood loss in women after surgery may develop hemorrhagic shock. In the most severe cases, with significant blood loss and in the absence of timely treatment may lead to death. In the case that was not made cleaning of the abdominal cavity, the patient has a high risk of developing adhesions, and re-rupture of the ovary.
Many women after the surgery are asking – is it possible subsequent pregnancy? If the operation was limb-sparing and the woman still had one healthy ovary, then chances of getting pregnant increase rapidly. But it should be noted that complications such as the presence of adhesions or other heavy consequences apoplexy significantly reduce the chances of conception. Also, after the rupture of the ovary is extremely high risk of ectopic pregnancy. Therefore, after the treatment of this gynecological pathology pregnant woman should be under strict medical supervision.