Ovarian apoplexy. What is it, symptoms, pictures, how to treat, the effects of burn surgery, clinical guidelines for disease in gynecology

Ovarian apoplexy relate to dangerous states for the life of the woman, because it is such a pathology which is accompanied by a large blood loss and pain shock. The inflammatory process affects not only the reproductive organs, but also extends to the whole peritoneum. Avoid negative consequences can only call an ambulance immediately.

What is ovarian apoplexy?

Apoplexy Ovary determined by tissue destruction and organ sharp hemorrhage. epididymis rupture occurs suddenly and is often accompanied by loss of consciousness. Clinical manifestations are so pronounced that sometimes become a cause of death. That is why ovarian apoplexy refers to acute gynecological pathology.

Disease develops spontaneously and always takes place rapidly, which serves as a basis for urgent surgery. Gap tissues accompanied by acute painful episodes.

Several distinct types of pathology:

• painful form It is characterized by severe pain with little or no blood loss;
• with anemicDiagnosed internal bleeding and minor pain attacks;
• mixed It occurs with increased blood loss, multiple discontinuities tissues and painful shock.

Depending on the stage hemorrhage may be insignificant disease.

When the complex during blood loss may reach 2 liters. At the initial stage of the patient shown holding conservative therapy, which in most situations is the preparation for the surgical procedures.

The causes of ovarian apoplexy

Ovarian apoplexy - it is a disease that is not insured by any one woman. According to medical statistics, more than 60% of applications pathology develops again.

The main predisposing factors include:

• Inflammation of the ovaries.
• Violation of the blood in the veins functioning appendages.
• Normalization of ovulation by drugs.
• Polycystic ovary diagnosed with cystic formations.
• Traumatization of blood vessels and tissues of the reproductive system.
• The sharp jump in intra-abdominal pressure that develops as a result of heavy lifting, excessive exercising or intense sex.
• Systematic failures in the bloodstream at a adhesive processes of appendages, tumors of the reproductive system or improper location of the uterus.
• Pregnancy.
• Inadequate conservative therapy means blood thinning.

risk group consists of patients with hormonal disorders. Provoke a negative state could nervous feelings, stress, pathology, neuro-psychological nature. Most cases of ruptures occur in the middle of the menstrual cycle, ie ovulation.

inflammation of the ovary

Inflammation of the ovary develops as a result of infection. According to statistics, this pathology is the first among all gynecological problems in women of childbearing age. Oophoritis (inflammation) may occur with a lesion of one or both appendages. The disease can spread to the uterus tube. Salpingitis develops.

By provoking factors include surgical manipulation in the pelvis, childbirth, menstrual cycle, supercooling.

Among the most dangerous pathogens Chlamydia, gonococcal, trichomonazice bacteria. Often, especially when weakened immunity in women, can cause inflammation even E. coli. Symptomatic picture appears discomfort in the abdomen, swelling of the ovary develops, there are specific selection. The disease can provoke an attack of appendicitis.

Varicose veins of the ovary

Varicose veins ovary determined with insufficient hematopoiesis in venous vessels appendage. Develops pathology due to obstruction of any of the veins. Almost always diagnosed as a type of varicose veins of the female reproductive system. The main reasons include disruptions in the functioning of connective tissue.

Among the main precipitating factors considered:

• difficult working conditions that require prolonged stay in one position (sitting or standing), causing and increasing blood stasis venous pressure;
• period of gestation and birth of the second, the third child, causing severe strain on the blood vessels and veins, from which develops a higher load on the appendages;
• disruptions in the functioning of the reproductive system, tumors, endometrial lesions, with ligament problems provoke disturbances in the veins of the ovaries;
• hyperestrogenia developed with increased production of estrogens, causes growth of polyps, uterine fibriomy, cancer and is the cause of varicose veins in the ovary;
• birth control pills without medical consultation may provoke side effects such as increased pressure in the veins of the pelvis.

Drug stimulation of ovulation

Stimulation of ovulation by drugs needed for pregnancy, if the patient is not a natural ovulation. This method is effective in a situation where healthy follicles are formed, but the process is not completed for several reasons. Medical stimulation is indicated for the diagnosis of polycystic ovary or ovulation having irregular.

The negative consequences of such a method is a hormonal imbalance in women. Cysts may appear, in exceptional cases, there is ovarian rupture. Such side effects are unpredictable and are formed due to the individual patient's reaction.

polycystic ovaries

Abnormal structural and functional abnormalities in the ovaries with polycystic cause a problem of menstrual function, and provoke sterility. Often appendages increased by 6 times. Change their structure, there are multiple cysts. Celebrated seal ovarian capsule.

Body rejects multiple education, develop processes of formation of new connective tissue. At the same time invariably occur ruptures cystic follicles, and the result of this process is tissue damage. Opens bleeding. Doctors put patient diagnosed with - ovarian apoplexy.

Symptoms of ovarian apoplexy

The clinical picture of disease often has no specific symptoms. Symptoms occur depending on how strong is the blood loss. In some patients, symptoms are generally hidden, and felt a slight pain in the pubic area.

Among the main features considered:

• a sudden drop in blood pressure, irregular heartbeat;
• fast fatiguability;
• loss of consciousness;
• irregular menstruation;
• problems with urination;
• pain discomfort in the lower abdomen.

Ovarian apoplexy - it is a disease that often takes place at a reasonable picture with other acute conditions:

• chrevoobraznogo inflammation process;
• sharp pain in the pancreas;
• ectopic pregnancy;
• exacerbation of intestinal diseases;
• renal colic.

Abdominal pain

Pain syndrome develops in the reproductive system, in the pubic area. Less commonly, seizures can spread to the leg, to give to the tailbone and back. Pain is almost always occur suddenly and are simply intolerable. Often, a woman, just a day or two before the breaking of the epididymis may feel a particular discomfort in the abdomen.

Minor attacks are developing as a result of the fact that blood clots formed a hematoma, which puts pressure on the surrounding tissue.

If the compressed blood vessels and nerve endings, the acute pain attack develops. For two-sided apoplexy pain are herpes and more diffuse in nature. If negative changes affect only the right ovary, the sensations are similar to the attack of appendicitis.

The sharp decrease in blood pressure, increased heart rate

A sudden drop in pressure in the veins and arteries, pale skin color are integral components of clinical apoplexy appendages. Along with the increased heart rate. The severity of these symptoms depends on the amount of blood loss. Mild it does not exceed 150 ml, in severe stages patient can lose more than 500 ml of blood.

generalized weakness

As a result of internal bleeding begins the process of deterioration of blood circulation throughout the body. Receives less oxygen. Its deficit is beginning to feel all the tissues and cells. Defeat affects the nervous system and the brain may not function normally. A woman complains of muscle weakness, fatigue, lethargy. Often develops apathy and drowsiness.

Menstrual disorders

ovarian rupture precedes menstruation or delay the appearance of spotting, not specific to the normal situation.

Once formed pain, separation disappear.

Experts emphasize that not all women with menstrual irregularities occur apoplexy.

Increased urination

Apoplexy accompanied by frequent urination. The usual rate is replaced by a visit to the toilet 10 times a day or more.

Sometimes there are false urge to defecate. This is due to the pressure of large blood clots in the rectum.

Diagnosis of ovarian apoplexy

Apoplexy ovary disease is in most cases accompanied by a large blood loss, and this requires urgent diagnostic methods such as ultrasound and laparoscopy.

In addition, important medical history on the basis of the patient's personal feelings. Appointed by gynecological examination and puncture of the posterior vaginal fornix. As a matter of urgency carry out an analysis of blood and urine.

Gynecological examination

On examination, the woman identified by palpation of the ovary pain. The patient complains of discomfort, often turns into a violent attack. If a strong bleeding, vaginal mucosa paler color than normal. Gynecologist detects abnormalities of the uterus and the size of the state. If necessary, appoint additional tests.

Pelvic ultrasound

US helps doctors confirm or deny the apoplexy of the ovary up to 100%.

Special equipment helps to identify how appendages increased in size.

On the screen the doctor sees the structural formation of the corpus luteum, diagnoses the presence of anemic forms in the uterus or ovaries.

Laparoscopy

Diagnosis by microscopic laparoscope conducted through an incision in the navel. This helps the surgeon to detect even small amounts of blood in the pelvis. If there are any lumps, then rupture occurred a day or two ago. It explores not only the cavity of the ovary, fallopian tubes but also for hematomas and cysts.

Puncture of the posterior vaginal fornix

The posterior vaginal wall is punctured for collecting fluid from a stock recess. Such manipulation is called the posterior vaginal fornix puncture and allows you to install a feature of the disease state.

By the presence of blood, pus or exudate is determined by the stage of apoplexy. Normally, this liquid should be at minimum light yellow highlights. It confirmed the gap, if the blood is bad folds.

Conservative treatment of ovarian apoplexy

Ovarian apoplexy (it is a pathological condition that can develop suddenly, even in absolutely healthy woman) can not because of individual testimonies immediately repaired surgically method.

Sometimes doctors prefer conservative treatment, especially when mild. He preferred if the pain attacks are not very strong, and blood loss is insignificant. Is shown receiving an antispasmodic, hemostatic therapy and vitamins of group B.

antispasmodics

The disease is accompanied by pain of varying intensity, and one way of first aid to the patient is the appointment of antispasmodics. Medications designed to block muscle spasms and pain attacks in the abdomen.

Antispasmodics applied at apoplexy appendages are presented in the table:

name means	Operating principle	Features appointment
Papaverine	Thereby reducing muscle tone of the pelvic peritoneum and eliminates attack within 15 -20 minutes.	Intramuscular administration of 1-2 ml of the preparation once every 6 hours.
Drotaverinum	Relieves spastic syndrome, activates the oxygen supply to the affected tissue.	Injections of 2 ml at 12 hours.
Buscopan	Normalizes muscles, relieves their contractile activity.	From 10 to 20 mg of 3 p. / Day.

Hemostatic agents

To stop internal bleeding at break ovary requires administering drugs resorptive action:

Medicine	Operating principle	appointment
Traneskam	Promotes antifibrinolytic effect, relieves processes profibinolzina activity.	Intravenous 1.5 g 4 times a day for 6 days.
ambenom	Is involved in thrombotic processes in affected tissues and vessels internal organs, it has an inhibitory effect.	5 ml of intravenously on individual indications.
Etamzilat.	It enhances the formation of platelets produces angioprotektornoy effect.	Intramuscular injection of 2 ml 4 times per day.

vitamins

Gynecological bleeding compulsorily appointed B vitamins These processes activate compensatory recovery functions for complex diseases and help to reduce blood loss. To reduce the clinical ovarian rupture and improve postoperative rehabilitation vitamins administered by intramuscular injection.

the following vitamins:

1. vitamin B1 It is indicated for the normalization of carbohydrate, protein and fat metabolism. Dosage - 1 ml intramuscularly on alternate days.
2. vitamin B6 used to improve the digestibility of amino acids and improve lipid metabolism. Discharged apoplexy patients diagnosed with 1 ml of a day.
3. cyanocobalamin It improves blood clotting, and normalizes blood formation. Therapeutic dosage leaves 200 mg every other day.

Surgical treatment of ovarian apoplexy

Drug mild apoplexy therapy rarely leads to positive results. In most cases, the resulting blood clots cause adhesions. Almost half of the patients eventually suffer from infertility. In 15% of cases are reported recurrent disease.

Therefore, gynecologists consider the optimal surgical treatment method for ovarian apoplexy.

Modern surgeons prefer to spend liquidate consequences of ovarian apoplexy way laparoscopic surgery. After all, after it is left large scars, and the recovery period takes much less time than after conventional surgery. In the presence of contraindications apply laparotomy procedures.

Indications to Step

Ovarian apoplexy - it is an acute pathological condition that can have serious consequences not only for the health of women, but also bears a direct threat to her life. When the average degree of apoplexy, there are risks to fertility. If diagnosed severe degree, in the absence of medical care not turndown possibly fatal.

When the fluid in the abdominal cavity revealing the results of the ultrasound scan operation is carried out without fail. Such a method is often the only correct and severe pain. In such cases, conservative therapy can be an alternative to surgery.

Contraindications

Assign or operation can only postpone the attending physician in view of the individual characteristics of the patient and the presence of other pathologies.

Absolute contraindications are:

• complex cardiovascular diseases;
• high blood pressure;
• abdominal hernia and diaphragm;
• severe depletion of the body of the patient;
• a large loss of blood;
• kidney and liver in the acute form;
• bronchial asthma.

Among the acceptable conditions for surgery at apoplexy are:

• drug allergy;
• peritonitis;
• pregnancy after 16 weeks;
• tumors of the pelvic organs.

Methods of surgery for apoplexy

Almost all patients with a confirmed diagnosis appoint laparoscopy. This method allows more gentle hold all manipulations with minimal risk for the woman. If there are contraindications, then spend laparotomy.

Way operations are used only in exceptional cases. If identified a large hemorrhage in the peritoneum, developed sepsis or with rupture of ovarian and other affected organs.

The laparoscopic method

This type of operation is performed by means of special drug - laparoscope and camcorders. The surgeon, producing three microscopic (1.5 cm) puncture in abdominal wall is sutured affected part of the ovary.

By applying high frequency current to heat up adjacent tissue and stop the bleeding. Remove diseased appendage, in the extreme case, if there was a torsion tube to the uterus. A situation may occur, and with the inflammation of the appendix or pregnancy outside the uterus.

laparotomy method

Laparotomy is indicated for the presence of the patient hernia, because of which to spend a few cuts in different places impossible. The indication is profuse bleeding, which can not be stopped during laparoscopy. The essence of the operation in carrying out a wide section above the pubic part of the body up to 10cm. An important condition is to conduct a post-operative antibiotic therapy.

The recovery period after apoplexy

After laparoscopic surgery the patient is allowed to get out of bed after a few hours. Allowed the use of light broths. Discharged from the hospital for 7-10 days. Laparotomy due to recovery lasts 12-14 days. Appointed 2-3 ultrasound to trace the recurrence of apoplexy. The patient should have regular blood and urine tests.

Individually needed hormonal drugs. Driving the use of antibiotics at the discretion of the attending physician.

Each patient is recommended to use a compression garment or bandage for 60 days. Next 2 months sex should be excluded. Back to normal fulfilling life and full health the woman can through 50-60 days. In case of pain, heavy bleeding should immediately call an ambulance.

Consequences and complications

Doctors possible consequences after apoplexy conventionally divided into 2 types: long-term and older. For the first time after the rupture of the ovary may occur a large loss of blood, which is life threatening. If slow to call an ambulance, a high risk of the onset of hemorrhagic shock, the state is incompatible with life.

By late complications include:

• ectopic pregnancy often occurs due to a hindered movement of the egg in the uterus due to postoperative adhesion;
  
• the formation of adhesions in the pelvis, which are the result of poor quality of the operation or failure of the procedure of the patient the benefit of conservative therapy;
• infertility, often develops after removing the ovary or adhesions;
• the risk of re-apoplexy exists for hormonal disorders or if was applied only conservative treatment.

Apoplexy Ovary condition where the self-treatment is unacceptable and not suffering a pathology, such correction techniques as folk remedies. The only possible and correct to conduct surgery or complex treatment.

Registration of the article: Lozinski Oleg

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What is ovarian apoplexy, symptoms, causes and treatment: