Often it planned right ovary apoplexy, due to the speed of circulation is taking place in it, and the fact that its blood supply is carried out from the aorta. The causes of the most different and divided into exogenous and endogenous.
What it is?
Ovarian apoplexy - rupture of tissue and organ blood vessels, which is characterized by a sudden sharp pain in the abdomen. Very often it can be complicated by significant blood loss and as a result of severe anemia. Female ovary at break can lose up to 0.5 liters of blood, which represents a danger to its life.
The causes of ovarian apoplexy
The immediate cause of apoplexy ovary are always disturbances in the blood vessels and tissues ovary, usually formed due to chronic inflammation.
Changed both the ovary tissue and blood vessels, its feeder (sclerosis, scarring, varicose veins) lead to increased risk of rupture. In certain days of the menstrual cycle (mid-cycle and the second phase) increases the load on the vessels, in combination with pathological changes and provoking factors is the cause apoplexy ovary.
Factors that may serve as an additional cause of ovarian apoplexy are:
- Disorders of blood in which its disturbed coagulation, as well as long-term use of anticoagulants;
- Hormonal disorders, enhances blood supply to the ovary tissue, including caused by artificial stimulation of ovulation;
- Neuro-psychological factors and stress.
All of the above sets the stage for ovarian apoplexy occurred. When there is a combination of these factors with pathological vascular changes and of the ovary, any physical force to cause tension of the abdominal muscles can be the last straw, external cause apoplexy ovary. Such efforts often serves as a rapid sexual intercourse (often), sport, horse riding, etc. In some cases, ovarian apoplexy can occur spontaneously, at the time of full peace.
Symptoms of ovarian apoplexy
The main symptom is a sudden sharp pain in the lower abdomen. Pain compounded strong cramps, dizziness, nausea, vomiting, and general weakness of the body.
It causes severe pain - the pressure of accumulated blood in the pain receptors of the surrounding tissues. They can be given to the navel, lower back, anus, foot. Severe hemorrhage causes general malaise, because the body has a severe shortage of oxygen.
For ovarian apoplexy is also characterized by the presence of these symptoms:
- Bloody vaginal discharge, resembling monthly, but not so abundant and occur in the middle of the cycle. Sometimes the rupture is preceded by a missed period.
- The sharp decrease in blood pressure, increased heart rate, palpitations, blanching of the skin. The patient noted a strong thirst, the skin is covered with cold sweat.
- Frequent urination and false urge to defecate. This is due to the stretching of the bladder wall under the influence of certain hormones, as well as because of the mass of blood pressure in the rectum.
Diagnostics
If there is a suspicion that the bursting of the ovary, conduct the following diagnostics:
- Held ultrasound of internal female organs.
- Blood is taken for the overall analysis. When apoplexy may decrease or increase in hemoglobin (occurs when blood begins to thicken). Can rise and leukocytes.
- Determined level of human chorionic gonadotropin hormone in the blood (to prevent ectopic pregnancy). Often the bleeding occurs due to rupture of the fallopian tube due to improper attachment of the ovum or after the day before the abortion and any serious consequences.
- Full inspection and examination of the skin, mucous membranes. Gynecological examination revealed normal color genitals and inside of the vagina. Sometimes it may be slightly different, becoming paler pathology. Hold bimanual examination often fails due to increased pain symptoms. The examination is usually normal uterus, and as appendages one of them (in which the abnormality occurred) will be increased in size.
- Take content puncture the abdominal cavity through the posterior vaginal vault walls.
Laparoscopy is prescribed to confirm the diagnosis and possible correction occurred pathology. Laparoscopy is a diagnostic procedure simultaneously with ovarian apoplexy and curative. That she confirms violation with 100% probability.
Treatment of ovarian apoplexy
Conservative treatment strategy is possible only in mild cases of ovarian apoplexy without obvious signs of internal bleeding.
Conservative measures with ovarian apoplexy include the appointment of strict rest, cold on his stomach, suppositories with belladonna, antispasmodics, vitamins, hemostatic drugs. After subacute period carried diathermy, electrophoresis with calcium chloride currents Bernard. If signs of bleeding rise shows immediate surgery.
In recent years, gynecology, as a rule, surgical treatment of ovarian apoplexy. Conservative treatment is prescribed only to patients with mild disease and realized reproductive function. If a woman is planning a pregnancy, the preferred surgical treatment of ovarian apoplexy.
operative therapy
The use of video endoscopic equipment is not only the most accurate method of diagnosis, but also one of the most important ways to treat diseases.
Operation with the laparoscopic access has a number of significant advantages:
- maximum operational sparing treatment;
- the absence of pain;
- preserving reproductive functions;
- reducing the period of rehabilitation;
- lack of pronounced postoperative cosmetic defect.
The operation is performed in the main, organ direction oophorectomy performed only when massive bleeding and complete tissue damage. Displacement of operation depends on the severity of the patient's condition and may include the following surgical procedures:
- closure of the gap space of the ovary tissue;
- coagulation gap diseased tissue;
- ovarian wedge resection, in addition to the excision of damaged tissues allows to eliminate possible factors of infertility;
- oophorectomy (removal of the ovaries).
vascular coagulation is carried out carefully as possible, using the bipolar coagulator. all blood clots are removed At the end of surgical procedures, and the peritoneum is carefully washed. Due to the high risk of spontaneous abortion in case of pregnancy, induction of labor is assigned.
In the postoperative period the measures aimed at preventing the formation of adhesions, the normalization of hormonal processes, rehabilitation of reproductive capacity. In the recovery period after apoplexy ovarian patients made competent selection contraception appointed physiotherapy (magnetotherapy, ultrasound, laser therapy, electrophoresis and zinc, Lydasum, electrostimulation Fallopian tubes).
Effects
Prediction in most cases after tearing ovary (especially in the case of medical treatment) is favorable. But it is not excluded and the effects of:
- Infertility. It develops in 42% of patients, which promotes intense adhesions, hormonal imbalance and chronic inflammatory diseases of the ovaries and appendages. But if one healthy ovary apoplexy and persists after surgery, the chances of getting pregnant in the future are great.
- Adhesions. Conservative therapy or distancing timing operation in 85% of cases leads to the formation of adhesions in the pelvis. This contributes to the presence of blood and clots in the abdomen, which will eventually be organized and cause the formation of adhesions. Furthermore, provokes adhesions duration operation, open abdominal wound (laparotomy), the presence of the appendages chronic inflammation and postoperative morbidity.
- Ectopic pregnancy. It increases the risk of ectopic pregnancy due to the formation of adhesions in the pelvis, torsion and inflection of the fallopian tubes.
- Relapse. Repeated apoplexy as the damaged and the healthy ovary occurs in 16% (according to some According to 50%) cases, facilitated background disease (hormonal imbalance, chronic adnexitis).
prevention
Patients who have suffered a rupture of the ovary and passed a full course of rehabilitation is recommended to undergo laparoscopic examination before planning pregnancy.
Because of the potential risk of development of disease in healthy women, it is recommended to follow some precautions:
- regular visits to the gynecologist (2 times a year);
- timely treatment of infectious and inflammatory diseases of the reproductive organs;
- control and correction of hormonal background;
- elimination of heavy physical exertion;
- competent selection of contraceptive methods.
Careful attitude to their reproductive health protection of every woman from unpleasant and dangerous diseases. In case of disease, timely recourse to experts is a guarantee of successful cure and preserve the reproductive functions of the body of each patient.
Forecast
Timely detection and emergency treatments have a favorable prognosis with preservation of reproductive function. However, pregnant women in the future requires increased attention on the part of physicians. No time to provide medical assistance and a strong blood loss can be fatal.
