Ovarian apoplexy is a very serious condition, which is accompanied by a rupture of their tissues. As a result of this process, blood enters the ovarian tissue and abdominal cavity. The disease requires immediate treatment, since otherwise the development of hemorrhagic shock is possible. In the absence of timely assistance, the pathology may result in the death of the patient.
Of course, many women are interested in additional information. Why does ovarian apoplexy develop? What it is? The consequences of the pathology, its first symptoms and basic treatment methods are important information that you should familiarize yourself with. The sooner the disease is diagnosed, the higher the probability of a favorable outcome for the patient.
Ovarian apoplexy: ICD-10 code, general characteristics of the disease
To begin with, it is worthwhile to deal with general information about this pathology. Ovarian apoplexy (ICD-10 code N83) is an acute condition that is accompanied by rupture of ovarian tissue. As a rule, first a hematoma appears in the area of the affected organ, as a result of which the ovarian pressure rises inside - this is accompanied by sharp pains. The rise in pressure leads to a violation of the integrity of the ovary. Even the slightest rupture of the membrane is sometimes accompanied by massive bleeding.
Pathology can develop at different stages of the menstrual cycle. Most often, the right ovary is affected, as the right ovarian artery departs directly from the aorta. In addition, the organ on this side has a more developed lymphatic system, a large mass and size.
According to statistics, in most cases, young women aged 20 to 35 experience a similar problem.
Causes of the development of the disease
In fact, the causes of ovarian apoplexy can be different. But in most cases, the gap appears against a background of diseases accompanied by dystrophic or sclerotic changes in the tissues of the ovary.
- Often apoplexy is the result of the progression of polycystic. Such a disease in most cases begins against the background of hormonal disorders in the body of a woman. Small cysts, prone to growth, form in the tissues of the ovaries - gradually the pressure inside the organ rises, which can result in rupture of its tissues. In addition, such a disease increases the risk of malignant degeneration of cells.
- Varicose veins of the ovaries are another reason. Expansion of the lumen of blood vessels, a decrease in their functionality leads to accumulation of blood. There is always a risk of rupture of the vascular walls inside the ovary. A similar pathology is associated with increased fragility of the venous walls, a hereditary predisposition, as well as improper use of hormonal contraceptives.
- Apoplexy can be the result of oophoritis. Against the background of this disease, inflammation of the ovarian tissues is observed, which is often complicated by severe edema, the formation and accumulation of purulent masses, which, in fact, can lead to rupture. Oophoritis most often develops against the background of infectious lesions (in particular, against the background of the activity of sexually transmitted microorganisms).
- The list of causes also includes sclerosis of the ovarian stroma. Pathology is accompanied by proliferation of connective tissues, which gradually replace the functional, glandular structures of the organ.
- Hyalinosis is a form of protein dystrophy, which is accompanied by an accumulation of plasma proteins and lipids in the ovarian capsule, as well as on the walls of blood vessels.
- The cause may be various diseases accompanied by blood thinning. The same picture is observed against the background of prolonged use of anticoagulants.
- Sometimes apoplexy develops against the background of neuroendocrine disorders, which are accompanied by serious hormonal disorders.
In addition, doctors identify some risk factors that, if there are prerequisites, can cause ovarian rupture. Their list includes:
- obesity (excess fatty tissue in the peritoneum often compresses blood vessels, disrupting normal blood circulation in the ovaries);
- horse riding, weight lifting, intense / excessive physical exertion;
- abdominal injuries;
- aggressive sexual intercourse;
- some gynecological procedures.
It is worth noting that sometimes ovarian rupture occurs at rest or even during sleep.
The main symptoms of pathology
Symptoms of ovarian apoplexy can be different. Their intensity directly depends on the form and stage of development of the pathology, the presence of concomitant diseases, the amount of blood loss and some other factors.
The first and main symptom is pain. Pain syndrome is associated with irritation of receptors in the tissues of the ovary, as well as with spasm of the vascular walls.
As a rule, pain occurs suddenly, sometimes against the background of well-being. Unpleasant sensations are localized in the lower abdominal cavity, but sometimes they can spread to the lower back and navel, perineum and anus.
The pain in most cases is acute. Sometimes it can be constantly present, in other cases it can appear and disappear according to the type of contractions (paroxysmal). The duration of the attack can vary from 30 minutes to several hours. Sometimes such “contractions” are repeated several times a day. Palpation of the abdomen, as well as gynecological examination, are accompanied by increased unpleasant sensations.
If blood loss occurs , the symptoms of ovarian apoplexy may be different. In addition to pain, the following disorders occur:
- the patient's skin turns pale, increased sweating is observed;
- blood loss leads to a decrease in blood pressure;
- during the examination, the doctor may note a weakening or increased heart rate (bradycardia or tachycardia);
- loss of blood is associated with the appearance of sudden weakness, dizziness (sometimes up to a swoon);
- often chills, fever;
- patients sometimes complain of nausea (such episodes often end with vomiting);
- dry mucous membranes in the mouth can be observed;
- blood impurities may be present in the vaginal discharge;
- patients complain of frequent urination, constant urge to defecate.
It is worth noting that in most cases, patients are taken to the hospital with complaints of sharp, sharp pains in the lower abdomen. The same symptoms are observed against the background of other diseases, in particular acute appendicitis, ectopic pregnancy, renal colic, severe inflammation of the abdominal wall, acute form of pancreatitis. That is why correctly carried out differential diagnostics is so important.
The above symptoms are an occasion to urgently consult a doctor. In no case can acute pain and weakness be ignored, since the life of a woman depends on the timeliness of therapy.
Forms of the development of the disease
In modern medicine, three forms of ovarian apoplexy are distinguished, each of which has its own set of symptoms.
- Painful, or pseudoappendicular, apoplexy is accompanied by severe pain syndrome, which is sometimes associated with nausea. Often, such symptoms are mistaken for acute appendicitis.
- Anemic / hemorrhagic ovarian apoplexy - the clinical picture with this form of the disease is characterized by vivid bleeding symptoms. Patients complain of weakness, constant dizziness, which sometimes end in fainting. The skin of women rarely turns pale, which is associated with the loss of a large amount of blood.
- A mixed form of pathology combines the symptoms of the two previous forms of apoplexy.
You should immediately call a doctor if you suspect ovarian apoplexy. Emergency care and proper therapy in this case are extremely important.
The degree of development of pathology
For the doctor, the volume of blood loss in the patient is important. Depending on this factor, three stages of development of ovarian apoplexy are distinguished:
- first degree (mild) - intraperitoneal blood loss is not more than 150 ml;
- second degree (medium) - against the background of pathology, the volume of lost blood ranges from about 150 to 500 ml;
- the third degree (severe) - the level of blood loss is quite large (blood volume exceeds 500 ml).
What complications does the disease lead to?
You already know why ovarian apoplexy develops and what it is. The consequences of such a pathology can be extremely dangerous:
- To begin with, it is worth noting that with an untimely diagnosis of the hemorrhagic form of apoplexy, the probability of a fatal outcome is high, which is associated with heavy blood loss and the accumulation of a large amount of fluid in the abdominal cavity.
- An organ rupture sometimes disrupts a woman's reproductive function. In particular, after a previous apoplexy in the ovary region, as well as in the tissues of the fallopian tubes, adhesions form that interfere with the normal advancement of the egg - this is how difficulties arise with fertilization.
- According to statistics, apoplexy increases the risk of developing an ectopic pregnancy in the future.
- After a similar pathology, the formation of adhesions in the abdominal cavity is possible. That is why patients during the rehabilitation period are prescribed anti-inflammatory drugs, as well as special physiotherapy for six months - this can prevent the occurrence of such complications.
- If the patient was treated conservatively, then the likelihood of developing repeated apoplexy in the future is about 50%.
Apoplexy and pregnancy
In itself, such a pathology is not a cause of infertility. Nevertheless, even with the correct treatment for ovarian apoplexy, there is a possibility of adhesions in the fallopian tubes and abdominal cavity. That is why women have difficulties both with fertilization and with the successful bearing of a child.
If the patient became pregnant, then she should carefully monitor her health. Previously transferred apoplexy should be reported to the doctor. According to statistics, there is a fairly high risk of miscarriage or premature birth.
Diagnostic measures
Timely diagnosis of ovarian apoplexy is extremely important. If we are talking about hemorrhagic forms, then even the slightest delay can result in significant blood loss, hemorrhagic shock and the death of the patient.
First of all, it is necessary to collect an anamnesis and get acquainted with the patient's complaints. Obligatory is a gynecological examination. The natural color of the vagina is preserved, only occasionally there is a slight pallor of tissues. The size of the uterus is also normal. Nevertheless, the affected ovary increases, and its palpation is accompanied by sharp, sharp pains.
A blood test is also needed. Sometimes there is a slight increase in the number of leukocytes, and the hemoglobin level also decreases, which is associated with blood loss.
Visible ovarian apoplexy on ultrasound. During the examination, a specialist can examine the organs of the genital pelvis, notice the accumulation of fine and medium liquid in the ovary, as well as in the abdominal cavity. A puncture of the posterior vaginal fornix is performed, which makes it possible to detect an accumulation of serous fluid, blood or pus in the abdominal cavity. An analysis is also carried out on the level of chorionic gonadotropin - this allows you to exclude (or confirm) the presence of an ectopic pregnancy.
Sometimes laparoscopy is additionally performed - surgical intervention, during which specialist instruments are introduced into the small pelvis through small punctures of the abdominal wall. During the procedure, a specialist can detect blood and clots in a free cavity, evaluate the size and condition of the uterus, and identify inflammatory lesions of the fallopian tubes.
During diagnosis, it is extremely important to determine the causes of ovarian apoplexy, as well as the form and stage of development of the pathology. It is these factors that largely determine the success of treatment.
First aid
If there are acute pains and other symptoms described above, then the patient must be urgently taken to the hospital ward and, therefore, an ambulance team must be called. Only a doctor after examination can diagnose ovarian apoplexy.
What to do, waiting for the arrival of doctors? In fact, not many can help a woman at home. It is only necessary to lay the patient, placing a pillow under his head. Doctors do not recommend taking analgesics, anti-inflammatory drugs or other medications that help cope with pain - this can complicate the diagnosis process or aggravate the course of the disease.
Conservative therapy
Conservative treatment of ovarian apoplexy is carried out only in the most mild cases, when the symptoms are mild and there is no bleeding. The treatment regimen in this case is as follows:
- the patient needs complete physical rest;
- ice is placed on the lower abdomen, as this helps to narrow the blood vessels and reduce the risk of bleeding;
- hemostatic drugs are also used, in particular Ascorutin and Vikasol;
- antispasmodics are used to relieve pain, such as Papaverine or No-shpa;
- patients are prescribed vitamin complexes (drugs are used that contain vitamins B12, B1 and B6, as well as ascorbic acid).
Such treatment is carried out only in a hospital setting - the patient should be constantly under the supervision of a doctor. If bleeding has opened, then the woman is prescribed an operation.
Ovarian apoplexy increases the risk of adhesions, especially in cases where therapy was carried out using drugs. That is why such treatment is prescribed to women who do not plan to have children in the future. If we are talking about young patients, then the most optimal option is surgery.
Apoplexy Surgery
Most often, apoplexy is treated by surgery. In this case, laparoscopy is performed. This procedure has many advantages:
- to begin with, it is worth noting that this is the most gentle method, as the instruments are inserted through small punctures in the abdominal stack (there are no large scars on the skin);
- after such an operation, the reproductive functions of the reproductive system are most often preserved;
- the rehabilitation period does not last long, there is no pain;
- the risk of tissue infection is minimal.
The technique largely depends on the form of apoplexy, the volume and speed of blood loss, as well as some other tissues.
- In most cases, the doctor simply neatly sutures the torn ovarian tissue.
- If necessary, coagulation of gaps is carried out - for this purpose a special bipolar coagulator is used.
- Sometimes the affected ovarian tissue is excised, and then sutured. At the same time, the formation of formed adhesions can be carried out.
- Complete removal of the ovary is carried out only if there is a complete damage to its tissues or massive bleeding.
During the rehabilitation period, women are prescribed special medications. In addition, various physiotherapy methods are used, including electrophoresis of lidases and zinc, ultrasound therapy, magnetotherapy, and electrical stimulation of the fallopian tubes. Such procedures help prevent the development of various complications, in particular the adhesive process.
Ovarian apoplexy: clinical guidelines for preventing the disease and its relapse
In fact, there are no specific means for the prevention of such a disease. Women are advised to avoid exposure to risk factors. In addition, all gynecological diseases, in particular oophoritis and adnexitis, must respond to treatment on time.
If a woman has suffered a painful form of ovarian apoplexy, then the prognosis is favorable - the body quickly and completely recovers. But after a hemorrhagic form of pathology, hormone therapy is needed - this will help prevent relapse of the disease.