In the article, we consider what apoplexy is. Pathology is a sudden rupture of the tissues of this organ, which provokes the development of bleeding in the abdominal cavity. Ovarian rupture is accompanied by a powerful pain syndrome.
Description of the disease
In most cases, there is a violation of the integrity of the corpus luteum or cystic formation of this structure. As a rule, this arises as a result of pathological vascular changes against the background of an intense inflammatory process. Usually, apoplexy occurs during ovulation or at the stage of vascularization of the corpus luteum. Most of all, young women are affected by this disease.
Not everyone knows what apoplexy is. She is an emergency in gynecology, which is characterized by rupture of the ovary. With apoplexy, hemorrhage develops in ovarian tissues, with varying severity of bleeding in the abdominal cavity and severe pain syndrome.
Synonyms for apoplexy are heart attack, hematoma, and ovarian rupture. This pathology occurs in 1-3% of women with various gynecological diseases, most often - from the age of 20 to 35 years. Apoplexy of the right ovary occurs more often, due to its richer blood supply through the right ovarian artery, which departs directly from the aorta. The ovary on the right is distinguished by its large size, weight and developed lymphatic system. The left ovary is supplied through the left ovarian artery, which branches off from the renal artery.
According to clinical and morphological characteristics, hemorrhages can be distinguished from follicular ovarian cysts, mature follicles during ovulation, corpus luteum cysts, ovarian stroma, dysfunctional ovaries. The gap causes the development of intra-abdominal bleeding in approximately 0.5-2.5% of sick women.
Causes of Apoplexy
Pathogenetically, the development of ovarian apoplexy is associated with the specificity of ovarian tissues. Predisposing factors of this disease are the features of the blood supply to the pelvic organs, changes in the permeability of the ovarian vessels in various phases of the menstrual ovarian cycle. In the presence of violations in the structures of the vascular walls due to vascular expansion and blood filling, their permeability can increase until the occurrence of integrity disorders.
Sclerotic and dystrophic changes in the ovarian tissues due to varicose ovarian veins, polycystic ovaries, oophoritis, inflammation of the appendages, abortion, etc. can be the background on which ovarian apoplexy occurs. The risk of developing ovarian apoplexy is increased based on drug stimulation of ovulation, which often entails pathological disorders of ovulatory processes and the formation of the corpus luteum. Some authors cite neuroendocrine pathologies as the causes of apoplexy, which are accompanied by a change in the functionality of the vessels of ovarian tissues, as well as the use of anticoagulant drugs.
Abdominal injuries, excessive physical stress, horse riding, sports, violent or interrupted intercourse, and other moments associated with an increase in intra-abdominal pressure can provoke an ailment. Nevertheless, ovarian apoplexy is observed in the absence of the above provoking factors. A frequent phenomenon is the situation when an ovarian rupture is combined with the development of appendicitis. Apoplexy can occur in any phase of the menstrual cycle, but most often this happens during the ovulatory period or on the eve of menstruation, when the concentration of gonadotropic hormones reaches its highest level. In addition, a variant of the development of an ailment with a delay in menstruation is possible.
Next, find out what are the forms of apoplexy.
Classification of types of apoplexy
Given the prevailing symptoms of this pathological condition, the following types can be distinguished:
- a pain form, in the event of which a bright pain syndrome without symptoms of internal bleeding is noted;
- hemorrhagic or anemic type with a predominance of signs of bleeding in the abdominal cavity;
- a mixed form that combines the symptoms of pain and anemic types of apoplexy.
Nevertheless, since in reality a pathological phenomenon is always accompanied by bleeding of various degrees of intensity, at the moment it is customary to subdivide the disease into severities. When taking into account the amount of bleeding, mild, moderate and severe degrees of the disease are distinguished. Symptoms are completely dependent on the form of apoplexy.
Symptomatology
The main manifestations of the pathological phenomenon are pain and symptoms of internal bleeding.
Soreness with ovarian apoplexy occurs acutely and, as a rule, is localized in the lower abdomen. In this case, there is an irradiation of pain in the lumbar and umbilical zone of the perineum, rectum. Soreness can be of a different nature - constant or paroxysmal, stitching or cramping type. A pain attack lasts from 30 minutes to several hours, and periodically returns during the day.
The occurrence of bleeding during apoplexy is accompanied by a decrease in blood pressure, pallor of the skin, weakening and increased heart rate, general weakness, fainting, dizziness, chills, vomiting, dry mucous membranes of the mouth, urge to defecate, and frequent urination. After a delay in menstruation, bloody discharge from the genital tract is often noted. If emergency measures are not taken in this condition, internal bleeding begins to progress and can pose a serious threat to life. Signs of apoplexy are important to recognize in a timely manner.
With a mild degree of pathology, short-term spontaneous pain attacks, shock, lack of peritoneal phenomena, nausea can occur.
What is moderate apoplexy? It occurs with severe pain, general weakness, fainting, vomiting, mild peritoneal phenomena, shock of the 1st degree. In severe forms of ovarian apoplexy, constant severe pain, flatulence, collapse, vomiting, tachycardia, cool sweat, shock of 2-3 degrees, severity of peritoneal symptoms, a decrease in hemoglobin concentration of more than 50% of normal values ββare observed. The clinic can be strengthened under the guise of acute appendicitis, ectopic pregnancy, uterine pregnancy, torsion of the ovarian cyst, renal colic, peritonitis, acute pancreatitis, which requires careful differential diagnosis.
Cyst apoplexy
The rupture of a cystic formation on the ovary is a pathology in which hemorrhage into the tissue occurs, a violation of the integrity of the cystic capsule with the release of its contents into the pelvic cavity.
This disease occurs mainly in adolescent girls and women in the reproductive period. Among acute surgical pathology - it is approximately 11%, and among gynecological diseases - about 10-27%, taking the 3rd place. The number of exacerbations of this condition occurs in approximately 40-69% of young women.
Cyst apoplexy can occur with ovulation disorders, as a result of which the corpus luteum forms with the formation of a neovulating follicle cyst (functional cyst). In 90-95% of patients with apoplexy, such a cyst occurs in the middle part of the menstrual cycle or in its last phase. Of these, in the ovulatory period, about 17%, in the second part of the cycle - in 82%.
The causes of the pathology of this species and the main symptoms
Among the most proposed mechanisms for rupture of ovarian cysts, preference is given to processes that occur from the moment of ovulation (12-14 days of the cycle) until the onset of menstruation. These processes are usually accompanied by excessive blood supply to the uterine appendages of the uterus, as well as an increase in the permeability of their vessels. A fundamental role in this pathological process is played by imbalances in the pituitary hormones - luteinizing, follicle-stimulating hormones, as well as prolactin.
Predisposing factors
Predisposing factors for the occurrence of this condition in a woman include:
- endocrine system dysfunctions, in particular, imbalance in the functioning of the hypothalamus-pituitary-ovary system;
- functional disorders of the nervous system, psycho-emotional lability, provoked by stressful situations, psychological stress and overwork;
- inflammatory processes of the urinary tract and genitals, leading to a rush of blood to the appendages and impaired microcirculation, as well as fibrotic and sclerotic changes in their tissues;
- dysmenorrhea and a large number of abortions;
- tumor or adhesions in the pelvic area;
- abnormal location of the uterus;
- congestion of the pelvis, varicose ovarian veins;
- stimulation of ovarian function, polycystic.
Clotting disorders also contribute to increased bleeding in various pathologies or when taking certain medications (antiplatelet agents and anticoagulants, acetylsalicylic acid, etc.).
The consequences of rupture of an ovarian cyst are in most cases the development of an adhesion process in the pelvic area with the further formation of tubal-peritoneal infertility, especially with conservative methods of treatment. Due to the occurrence of adhesions after rupture of cystic formation on the ovary, the frequency of onset of conception is only about 26%.
The effects of ovarian apoplexy are described below. What it is is now clear.
The consequences of the disease
Only emergency hospitalization and the implementation of all necessary measures for this pathological condition of the ovary will help prevent many serious complications and preserve the woman's reproductive functions. If you do not seek qualified medical help as an emergency, the consequences can be extremely dangerous.
Research results show that conservative treatment of ovarian apoplexy does not always help to achieve a positive result. Blood that has entered the abdominal cavity forms a breeding ground for pathogenic microorganisms, where the process of aseptic inflammation begins. As a result, adhesions form that disrupt the natural structure of the ovary and surrounding tissues. In such situations, the most frequent complication is the termination of the reproductive functions of patients. Pain after apoplexy is also a common occurrence.
Weak bleeding is not as dangerous as heavy bleeding, but they can also lead to serious consequences.
Inflammatory processes in the pelvic zone, repeated hemorrhage in the ovary, adhesions, peritonitis, loss of reproductive function are the most serious consequences of apoplexy. In severe forms of this disease, surgeons may decide to remove the ovary, which leads to infertility. However, this disease in itself does not affect the conception. The decisive obstacle to fertilization are adhesions that occur in the ovary and fallopian tube. After apoplexy of the ovary or cyst, ectopic pregnancies are often observed in women. If bleeding cannot be prevented in time, then ovarian apoplexy can even lead to the patient's death.
During pregnancy, this pathology does not happen often. In such situations, surgery is performed through laparotomy. As another negative consequence of apoplexy, a high risk of miscarriage should be noted.
If you follow all the medical recommendations and observe all the conditions of therapy, then you can avoid the negative consequences of this disease or minimize them. Anti-inflammatory therapy and physiotherapy sessions are a mandatory postoperative course. In addition, the use of hormonal medications and contraception for six months is important. According to statistics, under the condition of emergency hospitalization and proper treatment of patients with apoplexy, the prognosis is usually favorable.
Diagnostics
Statistics claim that the correct diagnosis for apoplexy is only 5%. Such a small percentage is due to the fact that the disease has no characteristic and pronounced features, and is often perceived as another disease.
The diagnosis of apoplexy must be made promptly, since the more time it takes to diagnose, the more blood loss is exacerbated, and this is a serious threat to a woman's life.
The most effective diagnostic methods are:
- Ultrasound with apoplexy, which allows you to see the corpus luteum in the ovary and characteristic bleeding in it or free fluid in the posterior arch or abdomen;
- laparoscopy, which makes it possible to diagnose with a 100% guarantee, and also makes it possible to correct even complex pathologies.
Tissue rupture of the ovary during laparoscopy looks like a raised spot up to 0.5 cm in diameter with a specific hemorrhage or in the form of a corpus luteum with a pronounced defect or rupture of the tissue, which is often accompanied by bleeding.
In addition, the following diagnostic methods are used:
- general blood test, during which reduced hemoglobin will be noticeable;
- puncture of the posterior fornix, which makes it possible to suspect intra-abdominal hemorrhage;
- characteristic pain syndrome that occurs in the middle or the final part of the menstrual cycle.
The final diagnosis is usually made during surgery, with direct visualization of tissue damage.
What are the clinical guidelines for apoplexy?
Treatment
The main goal of apoplexy therapy is to prevent the development of bleeding and restore the integrity of the organ while preserving all organs. It is important that the patient retains fertility. If there is a suspicion of apoplexy, then the patient must immediately take a horizontal position. In addition, a woman should be quickly taken to a surgical or gynecological hospital.
Conservative therapy is possible in the case of simple forms of pathology. Such treatment consists in taking hemostatic drugs, vitamins and antispasmodics. The patient needs cooling of the lower abdomen and rest. Treatment is carried out in a hospital. With a worsening of well-being and the appearance of intracavitary bleeding, it is necessary to resort to surgical intervention.
Surgery for apoplexy is considered the most effective, because it allows you to accurately diagnose pathology and take the necessary measures. Surgical intervention is carried out by laparoscopic or laparotomic access. With laparotomy, it is possible to coagulate a damaged vessel. With laparoscopy, excess blood is removed from the abdominal cavity, after which it is washed with antiseptic solutions, and the damaged vessel is sutured. However, if there is a pathology of the cyst, then resort to its removal and suturing of the ovary. Operation with apoplexy does not provoke serious cosmetic defects and is performed under anesthesia. It allows you to achieve the fastest possible rehabilitation, and reproductive functions remain unaffected. After apoplexy during surgery, the ovary is removed only with severe hemorrhage, if it affects this organ completely. During pregnancy, it is sutured, but no resection is performed.
We examined what apoplexy is. This is a rather dangerous pathology, which is fraught with serious health problems.