Apoplexy of the ovaries 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 the abdominal cavity. The disease requires immediate treatment, otherwise hemorrhagic shock may develop. In the absence of timely assistance, the pathology may end in the death of the patient.
Of course, many women are interested in more information. Why does ovarian apoplexy develop? What it is? The consequences of the pathology, its first symptoms and the main methods of treatment are important information that you should familiarize yourself with. The sooner the disease is diagnosed, the higher the likelihood of a favorable outcome for the patient.
Ovarian apoplexy: ICD-10 code, general characteristics of the disease
To begin with, it is worth understanding the general information about this pathology. Ovarian apoplexy (ICD-10 code N83) is an acute condition that is accompanied by rupture of ovarian tissues. As a rule, firsta 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 shell is sometimes accompanied by massive bleeding.
Pathology can develop at different stages of the menstrual cycle. Most often, the right ovary is affected, since the right ovarian artery departs directly from the aorta. In addition, the organ on this side has a more developed lymphatic system, greater mass and size.
According to statistics, in most cases, young women aged 20 to 35 years old face a similar problem.
Reasons for the development of the disease
In fact, the causes of ovarian apoplexy can be different. But in most cases, the gap appears against the 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 disease. A similar disease in most cases begins against the background of hormonal disorders in the body of a woman. In the tissues of the ovaries, small cysts are formed that are prone to growth - gradually the pressure inside the organ increases, which can result in a rupture of its tissues. In addition, such a disease increases the risk of malignant cell transformation.
- Varicose veins of the ovaries is 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. Such a pathology is associated with increased fragility of the venous walls, hereditary predisposition, as well as improper use of hormonal contraceptives.
- Apoplexy may 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 ovarian stromal sclerosis. Pathology is accompanied by the growth of connective tissues, which gradually replace the functional, glandular structures of the organ.
- Hyalinosis is a form of protein degeneration, which is accompanied by the 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 long-term use of anticoagulants.
- Sometimes apoplexy develops against the background of neuroendocrine disorders, which are accompanied by fundamental hormonal imbalances.
In addition, doctors identify some risk factors that, if there are prerequisites, can provoke ovarian rupture. Their list includes:
- obesity (excessive adipose tissue in the peritoneum often compresses blood vessels, disrupting normal blood circulation in the ovaries);
- equestrianism, heavy lifting, intense/excessivephysical activity;
- abdominal injury;
- aggressive intercourse;
- some gynecological procedures.
It is worth noting that sometimes an ovarian rupture occurs at rest or even during sleep.
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 foremost symptom is pain. The 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 good he alth. Unpleasant sensations are localized in the lower part of the abdominal cavity, but sometimes they can spread to the lower back and navel, perineum and anus.
Pain in most cases is acute. Sometimes it can be present all the time, in other cases it can appear and disappear according to the type of contractions (paroxysmal). The duration of an attack can range from 30 minutes to several hours. Sometimes such "contractions" are repeated several times a day. Palpation of the abdomen, as well as a gynecological examination, is accompanied by increased discomfort.
If there is blood loss, the symptoms of ovarian apoplexy may be different. In addition to pain, the following disorders also occur:
- the patient's skin turns pale, there is increased sweating;
- blood loss leadsto lower blood pressure;
- during the examination, the doctor may notice a weakening or increased heart rate (bradycardia or tachycardia);
- blood loss is associated with the appearance of sudden weakness, dizziness (sometimes even fainting);
- often you can observe chills, fever;
- patients sometimes complain of nausea (such episodes often end in vomiting);
- dryness of the mucous membranes in the mouth can be observed;
- blood may be present in 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 symptomatology is observed against the background of other diseases, in particular acute appendicitis, ectopic pregnancy, renal colic, severe inflammation of the abdominal wall, acute pancreatitis. That is why a properly conducted differential diagnosis is so important.
The above symptoms are a reason to urgently see a doctor. In no case should acute pain and weakness be ignored, since a woman's life depends on the timeliness of therapy.
Forms of disease development
In modern medicine, there are three forms of ovarian apoplexy, each with its own set of symptoms.
- Painful, or pseudoappendicular, apoplexy is accompanied by severe pain syndrome, whichsometimes associated with nausea. Often, these symptoms are mistaken for acute appendicitis.
- Anemic / hemorrhagic ovarian apoplexy - the clinical picture in this form of the disease is characterized by vivid symptoms of bleeding. 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.
- Mixed form of pathology combines the symptoms of the two previous forms of apoplexy.
You need to call a doctor immediately if you suspect an ovarian apoplexy. Emergency care and proper therapy in this case are extremely important.
Degrees of development of pathology
For a doctor, the volume of blood loss in a patient is important. Depending on this factor, there are three stages in the development of ovarian apoplexy:
- first degree (mild) - intra-abdominal blood loss is not more than 150 ml;
- second degree (medium) - against the background of pathology, the volume of blood lost ranges from 150 to 500 ml;
- 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 should be noted that with untimely diagnosis of the hemorrhagic form of apoplexy, the probability of death is high, which is duewith profuse blood loss and accumulation of a large volume of fluid in the abdominal cavity.
- Rupture of an organ sometimes disrupts the reproductive function of a woman's body. In particular, after a previous apoplexy in the ovary, as well as in the tissues of the fallopian tubes, adhesions are formed that prevent 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 such a 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 way you can prevent the occurrence of such complications.
- If the patient was treated conservatively, then the probability of developing repeated apoplexy in the future is about 50%.
Apoplexy and pregnancy
In itself, such a pathology is not the cause of infertility. Nevertheless, even with the correct treatment of 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 becomes pregnant, she should carefully monitor her well-being. About the 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 death of the patient.
First of all, it is necessary to collect an anamnesis and get acquainted with the patient's complaints. A gynecological examination is mandatory. The natural color of the vagina is preserved, only sometimes there is a slight pallor of the tissues. The size of the uterus is also normal. However, the affected ovary enlarges, 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, as well as a decrease in hemoglobin, 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-dispersed fluid in the ovary, as well as in the abdominal cavity. A puncture of the posterior fornix of the vagina is performed, which makes it possible to detect the accumulation of serous fluid, blood or pus in the abdominal cavity. An analysis is also carried out for the level of chorionic gonadotropin - this allows you to exclude (or confirm) the presence of an ectopic pregnancy.
Sometimes laparoscopy is additionally performed - a surgical intervention, during which specialists instruments are inserted into the small pelvis through small punctures of the abdominal wall. During the procedure, the specialist can detect blood and clots in the free cavity, assess the size andcondition of the uterus, identify inflammatory lesions of the fallopian tubes.
During the diagnosis, it is extremely important to determine the causes of ovarian apoplexy, as well as the form and stage of development of the pathology. The success of treatment largely depends on these factors.
First Aid
If there are acute pains and other symptoms described above, then the patient must be urgently taken to the hospital department and, therefore, an ambulance brigade should be called. Only a doctor after examination can diagnose ovarian apoplexy.
What to do while waiting for the arrival of doctors? In fact, not many people can help a woman at home. It is only necessary to lay the patient with a pillow under her head. Doctors do not recommend taking analgesics, anti-inflammatory drugs or other medicines to help manage pain, which 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 mildest cases, when the symptoms are mild and there is no bleeding. The scheme of therapy in this case is as follows:
- patient needs complete physical rest;
- Ice is placed on the lower abdomen, as this helps constrict 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, which includevitamins B12, B1 and B6 are present, as well as ascorbic acid).
Such treatment is carried out only in a hospital - the patient must be constantly under medical supervision. If bleeding has opened, then the woman is prescribed an operation.
Apoplexy of the ovaries increases the risk of adhesions, especially in cases where therapy was carried out with drugs. That is why such treatment is prescribed for women who do not plan to have children in the future. If we are talking about young patients, then the best option is surgery.
Surgical intervention for apoplexy
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, since the instruments are inserted inside through small punctures in the abdominal stack (there are no large scars on the skin);
- after this kind of operation, the reproductive functions of the reproductive system are most often preserved;
- the rehabilitation period is short, there is no pain syndrome;
- The risk of tissue infection is minimal.
The technique largely depends on the form of apoplexy, the volume and rate of blood loss, as well as some other tissues.
- In most cases, the doctor simply stitches the ruptured ovarian tissue together gently.
- If necessary, carried outcoagulation of tears - 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 adhesions can be removed.
- Complete removal of the ovary is performed only if there is complete damage to its tissues or massive bleeding.
During the rehabilitation period, women are prescribed special medications. In addition, various methods of physiotherapy are used, including lidase and zinc electrophoresis, 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 relapses
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, should be treated 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 the hemorrhagic form of the pathology, hormonal therapy is necessary - this will help prevent relapses of the disease.
