In the article we will consider what apoplexy is. Pathology is a sudden rupture of the tissues of this organ, which provokes the development of bleeding into 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 occurs as a result of pathological vascular changes against the background of an intense inflammatory process. Usually apoplexy occurs during the period of ovulation or at the stage of vascularization of the corpus luteum. Young women are most affected by this disease.
Not everyone knows what apoplexy is. It is a gynecological emergency that is characterized by ovarian rupture. With apoplexy, hemorrhage develops in the ovarian tissues, bleeding of varying severity into the abdominal cavity and a syndrome of severe pain.
Apoplexy is synonymous with heart attack, hematoma, ovarian rupture. This pathology occurs in 1-3% of women with various gynecologicaldiseases, most often at the age of 20 to 35 years. Apoplexy of the right ovary occurs somewhat 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 by the left ovarian artery, which branches off from the renal artery.
By clinical and morphological features, one can distinguish hemorrhages from follicular ovarian cysts, mature follicles during ovulation, corpus luteum cysts, ovarian stroma, dysfunctional ovaries. The rupture causes intra-abdominal bleeding in approximately 0.5-2.5% of affected women.
Causes of apoplexy
Pathogenetically, the development of ovarian apoplexy is associated with the specifics of ovarian tissues. The 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 disturbances in the structures of the vascular walls due to vascular expansion and blood supply, their permeability can increase up to the occurrence of integrity violations.
The background on which ovarian apoplexy occurs can be sclerotic and dystrophic changes in ovarian tissues due to ovarian varicose veins, polycystic ovaries, oophoritis, inflammation of the appendages, abortion, etc. The risk of developing ovarian apoplexy increases based ondrug stimulation of ovulation, which often leads to pathological disorders of ovulatory processes and the formation of the corpus luteum. Some authors call neuroendocrine pathologies, which are accompanied by a change in the functionality of the vessels of ovarian tissues, as well as the use of anticoagulant drugs, as the causes of apoplexy.
Abdominal injuries, excessive physical overexertion, horseback riding, sports activities, violent or interrupted sexual intercourse and other moments associated with an increase in intra-abdominal pressure can provoke an ailment. Nevertheless, ovarian apoplexy is also observed in the absence of the above provoking factors. A common occurrence is the situation when rupture of the ovary is combined with the development of appendicitis. Apoplexy can occur in any phase of the menstrual cycle, but most often it 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 the disease with a delay in menstruation is possible.
Next, find out what are the forms of apoplexy.
Classification of types of apoplexy
Given the predominant symptoms of this pathological condition, the following types can be distinguished:
- painful form, in the event of which there is a bright pain syndrome without symptoms of internal bleeding;
- hemorrhagic or anemic type with a predominance of signs of bleeding into the abdominal cavity;
- mixed form thatcombines symptoms of painful and anemic types of apoplexy.
However, since in reality the pathological phenomenon is always accompanied by bleeding of varying degrees of intensity, it is currently customary to subdivide the disease into degrees of severity. When taking into account the amount of bleeding, mild, moderate and severe degrees of the disease are distinguished. Symptoms completely depend on the form of apoplexy.
Symptomatics
The main manifestations of the pathological phenomenon are pain and symptoms of internal bleeding.
Pain in ovarian apoplexy comes on acutely and is usually localized in the lower abdomen. At the same time, irradiation of pain in the lumbar and umbilical zone, the perineum, and the rectum is observed. Soreness can be of a different nature - constant or paroxysmal, stabbing or cramping type. The 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, dryness of the mucous membranes of the mouth, urge to defecate, frequent urination. After a delay in menstruation, bleeding 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, absence of peritoneal phenomena, nausea may occur.
What is moderate apoplexy? It proceeds with severe pain, general weakness, fainting, vomiting, mild peritoneal phenomena, shock of the 1st degree. In severe forms of ovarian apoplexy, there is constant severe pain, flatulence, collapse, vomiting, tachycardia, cool sweat, grade 2-3 shock, severity of peritoneal symptoms, a decrease in hemoglobin concentration of more than 50% of normal values. The clinic may intensify under the guise of acute appendicitis, ectopic pregnancy, uterine pregnancy, ovarian cyst torsion, renal colic, peritonitis, acute pancreatitis, which requires careful differential diagnosis.
Cyst apoplexy
Rupture of a cystic formation on the ovary is a pathology in which there is a hemorrhage into the tissue, 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 in women in the reproductive period. Among the acute surgical pathology - is approximately 11%, and among the gynecological diseases - about 10-27%, taking the 3rd place. The number of exacerbations of this condition occurs in about 40-69% of young women.
Cyst apoplexy can occur when ovulation is disturbed, as a result of which the corpus luteum is formed with the formation of a non-ovulating cystfollicle (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%.
Causes of the pathology of this variety 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 (day 12-14 of the cycle) until the onset of menstruation. These processes are usually accompanied by excessive blood filling of the uterine appendages, as well as an increase in the permeability of their vessels. The fundamental role in this pathological process is played by the imbalance of pituitary hormones - luteinizing, follicle-stimulating hormones, as well as prolactin.
Predisposing factors
Predisposing factors for this condition in women include:
- dysfunctions of the endocrine system, in particular, imbalance in the work of the hypothalamus-pituitary-ovarian system;
- functional dysfunctions of the nervous system, psycho-emotional lability provoked by stressful situations, psychological stress and overwork;
- inflammatory processes of the urinary tract and genital organs, leading to a rush of blood to the appendages and impaired microcirculation, as well as to fibrotic and sclerotic changes in their tissues;
- dysmenorrhea and a high number of abortions;
- tumor or adhesive process in the area of smallpelvis;
- abnormal position of the uterus;
- pelvic congestion, ovarian varicose veins;
- stimulation of ovarian function, polycystic.
Increased bleeding is also facilitated by clotting disorders 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 adhesive 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 the rupture of the cystic formation on the ovary, the frequency of conception is only about 26%.
The consequences of ovarian apoplexy are described below. What it is is now clear.
Consequences of illness
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 reproductive functions of a woman. If you do not seek qualified medical help on an emergency basis, the consequences can be extremely dangerous.
Research results prove that conservative therapy of ovarian apoplexy does not always help to achieve a positive result. The blood that has entered the abdominal cavity forms a breeding ground for pathogenic microorganisms, where the process of aseptic inflammation begins. HowAs a result, adhesions are formed that disrupt the natural structure of the ovary and nearby tissues. In such situations, the most common complication is the cessation of the reproductive functions of patients. Pain after apoplexy is also not uncommon.
Light bleeding is not as dangerous as heavy bleeding, but it can also lead to serious consequences.
Inflammatory processes in the pelvic area, repeated hemorrhage in the ovary, adhesive process, peritonitis, loss of reproductive function are the most severe 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 conception. Adhesions that occur in the region of the ovary and fallopian tube become a decisive obstacle to fertilization. After an ovarian apoplexy or a cyst, ectopic pregnancies are often observed in women. If bleeding is not prevented in time, then ovarian apoplexy can even lead to the death of the patient.
During pregnancy, this pathology does not happen often. In such situations, surgery is performed through laparotomy. Another negative consequence of apoplexy is the high risk of miscarriage.
If you follow all medical recommendations and follow all the conditions of therapy, you can avoid the negative consequences of this disease or minimize them. anti-inflammatory therapy andphysiotherapy sessions are a mandatory postoperative course. In addition, it is important to use hormonal medications and contraception for six months. According to statistics, with emergency hospitalization and proper treatment of patients with apoplexy, the prognosis is usually favorable.
Diagnosis
Statistics says that the correct diagnosis of apoplexy is only 5%. Such a small percentage is due to the fact that the disease does not have characteristic and pronounced features, and is often perceived as another disease.
Diagnosis of apoplexy must be made promptly, because the more time it takes to diagnose, the more blood loss is aggravated, and this is a serious threat to a woman's life.
The most effective diagnostic methods are:
- Ultrasound for apoplexy, which allows you to see a corpus luteum in the ovary and characteristic bleeding into it or free fluid in the posterior fornix or abdomen;
- laparoscopy, which allows with a 100% guarantee to make a diagnosis, and also makes it possible to correct even complex pathologies.
Rupture of ovarian tissue looks laparoscopy as 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 tissue rupture, 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 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 childbearing function. If there is suspicion of apoplexy, then the patient must immediately take a horizontal position. In addition, the woman should be quickly taken to a surgical or gynecological hospital.
Conservative therapy is possible in case of simple forms of pathology. Such treatment consists in taking hemostatic drugs, vitamins and antispasmodics. The patient needs to cool the lower abdomen and rest. Treatment is carried out in stationary conditions. In case of deterioration of he alth 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 the pathology and take the necessary measures. Surgical intervention is carried out by laparoscopic or laparotomic access. With laparotomy, it is possible to coagulate the damaged vessel. During laparoscopy, excess blood is removed from thethe abdominal cavity, after which washing with antiseptic solutions is carried out, and the damaged vessel is sutured. However, if the pathology of the cyst occurs, then they resort to its removal and suturing of the ovary. The operation for 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 an apoplexy during surgery, the ovary is removed only in case of a serious hemorrhage, if it completely affected this organ. During pregnancy, it is sutured, resection is not performed.
We looked at what apoplexy is. This is a rather dangerous pathology that is fraught with serious he alth problems.
