Ovarian apoplexy is a sudden hemorrhage in the
ovary at rupture of vessels graaf bubble, ovarian stroma,
follicular cyst or cyst of the corpus luteum, accompanied by
violation of the integrity of its tissue and bleeding into the abdominal cavity.
Ovarian tissue rupture is an extremely dangerous condition that
accompanied by severe pain and blood loss.
Поэтому давайте рассмотрим в этой статье: что является
причиной апоплексии, какие признаки характерны для
of this disease and the possible consequences for the female
Apoplexy: what is it?
Ovarian apoplexy is spontaneous, rapidly progressive.
hemorrhage into the ovary followed by the outflow of blood for his
the limits. При этом у женщины возникает резкая сильная боль в
lower abdomen. If a повреждается крупный сосуд, то происходит
hemorrhage into the peritoneum. In another way, this disease is called
heart attack or ovarian rupture.
Apoplexy occurs in 1-3% of all women with gynecological
pathology, usually at the age of 20-35 years. Apoplexy develops more often
right ovary due to its richer blood supply
right ovarian artery extending directly from the aorta.
- The right ovary is characterized by large size, mass and
more developed lymphatic system.
- Blood supply of the left ovary is provided by the left ovarian
artery branching off the renal artery.
The clinical picture of apoplexy is always accompanied by two
the leading symptoms are pain and bleeding. Depending on the
the dominance of one of the symptoms of the disease conditionally allocate:
- Painful form, having signs of acute appendicitis and leading
symptom – pain.
- Anemic shape, reminiscent of the flow interrupted
- Mixed form with signs of the previous two.
The first and second forms of ovarian apoplexy never
are diagnosed in their pure form, since when a tissue is ruptured
bad stomach and hemorrhage.
Depending on the объема теряемой крови выделяют 3 формы такой
- Легкая – потеря крови не больше 150 мл (первая степень
- Средняя – объем теряемой крови от 150 мл до 0.5 л (вторая
- Тяжелая – теряется более 0.5 л крови (третья
Ovarian apoplexy is a fairly dangerous condition
17% in the structure of acute gynecological diseases and up to 2.5% –
among the causes of abdominal bleeding that creates severe
a threat to the life of a woman, therefore requires hospitalization and
The basis of ovarian apoplexy is long-existing
violation of the integrity of one (less often – several) ovarian vessels,
what happened after its rupture. Released blood passing
hematoma stage, poured into the abdominal cavity.
Every woman should know the answer to the question, what is
ovarian apoplexy and how to prevent this disease. The main
provoking factor is the progression of the vascular
Ovarian rupture is formed for the following reasons:
- Increased load on the vessels.
- The development of thrombocytopenia.
- The development of the disease villerbrand.
- Prolonged use of anticoagulants that promote
- Change hormonal levels.
- Inflammation of the ovaries and uterus.
- The course of adhesions.
Спровоцировать кровоизлияние способны:
- mechanical damage to the pelvic organs for example
- physical strain too intense or rough
- inept syringing, rough examination by a gynecologist;
- horseback riding.
Other causes of the disease include pressure on
vessels of the neoplasm (cyst), the release of the egg and rupture
follicle, uterus improperly positioned.
Симптомы апоплексии яичника
The main symptom of ovarian apoplexy is a sudden sharp pain in
due to the outflow of blood into the abdominal cavity and often
Radiating to the anus, umbilical zone and
Ovarian apoplexy is characterized by the following symptoms:
- lower abdominal pain;
- резкое снижение артериального давления, учащение
- общая слабость;
- violation of the menstrual cycle;
- frequent urination.
With the hemorrhagic form of the disease, if blood loss
growing signs may join these symptoms
evidence of intraperitoneal bleeding:
- loss of consciousness;
- pallor of mucous membranes and skin;
- sticky sweat;
- lower blood pressure.
On examination, the doctor detects the tension of the anterior abdominal wall
and bloating. Touching the belly is extremely painful for
If you find these signs of rupture of one of the ovaries,
should not hesitate to call a doctor. Progressive intra-abdominal
bleeding can be fatal.
Quite often, ovarian apoplexy occurs after sexual
act or occupation in the gym, that is, under certain
conditions when pressure in the abdominal cavity rises and it is possible
violation of the integrity of ovarian tissue. But, ovarian rupture may
to occur and against the background of complete health.
The picture of the disease resembles the clinic of acute appendicitis,
which is more common ovarian apoplexy, so the patient may
send to a surgical hospital. Differentiate these
diseases can be on the following grounds:
- При аппендиците отсутствует связь с фазами менструального
- The pain begins in the epigastric region, then descends into
- Nausea and vomiting are more persistent.
- The body temperature rises.
- The tension of the muscles of the abdominal wall of the right iliac region
It also identifies clear symptoms of peritoneal irritation.
Ovarian apoplexy should also be differentiated from such
- adnexitis (inflammation of the uterine appendage);
- torsion of the legs of an ovarian cyst;
- intestinal obstruction;
- perforated gastric ulcer;
- an attack of pancreatitis and colic – hepatic and renal.
For any severe abdominal pain and suspicion of internal
blood loss requires urgent delivery of women to the hospital. how
as a rule, in such conditions, a general diagnosis of acute
stomach”. And clarification of the cause of this condition is already in progress.
Consequences for the female body
The consequences of gynecological pathology are directly dependent on
severity of the disease and profusion of blood loss.
- So, with significant blood loss in women after surgery
hemorrhagic shock may develop.
- In the most severe cases, with significant blood loss and
Failure of timely treatment can be fatal.
- In case the abdominal cavity was not cleaned,
patients have a high risk of developing adhesions, as well as
re-rupture of the ovary.
- In case of ovarian apoplexy during pregnancy is high
probability of miscarriage and premature birth.
Important! In most cases, the above complications
develop in the absence of timely, professional
After examining complaints, medical history (determining phase
menstrual cycle, the presence of concomitant pathologies) and examination
women carried out diagnostic studies:
- Gynecological examination. If there is no hemorrhage in the abdominal
cavity, then in the gynecological examination of the vaginal wall
have a normal shade. Otherwise they are pale. Uterus
normal size. When anemic form of wall apoplexy
the vagina hang over. Feel the size of the ovaries practically
impossible due to severe pain.
- Blood test. In general, a blood test may occur.
decrease in hemoglobin level (in anemic and mixed forms
- УЗИ – для изучения структуры желтого тела, образования в
- Laparoscopy. Into the abdominal cavity through a puncture is injected
optical device (endoscope) for a thorough inspection. Method
allows you to accurately determine the cause of bleeding and nature
ovary apoplexy. If necessary, this method can be immediately
- Puncture of the abdominal cavity from the vagina, performed under
Лечение апоплексии яичника
When considering possible treatments for ovarian apoplexy,
First of all, it is necessary to note the importance of its urgency, because
as a whole, this condition is a serious threat to life.
If you do not stop blood loss, which can be achieved in the end
of considerable size, a similar consequence of apoplexy may
попросту привести к летальному исходу.
The choice of treatment depends on the result of hematological tests.
(complete blood count), the degree of bleeding, and the presence or
lack of peritoneal symptoms (pain, arising
with irritation of the peritoneum).
- In mild form – conservative treatment (cold on the lower abdomen,
bed rest, observation, examination).
Лечение производится в стационаре и показано лишь в том
when the pain syndrome is not pronounced, and the amount of lost
- Moderate and severe form – surgical treatment.
Conservative treatment of ovarian apoplexy includes:
- Cold compresses on the lower abdomen.
- Prescription of drugs from the hemostatic group.
Medicines such as vikasol, askorutin, etamzilat, contribute to
- The use of antispasmodics (papaverine, drotaverine,
- Injections of ascorbic acid and vitamins of group B.
In no case should the treatment of the disease be postponed or
detract, at the same time it should be gentle and
aim to preserve the ability to bear children.
It is worth noting that conservative methods are not always used.
even with mild apoplexy, as they cannot eliminate
the presence of clots in the abdominal cavity. As a result, after such
treatments often have the following complications:
- formation of adhesions;
To exclude the development of the above states most
Doctors adhere to surgical treatment
В случае возникновения симптомов, указывающих на
ovarian apoplexy, you should immediately take horizontal
position as well urgently call an ambulance for
subsequent hospitalization in the surgical or gynecological
hospital The pathology is diagnosed by a gynecologist.
Apoplexy can cause severe bleeding.
The volume of blood loss in some cases is more than 1 liter.
Such massive bleeding can directly threaten life.
Operation при апоплексии яичника предполагает бережное
repair damaged tissue. Ovary is removed
only in the presence of excessive blood loss, when it is impossible
maintain the integrity of damaged tissues and blood vessels.
If the gap occurred while the woman was carrying the child,
surgery will prevent miscarriage and
keep the pregnancy.
Operation при апоплексии может выполняться двумя методами:
- laparoscopic (through a small hole in the abdominal
- laparotomic (when cutting the abdominal wall).
Basically, surgical treatment of apoplexy is performed by the method
laparoscopy. This technique is the most gentle and
low-impact, and the recovery period after it flows
Recovery period after surgery
With uncomplicated form of apoplexy, the average recovery period
after laparoscopic surgery last a week, and after
laparotomy – two weeks. Already on the first day after laparoscopic
operations are allowed to get out of bed, as well as eat
In the postoperative period, measures are taken to
prevention of adhesions formation, normalization of hormonal
processes, restoration of reproductive capabilities. For a while
recovery period after ovarian apoplexy patients
- грамотный подбор контрацепции,
назначается физиотерапия (магнитотерапия, ультразвук, лазеротерапия,
electrophoresis with zinc,
лидазой, электростимуляция маточных труб).
If the operation was successful and the rehabilitation course is safely
passed, the patient may have questions on planning
next pregnancy. Planning is possible however first
doctors will need to make sure that all the consequences of apoplexy
the ovary is safely overcome. To this end, the patient is held
The rehabilitation course also helps to avoid many of the consequences.
diseases. Doctors call the main ones:
- formation of adhesions that minimize the chances
- inflammation of the genital organs and the abdominal cavity;
- problems with the menstrual cycle and hormones;
- recurrence of the disease;
After the end of rehabilitation activities before
recommend the patient to plan the next pregnancy,
It is advisable to perform diagnostic laparoscopy, allowing
assess the condition of the fallopian tube and other organs of the small pelvis. If a
with the control laparoscopy revealed no pathological changes,
then the patient is allowed to plan a pregnancy next
After discharge from the hospital, it is important to prevent recurrence.
future diseases, i.e. eliminate risk factors and timely
treat diseases that provoke ovarian apoplexy. If a у вас
there were suspicions of rupture of the ovary, you need to take
horizontal position and call an ambulance for
Considering the fact of the possibility of developing ovarian apoplexy in
gynecologically healthy women, to measures of prevention of its development
can be attributed to:
- elimination of excessive physical exertion, especially during
menstruation, as well as stress and hypothermia;
- prevention of inflammatory diseases of the genitals;
- timely correction of hormonal disorders.
Ovarian apoplexy is not only a serious disease
organ, but also the entire reproductive system. His diagnosis and treatment
must take place exclusively in the hospital under
supervision of experienced doctors.