Apopleksiya of an ovary
Apopleksiya of an ovary – the medical emergency in gynecology which is characterized by sudden violation of integrity (rupture) of tissues of ovary. At an apopleksiya of an ovary there is hemorrhage in ovarialny fabric, various degree of expressiveness bleeding in an abdominal cavity and a sharp pain syndrome. Diagnostics is based on methods of the general survey, results of a puncture of the back arch of a vagina, ultrasonography of a small pelvis, a laparoscopy. Treatment of an apopleksiya of an ovary is more often emergency surgical – organ-preserving or radical. With the timely help and lack of complications (peritonitis, solderings) the forecast for life and the subsequent pregnancy favorable.
Apopleksiya of an ovary
As synonyms of an apopleksiya of an ovary serve the hematoma, a heart attack, a rupture of an ovary. Apopleksiya of an ovary occurs at 1-3% of all women with gynecologic pathology, is more often at the age of 20-35 years. More often the apopleksiya of the right ovary develops that is connected with its richer blood supply by the right yaichnikovy artery departing directly from an aorta. The right ovary is characterized by the big sizes, weight and more developed lymphatic system. Blood supply of the left ovary is carried out by the left yaichnikovy artery which is branching off from a renal artery.
On kliniko-morphological features allocate hemorrhages from follicular cysts of an ovary, mature follicles at an ovulation, stroma of ovaries, cysts of a yellow body, disfunktsioniruyushchy ovaries. Apopleksiya of an ovary serves as the reason of intra belly bleeding at 0,5-2,5% of patients.
Ovary apopleksiya reasons
Development of an apopleksiya of an ovary pathogenetic is connected with specifics of ovarialny fabric. The contributing factors are features of a krovenapolneniye of bodies of a small pelvis, change of permeability of yaichnikovy vessels in different phases of an ovarialny menstrual cycle. In the presence of changes of vascular walls as a result of expansion and a krovenapolneniye of vessels their permeability can increase up to violation of an integrity.
As background on which there is an ovary apopleksiya dystrophic and sclerous changes of yaichnikovy fabric owing to a polikistoz of ovaries, a varicosity of an ovary, an ooforit, an inflammation of appendages, termination of pregnancy etc. can serve. The probability of an apopleksiya of an ovary increases in connection with medicamentous stimulation of an ovulation that can cause violations of processes of an ovulation and formation of a yellow body. Some authors as the reasons of an apopleksiya of an ovary are called the neuroendocrine frustration which are followed by change of properties of vessels of ovarialny fabric and also reception of anticoagulants.
The stomach injury, physical overstrain, riding, sports occupations, the rough or interrupted sexual intercourse and other moments connected with increase in intra belly pressure can provoke an ovary apopleksiya. However the apopleksiya of an ovary is noted also in the absence of provocative factors. Quite often the rupture of an ovary correlates with development of appendicitis. Apopleksiya of an ovary can arise in any phase of a menstrual cycle, but it happens to a thicket in the period of an ovulation or on the eve of periods when the content of gonadotropny hormones reaches the peak. The option of emergence of an apopleksiya of an ovary against the background of a delay of monthly is also possible.
Classification of forms of an apopleksiya of an ovary
Taking into account the prevailing symptomatology allocate the following forms of an apopleksiya of an ovary: an anemichesky or hemorrhagic form with prevalence of symptoms of bleeding in an abdominal cavity; a painful form at which the strong pain syndrome without symptoms of internal bleeding is noted; the mixed form combining symptoms of an anemichesky and painful form of an apopleksiya of an ovary.
However, as actually the ovary apopleksiya is always followed by bleeding of various degree of expressiveness, now it is accepted to subdivide pathology into severity. Taking into account the size of bleeding differ easy, average and heavy degree of an apopleksiya of an ovary.
Ovary apopleksiya symptoms
The main manifestations of an apopleksiya of an ovary are pain and symptoms of internal bleeding.
The pain syndrome at an apopleksiya of an ovary arises sharply, is localized in the lower departments of a stomach; irradiation of pain to the umbilical or lumbar area, a rectum, a crotch can be noted. Pain can have various character - constant or pristupoobrazny, pricking or skhvatkoobrazny. The painful attack proceeds of half an hour till several o'clock, periodically comes back within a day.
Development of bleeding at an apopleksiya of an ovary is followed by decrease HELL, increase and weakening of pulse, pallor of skin, the general weakness, dizziness, faints, oznoba, dryness mucous a mouth, vomiting, the speeded-up urination, desires to defecation. After a delay of periods bloody allocations from a genital tract are quite often noted. Without acceptance of emergency measures intra belly bleeding can progress and create serious threat of life of the patient.
Spontaneous short-term painful attacks, nausea, lack of the peritonealny phenomena and shock are characteristic of easy degree of an apopleksiya of an ovary. Apopleksiya of an ovary of moderate severity proceeds with the severe pain, the general weakness, vomiting, a faint which is unsharply expressed by the peritonealny phenomena, shock of the I degree. At a heavy apopleksiya of an ovary the expressed constant pain, an abdominal distension, vomiting, a collapse, cold sweat, tachycardia, shock of the II-III Art., expressiveness of peritonealny symptoms, decrease in hemoglobin more than 50% of norm is noted. The clinic of an apopleksiya of an ovary can accrue behind a mask of extra-uterine pregnancy, an acute appendicitis, uterine pregnancy, a perekrut of a cyst of an ovary, renal colic, sharp pancreatitis, peritonitis that demands attentive differential diagnostics.
Diagnostics of an apopleksiya of an ovary
Usually patients with an apopleksiya of an ovary are hospitalized with the diagnosis "a sharp stomach". For specification of the reasons of pathology surgeons, gynecologists, urologists are involved in diagnostics. Apopleksiya of an ovary demands bystry and exact recognition as increase of bleeding makes heavier a state and can threaten the woman's life. Carrying out gynecologic survey on a chair, hemoglobin measurement, carrying out a puncture of the back arch of a vagina, ultrasonography of a small pelvis, a laparoscopy is important for differential diagnostics of an apopleksiya of an ovary.
Characteristic signs of an apopleksiya of an ovary are complaints to emergence of sharp belly-aches in the middle of a menstrual cycle or its second half. At the general survey and a palpation morbidity on side of the involved ovary, swelling of a stomach, positive peritonealny symptoms pays attention. In the general blood test at an apopleksiya of an ovary noticeable decrease in hemoglobin, is noted. For an exception of extra-uterine pregnancy blood on HGCh is investigated.
During the vaginal research the gynecologic nature of pathology is specified: sharp morbidity side and the back arch, a pulsation of vessels of the arches, in case of massive hemorrhage – a vybukhaniye of the back arch comes to light. At shift in sides of a neck of a uterus there is severe pain. The uterus sizes are usually not changed, sometimes slightly increased, a consistence dense. The interested appendage painful, is increased to the egg sizes, has an elastic consistence and limited mobility. At an apopleksiya of an ovary releases of blood from a genital tract are possible.
During a puncture of the back arch of a vagina at an apopleksiya of an ovary receive blood or serous and bloody liquid. The ultrasonic picture at an apopleksiya of an ovary is characterized by availability of free liquid in a stomach, symptoms of hemorrhage in ovarialny fabric on the struck party. For final diagnostics of an apopleksiya of an ovary and elimination of bleeding the laparoscopy is shown.
Treatment of an apopleksiya of an ovary
Conservative tactics is possible only in mild cases of an apopleksiya of an ovary in the absence of strong indications of internal bleeding. Conservative actions at an apopleksiya of an ovary include purpose of strict rest, cold to a stomach, suppositories with a belladonna, spazmolitik, vitamins, styptic medicines. After subsiding of the sharp period carry out a diathermy, an electrophoresis with chloride calcium, Bernard's currents. At emergence of signs of increase of bleeding immediate operation is shown.
In recent years the gynecology, as a rule, carries out surgical treatment of an apopleksiya of an ovary. Conservative treatment is appointed only to patients with an easy form of pathology and the realized reproductive function. If the woman plans pregnancy, then preference is given to surgical treatment of an apopleksiya of an ovary.
Surgical tactics at an ovary apopleksiya usually includes carrying out a laparoscopy, is more rare – a chrevosecheniye (at impossibility of carrying out endoscopic operation). As a contraindication to a surgical grant extreme degree of hemorrhagic shock can serve. Operation is tried to be performed in most sparing way, keeping ovary tissues. Operation volume at an apopleksiya of an ovary can include coagulation of places of a rupture of ovarialny fabric, a wedge-shaped resection of an ovary, an ushivaniye of a rupture of an ovary, an ooforektomiya, an adneksektomiya. An important point of expeditious treatment of an apopleksiya of an ovary is careful washing of an abdominal cavity, removal of clots that is extremely important preventive measure of development of adhesive process and infertility.
In the post-operational period the measures directed to the prevention of formation of solderings, normalization of hormonal processes, restoration of reproductive opportunities are taken. For the period of the recovery period after an ovary apopleksiya to patients competent selection of contraception is made, the physical therapy is appointed (magnetotherapy, ultrasound, laser therapy, an electrophoresis with zinc, lidazy, electrostimulation of uterine tubes).
Complications and the forecast at an ovary apopleksiya
At the considerable blood loss accompanying an ovary apopleksiya hemorrhagic shock can develop, and with out of time given help – a lethal outcome. Conservative maintaining an apopleksiya of an ovary is fraught with development of adhesive process in a small basin (85,7%), infertility (42,8%), a repeated rupture of an ovary (about 50%). Timely recognition and active treatment of an apopleksiya of an ovary is followed by the favorable forecast in respect of preservation of life and reproductive function. Conducting pregnancy at patients after an apopleksiya of an ovary requires special attention from the obstetrician-gynecologist.
Prevention of an apopleksiya of an ovary
Not to allow emergence or repetitions of an apopleksiya of an ovary performing treatment of the available gynecologic diseases (an adneksit, an ooforit, SPKYa, STD, etc.), an exception of provocative factors, observation at the gynecologist is necessary. At suspicion on an apopleksiya of an ovary it is necessary to provide sick rest, to give horizontal position, to put cold on a stomach and to call the ambulance.