Ovarian apoplexy

Last updated September 05, 2021

Ovarian apoplexy is a sudden rupture in the ovary, commonly at the site of a cyst, accompanied by hemorrhage in the ovarian tissue and/or intraperitoneal bleeding.

Symptoms and signs

Clinical symptoms of apoplexy associated with the basic mechanism of this disease:

Pain, which occurs primarily mid-cycle or after a minor delay in menstruation (at the time of the rupture of a corpus luteum cyst, for example). Pain is most often localized in the lower abdomen. Sometimes the pain may radiate to the rectum or to the lumbar or the umbilical region.^[1]
Bleeding into the abdominal cavity, which may be accompanied by:

low blood pressure
increase in heart rate
weakness and dizziness ^[2]
syncope
chills
fever up to 38°C
vomiting
dry mouth

Sometimes there may be inter-menstrual bleeding or spotting after menstruation. Quite often, ovarian apoplexy occurs after intercourse or training in the gym, when pressure in the abdomen has increased or ovarian tissue has experienced some stress. However, rupture of ovarian tissue can occur in conjunction with other diseases.^{[ citation needed ]}

Pathogenesis

During a normal ovarian cycle (which accompanies the menstrual cycle) of a sexually mature woman, one or more follicles grow in the ovaries. The oocyte in the follicle matures to prepare for potential fertilisation. As the cycle progresses, a smaller number of dominant follicles (typically only one) begin to stand out, and reach a maximum size of about 20mm around the middle point of cycle. By this stage, the oocyte has finished maturing into an ovum (an egg), and ovulation occurs - the follicle ruptures and releases the ovum. A ruptured follicle forms a temporary cyst - a corpus luteum - which produces hormones to continue the cycle and mature the uterine lining.^{[ citation needed ]}

In cases of dystrophic and sclerotic changes in ovarian tissue, acute and chronic inflammatory processes in the uterus, or in polycystic ovary syndrome and some other diseases, as well as the result of medication that stimulate ovulation, certain irregularities in ovulation process and corpus luteum formation occur. As a result, blood vessels in the ovary contract, become dilated, and increase intra-ovarian bleeding. A hemorrhage can then occur in the corpus luteum due to the fragility of blood vessels, causing a hematoma. This is accompanied by pain, weakness, dizziness, nausea, vomiting, pale skin, and/or fainting. If left untreated, internal bleeding may increase and become a threat to the individual's health and life. Other possible causes of ovarian rupture include abdominal trauma, excessive physical stress, vigorous sexual intercourse, horseback riding, etc.^{[ citation needed ]}

Diagnosis

Typical complaints appear during the middle or second half of the menstrual cycle. On examination, there is marked soreness of the affected ovary, and positive symptoms of irritation of the peritoneum. In a general blood test, a marked decrease in hemoglobin levels can be seen (in the anemic and mixed forms of ovarian apoplexy). Pelvic ultrasound reveals in the affected ovary a large corpus luteum cyst with signs of hemorrhage in it and/or free fluid (blood) in the abdominal cavity. Because ovarian apoplexy is an acute surgical pathology, diagnosis must be confirmed rapidly, since delays between the event and surgical intervention increases the magnitude of blood loss and may be life-threatening.^{[ citation needed ]}

Classification

Painful type – the primary symptom is pain, without signs of intraperitoneal bleeding.
Anemic type – the primary symptom is internal (abdominal) bleeding, without pain.
Mixed type – a combination of pain and intraperitoneal bleeding.

However, according to recent data, this classification is inadequate, because the ovary cannot rupture without bleeding.

Therefore, a new pathology has been devised in which the condition is divided according to severity: mild, moderate and severe (depending on the magnitude of blood loss).

Treatment

Treatment depends on the type of ovary apoplexy and the severity of intra-abdominal bleeding, but the condition must be treated in a hospital. In the case of pain without signs of intra-abdominal bleeding, conservative therapy may be initiated, which includes bed rest, antispasmodics, and physiotherapy. In the presence or suspected internal bleeding, surgery is indicated via laparoscopy or laparotomy. Other treatments may include efforts to stop the bleeding or resection of the affected portion of the ovary. However, in cases in which there is extensive damage to the ovary, it may be necessary to remove it. After being discharged from the hospital, it is important to take steps to prevent a recurrence in the future. Such steps include avoiding risk factors or beginning a regimen of oral contraceptives to control ovarian activity.^{[ citation needed ]}

Related Research Articles

Ovary Female reproductive organ that produces egg cells

The ovary is an organ found in the female reproductive system that produces an ovum. When released, this travels down the fallopian tube into the uterus, where it may become fertilized by a sperm. There is an ovary found on each side of the body. The ovaries also secrete hormones that play a role in the menstrual cycle and fertility. The ovary progresses through many stages beginning in the prenatal period through menopause. It is also an endocrine gland because of the various hormones that it secretes.

The menstrual cycle is a series of natural changes in hormone production and the structures of the uterus and ovaries of the female reproductive system that make pregnancy possible. The ovarian cycle controls the production and release of eggs and the cyclic release of estrogen and progesterone. The uterine cycle governs the preparation and maintenance of the lining of the uterus (womb) to receive a fertilized egg. These cycles are concurrent and coordinated, normally last between 21 and 35 days in adult women, with a median length of 28 days, and continue for about 30–45 years.

Ovulation is the release of eggs from the ovaries. In women, this event occurs when the ovarian follicles rupture and release the secondary oocyte ovarian cells. After ovulation, during the luteal phase, the egg will be available to be fertilized by sperm. In addition, the uterine lining (endometrium) is thickened to be able to receive a fertilized egg. If no conception occurs, the uterine lining as well as the egg will be shed during menstruation.

Mittelschmerz is a medical term for "ovulation pain" or "midcycle pain". About 20% of women experience mittelschmerz, some every cycle, some intermittently.

An ovarian cyst is a fluid-filled sac within the ovary. Often they cause no symptoms. Occasionally they may produce bloating, lower abdominal pain, or lower back pain. The majority of cysts are harmless. If the cyst either breaks open or causes twisting of the ovary, it may cause severe pain. This may result in vomiting or feeling faint.and even cause head aches.

The corpus luteum is a temporary endocrine structure in female ovaries and is involved in the production of relatively high levels of progesterone and moderate levels of estradiol and inhibin A. It is the remains of the ovarian follicle that has released a mature ovum during a previous ovulation.

Anovulation is when the ovaries do not release an oocyte during a menstrual cycle. Therefore, ovulation does not take place. However, a woman who does not ovulate at each menstrual cycle is not necessarily going through menopause. Chronic anovulation is a common cause of infertility.

An ovarian follicle is a roughly spheroid cellular aggregation set found in the ovaries. It secretes hormones that influence stages of the menstrual cycle. Women begin puberty with about 60-80,000 follicles in each ovary, each with the potential to release an egg cell (ovum) at ovulation for fertilization. These eggs are developed once every menstrual cycle.

Ovarian hyperstimulation syndrome (OHSS) is a medical condition that can occur in some women who take fertility medication to stimulate egg growth, and in other women in very rare cases. Most cases are mild, but rarely the condition is severe and can lead to serious illness or death.

The estrous cycle is the set of recurring physiological changes that are induced by reproductive hormones in most mammalian therian females. Estrous cycles start after sexual maturity in females and are interrupted by anestrous phases, otherwise known as "rest" phases, or by pregnancies. Typically, estrous cycles repeat until death. These cycles are widely variable in duration and frequency depending on the species. Some animals may display bloody vaginal discharge, often mistaken for menstruation. Many mammals used in commercial agriculture, such as cattle and sheep, may have their estrous cycles artificially controlled with hormonal medications for optimum productivity. Naturally, estrous cycles are complemented by a rutting period of male counterparts within a species.

In biology, folliculogenesis is the maturation of the ovarian follicle, a densely packed shell of somatic cells that contains an immature oocyte. Folliculogenesis describes the progression of a number of small primordial follicles into large preovulatory follicles that occurs in part during the menstrual cycle.

The theca folliculi comprise a layer of the ovarian follicles. They appear as the follicles become secondary follicles.

The corpus hemorrhagicum is a temporary structure formed immediately after ovulation from the ovarian follicle as it collapses and is filled with blood that quickly clots. After the trauma heals, the subsequent structure is called the corpus luteum. Sometimes during ovulation, small blood vessels rupture, and the cavity of the ruptured follicle fills with a blood clot, a corpus hemorrhagicum.

Ovarian diseases are conditions that happen to young women which can affect their reproductive system and general health.

A heterotopic pregnancy is a rare complication of pregnancy in which both extra-uterine and intrauterine pregnancy occur simultaneously. It may also be referred to as a combined ectopic pregnancy, multiple‑sited pregnancy, or coincident pregnancy.

Ovarian torsion (OT) is when an ovary twists on its attachment to other structures, such that blood flow is decreased. Symptoms typically include pelvic pain on one side. While classically the pain is sudden in onset, this is not always the case. Other symptoms may include nausea. Complications may include infection, bleeding, or infertility.

The follicular cyst of the ovary is a type of functional simple cyst, and is the most common type of ovarian cyst.

A corpus luteum cyst is a type of ovarian cyst which may rupture about the time of menstruation, and take up to three months to disappear entirely. A corpus luteum cyst rarely occurs in women over the age of 50, because eggs are no longer being released after menopause. Corpus luteum cysts may contain blood and other fluids. The physical shape of a corpus luteum cyst may appear as an enlargement of the ovary itself, rather than a distinct mass -like growth on the surface of the ovary.

Ovarian pregnancy refers to an ectopic pregnancy that is located in the ovary. Typically the egg cell is not released or picked up at ovulation, but fertilized within the ovary where the pregnancy implants. Such a pregnancy usually does not proceed past the first four weeks of pregnancy. An untreated ovarian pregnancy causes potentially fatal intra-abdominal bleeding and thus may become a medical emergency.

Ovarian follicle dominance is the process where one or more follicles are selected per cycle to ovulate.

References

↑ Campbell JS, Conklin FJ, H Chang VY, Singh KC, Hurteau GD (1973). "Ovarian apoplexy, ovarian pregnancy and the IUCD". European Journal of Obstetrics & Gynecology and Reproductive Biology. 3 (1): 3–5, 7–9. doi:10.1016/0028-2243(73)90003-8.
↑ "5 Signs Of A Ruptured Ovarian Cyst". October 18, 2014.

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[1] Campbell JS, Conklin FJ, H Chang VY, Singh KC, Hurteau GD (1973). "Ovarian apoplexy, ovarian pregnancy and the IUCD". European Journal of Obstetrics & Gynecology and Reproductive Biology. 3 (1): 3–5, 7–9. doi:10.1016/0028-2243(73)90003-8.

[2] "5 Signs Of A Ruptured Ovarian Cyst". October 18, 2014.

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