CURRENT APPROACHES TO DIAGNOSTICS AND TREATMENT OF OVARIAN APOPLEXY

Objective. Analysis of rendering the medical aid to women with apoplexy of the ovary, determination of the basic clinical, laboratory and ultrasonic criteria which influence the choice of management, the evaluation of the immediate and long-term results of treatment of ovarian hemorrhages.

Materials and methods. There was studied medical aid to 888 women with ovarian apoplexy (OA) who referred to the gynecologic clinic of the Military Medical Clinical Center of the Southern region, in Odessa (Ukraine) from 2001 to 2009. Depending on the volume of hemoperitoneum the patients were divided into three groups: І group — 480 (54.0%) patients with hemoperitoneum under 200 ml; ІІ group — 283 (31.8%) women with intraperitoneal hemorrhage with volume from 200 to 500 ml; ІІІ group — 125 (14.1%) patients with volume of hemoperitoneum over 500 ml. The group І consisted of ІC group — 270 (30.4%) women who were given conservative treatment of OA, and ІL group — 210 (23.6%) patients whose main diagnostic and treatment measure was laparoscopic intervention. In ІC group 108 (40.0%) patients after controlling ovarian hemorrhage and obtaining the course of drug therapy were laparoscopically operated on with the diagnostic and therapeutic purpose in the “cold” period (І“C”LC subgroup).

Results and discussion. The average age of the patients was 28.3±5.2. The pelvic pain was the leading clinical symptom in all patients. Intense acute pain was more frequently encountered in patients of ІІ and ІІІ groups (62.2 and 92.3% respectively). According to the data of the transvaginal US made in the saggital plane, a linear dependence was observed between the level of free liquid and the volume of hemoperitoneum (r=0.63, p<0.05). In 792 (89.2%) patients the diagnosis of apoplexy of the ovary and intraperitoneal hemorrhage was made, and surgical intervention was indicated on the basis of clinical picture and US data. In the remaining cases — 92 (10.4%) diagnostic laparoscopy was required for confirming the diagnosis. The most frequently performed hemostatic operation was resection of the ovary — 477 (77.2%) interventions. The great volume of intraperitoneal hemorrhage was observed more frequently in the patients with ovarian hemorrhages in absence of the adhesive process, than in patients with the associated adhesive process. Thus, the average volume of hemoperitoneum discovered in patients with AO, in absence of the adhesive process was (273.5± ±21.3) ml, whereas in patients with the pronounced adhesive process of the small pelvis organs it was (141.4±35.5) ml. The cause of AO was the corpus luteum or cyst of the corpus luteum in more than the half of the cases — 348 (56.3%). The most frequent intraoperative finding in more than a half of patients of I“C”LX subgroup during the operation was an adhesive process in the small pelvis. The formation of persisting CHFO against a background of external endometriosis is found in one third women of this subgroup. The greatest frequency of AO relapse, formation of CHFO and the most prolonged period of subfertility were observed in the women of І“C”LC subgroup.

Conclusions. The manifestation of the clinical symptoms in apoplexy of the ovaries depends on the volume of intraperitoneal hemorrhage. The data analysis of transvaginal echography allows to determine quantitatively, with a high degree of accuracy the volume of intraabdominal hemorrhage and the morphological state of the affected ovary. Laparoscopy is not only a “gold standard” in diagnosis and treatment of AO, but also contributes to the prevention of ovarian hemorrhages in future. The application of laparoscopy as a main therapeutic and prophylactic method in AO allows to preserve, and sometimes to restore the reproductive function of a woman and to reduce the rate of the disease relapse development.