Differential Approach оf Ovarian Apoplexy Treatment іn Teenagers

Ovarian apoplexy is one of the most common pathological conditions in modern gynecology, especially in teenagers. Ovarian apoplexy can affect further reproductive plans and woman's life quality. Materials and Methods. 67 patients 14-18 years old with ovarian apoplexy took part in study. Depending on a hemoperitoneum and a clinical picture, we conducted a differential approach of ovarian apoplexy treatment. All patients went through ultrasound examination, blood pressure, pulse, temperature, hemoglobin level control in dynamics. A periodic hypothermia was created in the lower abdomen. Results and discussion. In the majority of patients we found factors that could provoke apoplexy in the collection of anamnesis. Among them are: physical activity – in 37 patients (55.2%), sexual intercourse – in 9 patients (13.4%), and in 10 patients (14, 9%), the ovarian apoplexy was provoked by the broken act of defecation (fastening). In the examination of patients in group 1 it was established that the general condition at admission to the hospital was satisfactory. At examination: pale skin and visible mucous membranes were observed in 20 (34.5%) teenagers, the blood pressure in all girls was within the norm, the hemoglobin level was not lower than 100 g/l. At palpation and percussion of the abdomen, 18 (31.0%) patients noted pain in the lower parts of different intensities, and in 15 (25.8%) – the phenomenon of "peritonism". In 2 (3.4%) teenagers had severe pain syndrome and positive symptoms of peritoneal irritation. In a vaginal or rectal study, 49 (84.5%) patients showed enlarged and painful appendages of the uterus on the one hand due to retinal cysts in the ovaries. The 2nd group patients had the general condition of average severity. The skin and visible mucous membranes were pale in 7 (77.8%) women. There was a slight violation of hemodynamics: a decrease in systolic blood pressure of more than 15-20 mmHg (from the so-called "working") in 6 patients (66.7%), an increase in the pulse rate (but not more than 100 beats/min) in 2 (22.2%), a decrease in hemoglobin to 95 g/l – in 3 (33.3%) patients. In 4 (44.4%) women, there were positive symptoms of peritoneal irritation. In a vaginal study in 7 (77.8%) patients, enlarged and painful appendages of the uterus on one side, as well as painful displacements of the cervix and "sensitive" posterior vagina were found. It was also found out that 23 (34.3%) women in the past had undergone treatment for inflammatory processes of the appendages of the uterus, 48 patients (71.6%) had a regular menstrual cycle, and 9 (13.4%) teenagers had undergone surgical intervention about acute appendicitis. One girl (1.5%) in the past has already been operated on ovarian apoplexy. Conclusion. A clinical picture, an ultrasound examination in combination with anamnesis data and laboratory diagnostic methods provided an opportunity to establish an exact diagnosis and to choose an optimal tactics for patient's management. Methods of treatment were chosen based on the clinical picture, which is also related to an intrahepatic bleeding.