Aim: Analysis of modern medical care for women with ovarian hemorrhage, determination of the main diagnostic criteria that influence the choice of treatment tactics and further prognosis of the outcome of treatment of ovarian apoplexy. Material and methods: The provision of medical care to 888 women with ovarian apoplexy. Depending on the volume of hemoperitoneum, all patients were divided into three groups.: Group I – 480 (54.0%) women in whom intraabdominal bleeding did not exceed 200 ml; Group II – 283 (31.8%) patients with hemoperitoneum ranged from 200 to 500 ml; Group III – 125 (14.1%) patients with hemoperitoneum volume greater than 500 ml. Results: According to the data of the transvaginal US , 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 to surgical intervention- on the basis of clinical picture and US data. The most frequently performed hemostatic operation was resection of the ovary – 477 (77.2%) interventions. 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 expressed 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%). Conclusions: The manifestation of the clinical symptoms in apoplexy of the ovaries depends on the volume of intraperitoneal hemorrhage. 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.

Aim. To evaluate the effectiveness of intra- and post-surgical resuscitation targeted at blood loss replacement in patients with moderate, severe and profuse intraperitoneal hemorrhage caused by ectopic pregnancy and ovarian apoplexy. Methods. Heart rate variability and cardiac intervals assessment were used as additional criteria for patient monitoring. 97 female patients with intraperitoneal hemorrhage of 500-1500 ml underwent endoscopic surgery. Autologous blood transfusion, as well as packed blood products and blood substitutes were used for blood loss replacement. Heart rate variability assessment and analysis of cardiac intervals indicate that pathogenesis of adaptation and blood loss compensation in female patients with intraperitoneal hemorrhage exceeding 500 ml depends on blood loss volume and methods of blood loss replacement. Results. Parameters of adaptation and blood loss compensatory mechanisms in patients with moderate and severe blood loss, who underwent intrasurgical autologous blood transfusion, were close to normal values at days 7 and 14 after treatment. Patients with severe and profuse intraperitoneal hemorrhage treated with packed blood products had the longest red blood count and heart rate variability recovery period. Conclusion. Heart rate variability assessment allowed effectively estimating the treatment effect in female patients with intraperitoneal hemorrhage as a complication of a gynecologic disease exceeding 500 ml.

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Purpose. 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 therapeutic tactics, 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 apoplexy of the ovary from 2012 to 2020. Depending on the volume of hemoperitoneum patients were divided into three groups: І group — 480 (54.0 %) patients whose volume of hemoperitoneum did not exceed 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 a volume of hemoperitoneum of more than 500 ml. The group І consisted of ІC group — 270 (30.4 %) women who were given conservative treatment of apoplexy of the ovary (AO), and ІL group — 210 (23.6 %) patients whose main diagnostic and treatment measure was laparoscopic intervention. Results of the study. The average age of the patients was (28.3±5.2). The pelvic pain was the leading clinical symptom in all patients. 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 to surgical intervention — 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 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 expressed 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 %). 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.