Ovarian apoplexy: assessment of regional characteristics, risk factors, and current approaches to organ-preserving treatment

Background. Ovarian apoplexy accounts for 0.5% to 2.5% of all gynecological pathologies and up to 10-19% of acute gynecological conditions. Recurrence rates range from 21% to 69%. Although ovarian apoplexy can occur at any age, it is most common in young patients of reproductive age. This makes the problem particularly significant, as previous ovarian apoplexy and its treatment are associated with decreased ovarian reserve and a 30-40% increased risk of reproductive loss and infertility. The relevance of this problem necessitates the development of minimally invasive hemostasis methods aimed at preserving ovarian tissue.
Objective. To analyze the clinical and epidemiological characteristics of ovarian apoplexy, evaluate the diagnostic and treatment methods used, and identify regional risk factors using the example of the Republic of Karelia.
Materials and methods. A retrospective cohort analysis was conducted of 121 cases of ovarian apoplexy treated at the Republican Hospital of Emergency and Urgent Medical Care (Petrozavodsk) in 2023-2024.
Results. The proportion of ovarian apoplexy in the structure of gynecological patients was 3.75% (121/3224), which is statistically significantly higher than the Russian average (~1.8%). The mean age of patients was 30.5 ± 7.31 years, with a peak incidence in the 18-29 age group (66.1%). Ovarian apoplexy was diagnosed significantly more often in the second phase of the menstrual cycle (85.9%, p < 0.05). The right ovary was the most common site of involvement (62.8%, p < 0.05). The leading precipitating factor was sexual intercourse (39.7%). Only 6.6% of patients used combined oral contraceptives. Surgical treatment was required in 58.7% of patients, with laparoscopic surgery used in all cases. Organ-preserving surgery (ovarian coagulation) were performed in 88.7% of surgical interventions.
Conclusion. A higher incidence of ovarian apoplexy has been established in Karelia, necessitating further investigation of the influence of regional factors (subarctic climate, photoperiodism). Key modifiable risk factors include poor adherence to effective hormonal contraception and the presence of chronic inflammatory processes. Laparoscopy with organ-preserving techniques has become established as the standard of care. To optimize management, it is necessary to implement regional preventive programs aimed at promoting effective contraception among young women.

1. Dronova N. S., Demchenko A. A., Mnatsakanyan G. E. The impact of ovarian apoplexy on ovarian reserve and reproductive health. Mezhdunarodnyi nauchnoissledovatelskii zhurnal. 2023; 12 (138): 1-5. (In Russ.) https://doi.org/10.23670/IRJ.2023.138.149.

2. Sulima A. N., Beglitse D. A., Volchenko I. G., Matyash O. V. Clinical aspects of ovarian apoplexy. Tavricheskiy mediko-biologicheskii vestnik. 2023; 26 (1): 54-57. (In Russ.) https://doi.org/10.29039/2070-8092-2023-26-1-54-57.

3. Deli A. D., Kasparova A. E., Kovalenko L. V., Sheludko V. S. Modern concepts of the causes and mechanisms of ovarian apoplexy. Vestnik SurGU. Meditsina. 2021; 2 (48): 77-84. (In Russ.) https://doi.org/10.34822/2304-9448-2021-2-77-84.

4. Pulappadi V. P., Manchanda S., Pritviraj Sk., Hari S. Identifying corpus luteum rupture as the culprit for haemoperitoneum. British J Radiologl. 2020; 94: 20200383. https://doi.org/10.1259/bjr.20200383.

5. Sen S., Maurya R., Sen G., Srivastava H. Atypical Presentation of a Giant Hemorrhagic Ovarian Cyst. J ObstetGynaecol India. 2022; 17 (72): 435-438. https://doi.org/10.1007/s13224-022-01625-y.

6. Ryazanov V. V., Sadykova G. K., Khodkevich I. S., Kutsenko V. P., Postanogov R. A., Witenberg G. D. Rupture of the ovarian corpus luteum cyst with hemoperitoneum. Case from practice. Vizualizaysiya v medicine. 2022; 4 (4): 15-20. (In Russ.) https://doi.org/1-06-079.89-072.1-073.756.8.

7. Sadykova G. K., Zheleznyak I. S., Ryazanov V. V., Khodkevich I. S., Ipatov V. V., Latysheva A. Ya., Oppedisano M. G. L. Ultrasound and computed tomography diagnostics of ovarian cyst rupture with hemoperitoneum. Izvestiya Rossiiskoi Voenno-medicinskoii akademii. 2023; 42 (1): 83-90. https://doi.org/10.17816/rmmar192524.

8. Rukhlyada N. N., Vinnikova S. V., Tsechoeva L. Shch., Biryukova E. I., Novikova E. I. Acute Abdomenin ginekology: A Guide for Physicians. Moscow: GEOTAR-Media, 2023. 104 p. (In Russ.)

9. Medvediev M. V., Malvasi A., Gustapane S. Hemorrhagic Corpus Luteum: Clinical Management Update. Turk J ObstetGynekol. 2020; 17: 300-309. https://doi.org/10.4274/tjod.galenos.2020.40359.

10. Paudyal P., Rawal S. J., Khakural P. Ruptured Corpus Luteum among Women Undergoing Laparotomy for Hemoperitoneum in a Tertiary Care Centre: a descriptive cross-sectional stady. Journal of Nepal Medical Association. 2023; 61 (258): 137-140. https://doi.org/10.31729/jnma.7987.

11. Kokh L. I. On the etiopathogenesis of ovarian apoplexy. Mother and Child in Kuzbass. 2014; 4 (59): 15-18. (In Russ.)

12. Toniyan K. A., Aryutin D. G., Semyatov S. M., Sokhova Z. M., Soyunov M. A., Connon S. R. D. Acute diseases of the uterine appendages: problems and prospects. Obstetrics and gynecology: news, opinions, training. 2018; 6 (3): 39-40. (In Russ.) https://doi.org/10.24411/2303-9698-2018-13906.

13. Malyshkina A. I., Batrak N. V. Acute abdomen in gynecology: analysis of the structure of surgical interventions for various urgent conditions. Vestnik Ivanovskoi medicinskoi akademii. 2021: 44-47. (In Russ.) https://doi.org/10.52246/1606-8157_2021_26_3_44.

14. Zharkin N. A., Tkachenko L. V., Kravchenko T. G., Gritsenko I. V. Ovarian apoplexy and its impact on reproductive health. Vestnik VolGMU. 2015; 1 (53): 10-14. (In Russ.)

15. Akulich N. S., Savitskaya V. M., Minich M. I. Ovarian apoplexy: clinical picture, diagnostic methods, management tactics. In: Modern Perinatal Medical Technologies in Solving the Problems of Demographic Security. Book of scientific papers. 2017; 10: 9-11. (In Russ.)

16. Lim W. H., Woods N., Lamaro V. P. Trends and outcomes of ruptured ovarian cysts. Postgraduate Medical Journal. 2022; 98: e9. https://doi.org/10.1136/postgradmedj-2020-138833.

17. Kim M. J., Kim H. M., Seong W. J. The predicting factors for indication of surgery in patients with hemoperitoneum caused by corpus iuteum cyst rupture. Scientific Reports. 2021; 11: 17766. https://doi.org/10.1038/s41598-021-97214-6.

18. Bobo T. I., Ano-Edward G. H., Bakare T. Y., Ogunlaja A. O. Sexual pleasure with ruptured corpus luteum cyst that ends in emergency room: A case report. Journal of Family Medicine and Primary Care. 2024; 13: 3427-3430. https://doi.org/10.4103/jfmpc.jfmpc_1282_23.

19. Zaitseva T. P., Golyak Yu. V., Dovnar L. N., Lazareich V. K., Savilo Yu. V. Modern tactics and principles of treatment of ovarian apoplexy. Aktualnye problemy meditsiny. Grodno. January 24, 2020; 258-262. (In Russ.)

20. Strizhakov A. N., Pirogova M. N., Shakhlamova M. N., Voloshchuk I. N., Smirnov A. A. The role of vascular endothelial growth factor and its receptors in ovarian angiogenesis and ovarian apoplexy. Voprosy ginekologii, akusherstva i perinatologii. 2014; 13 (5): 40-47. (In Russ.)

21. Ashurova N. G., Zaripova D. Ya., Solieva N. K., Bobokulova S. G. Features of laparoscopic treatment of adolescent girls with ovarian apoplexy. Elektronnyii nauchnyi zhurnal «Biologiya i integrativnaya meditsina». 2021; 3: 19-27. (In Russ.) http://integmed.uz/files/3n2021.pdf.

22. Ventskovsky B. M., Zhegulovich V. G., Zhegulovich Yu. V., Kazak A. V., Tsapenko T. V., Nogovskaya I. G. New approaches to the treatment of ovarian apoplexy to preserve and restore reproductive function. Reproduktivnoe zdorove: Vostochnaya Evropa. 2021; 11 (6): 686-701. (In Russ.) https://doi.org/10.34883/PI.2021.11.6.001.

23. Adamyan L. V., Sibirskaya E. V., Shcherina A. V. Pathogenetic aspects of premature ovarian failure. Problemy reproduktsii. 2021; 27 (1): 6-12. (In Russ.) https://doi.org/10.17116/repro2021270116.

24. Sulima A. N., Gudz O. V. Retrospective analysis of urgent gynecological laparoscopic surgeries in patients of childbearing age. Akusherstvo i ginekologiya. 2024; 1: 118-122. (In Russ.) https://doi.org/10.18565/aig.2023.247.

25. Mantecon O., George A., DeGeorge C., McCauley E., Mangal R., Stead T. S., Peplinski B, Ganti L. A Case of Hemorrhagic Ovarian Cyst Rupture Necessitating Surgical Intervention. Cureus. 2022; 14 (9): e29350. https://doi.org/10.7759/cureus.29350.

26. Godhiwala P., Agarwal H., Acharya S., Acharya N., Lahane V. An unusual presentation of a corpus luteum rupture. Gynecol Minim Invasive Ther. 2022; 11: 57-60. https://doi.org/10.4103/GMIT.GMIT_135_20.

27. Dobrokhotova Ju. E., Shchegolev A. A., Markarov A. E., Kotomina T. S., Khlynova S. A., Markova E. A., Slyusareva O. A. Gynecological emergencies under the guise of surgical pathology. Meditsinskii sovet. 2025; 19 (4): 60-69. (In Russ.) https://doi.org/10.21518/ms2025-147.

28. Morozov A. M., Sergeev A. N., Zhukov S. V., Sergeeva E. S., Silina S. E., Shchegolkov V. D. On the problem of differential diagnosis of acute appendicitis and acute gynecological diseases. Sovremennye problemy nauki i obrazovaniya. 2025; 1. (In Russ.) URL: https://science-education.ru/ru/article/view?id=33893 (Accessed:: 27.10.2025). https://doi.org/10.17513/spno.33893.

29. Borisova D. S., Chashchin V. P. Current issues of protection of reproductive health in population residing in cold climate regions (literature review). Gigiena i Sanitariya. 2022; 101 (8): 886-895. (In Russ.) https://doi.org/10.47470/0016-9900-2022-101-8-886-895.

30. Sheludko V. S., Kasparova A. E., Kovalenko L. V., Sokolova T. N. Factors Associated with Recurrent Pregnancy Loss in the Subarctic Region: a Literature Review. Ecologiya cheloveka. 2020; 6: 13-21. (In Russ.) https://doi.org/10.33396/1728-0869-2020-6-13-21.

31. Satybaldina B. A., Espaeva R. N., Sakhmuldinova L. S., Burychin K. V., Murtabaeva D. K. Ovarian apoplexy. Etiology. Pathogenesis. Treatment. Vestnik KazNMU. 2015; 4: 28-30. (In Russ.)

32. Thomas С. Ovulation: A cellular symphony in three movements. Seminars in Cell and Developmental Biology. 2025; 174: 103634. https://doi.org/10.1016/j.semcdb.2025.103634.

33. Yadav R., Sarkar M., Alam J., Bagaria D. Posttraumatic Corpus Luteal Cyst Rupture: A Diagnostic Enigma for Massive Hemoperitoneum. Cureus. 2023; 15 (4): e37067. https://doi.org/10.7759/cureus.37067.