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.