Ruptured Corpus Luteum

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Corpus luteum cysts develop from mature graafian follicles and are associated with normal endocrine function or prolonged secretion of progesterone. They usually are smaller than 3 cm in diameter. There can be intrafollicular bleeding because of thin-walled capillaries that invade the granulosa cells from the theca interna. When the hemorrhage is excessive, the cyst can enlarge, and there is an increased risk of rupture. Cysts tend to rupture more during pregnancy, probably due to the increased incidence and friability of corpus lutea in pregnancy. Anticoagulation therapy also predisposes to cyst rupture, and these women should receive medication to prevent ovulation. Patients with hemorrhagic corpus lutea usually present with sudden onset of severe lower abdominal pain. This presentation is especially common in women with a hemoperitoneum. Some women complain of unilateral cramping and lower abdominal pain for I to 2 weeks before overt rupture. Corpus luteum cysts rupture more commonly between days 20 and 26 of the menstrual cycle.

The differential diagnosis of a suspected hemorrhagic corpus luteum should include ectopic pregnancy, ruptured endometrioma, adnexal torsion, appendicitis, and splenic injury or rupture. Ultrasound examination may show free intraperitoneal fluid and perhaps fluid around an ovary. The diagnosis is confirmed by laparoscopy. The first step in treatment of a ruptured corpus luteal cyst is securing hemostasis. Once the bleeding stops, no further therapy is required: however, if the bleeding continues, a cystectomy should be performed with preservation of the remaining normal portion of ovary.

Progesterone is largely produced by the corpus luteum until approximately 10 weeks' gestation. Until approximately week 7. the pregnancy is dependent on the progesterone secreted by the corpus luteum. Human chorionic gonadotropin (hCG) maintains luteal function until placental steroidogenesis is established. There is shared function between the placenta and corpus luteum from week 7 to 10: after 10 weeks, the placenta emerges as the major source of progesterone.

Therefore, if the corpus luteum is removed surgically prior to 10 weeks' gestation, exogenous progesterone is needed to sustain the pregnancy. If the corpus luteum is excised after 10 weeks' gestation, no supplemental progesterone is required.

Comprehension Questions

[41.1] A culdocentesis is performed in a 19-year-old G1 P0 woman with lower abdominal pain and vaginal spotting. A total of 3 cc of clotted blood is aspirated. Which of the following is the best interpretation?

A. Hemoperitoneum is present.

B. No hemoperitoneum is present.

C. The blood probably came from a blood vessel.

D. The patient probably has an ectopic pregnancy.

[41.2] A 25-year-old woman G1 P0 is noted to have vaginal spotting and (i-human chorionic gonadotropin levels have plateaued in the 1800 mlU/mL range. Uterine curettage is performed, and no chorionic villi are seen on histologic examination. Which of the following is the most likely diagnosis?

A. Complete molar pregnancy

B. Intrauterine pregnancy

C. Incomplete molar pregnancy

D. Ectopic pregnancy

E. Spontaneous abortion

[41.31 Which of the following is the earliest indicator of hypovolemia in a young healthy patient?

A. Tachycardia

B. Hypotension

C. Positive tilt

D. Lethargy and confusion

E. Decreased urine output

|41.4| A 20-year-old woman is brought to the emergency room with a blood pressure of 70/40, heart rate 130 bpm, and a history of heavy vaginal bleeding. Which of the following is the most appropriate first step in treatment?

A. Isotonic intravenous fluids

B. Aggressive oral fluids

C. Immediate blood transfusion

D. Immediate uterine curettage

E. Intravenous dobutamine therapy

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