Author: Yuan Yuan (Jiangxi Maternal and Child Health Hospital)
“Doctor, I woke up this morning with severe pain in my left stomach. What’s the reason? Help me relieve the pain, I can’t take it anymore!”
Pushing the door and entering the clinic was a 26-year-old young girl, clutching her left stomach, sweat dripping from her forehead, and a very painful expression on her face.
“Have you had sex recently? Did you wake up suddenly? Has your body position changed a lot? Have you caught a cold?”
“None!”
“Is your period normal? When was your last period?”
“I usually have regular periods without dysmenorrhea, and my next period should be 5-7 days away.”
After some inquiry, I basically ruled out pregnancy-related diseases, and then asked her to do some tests, such as color Doppler ultrasound, blood routine, blood HCG, posterior fornix puncture, etc. Finally, based on the symptoms, physical examination and examination results she said, the initial consideration was rupture of the corpus luteum.
Actually, I have met many patients in the outpatient clinic who have similar experiences with this girl, but there are differences in lightness, severity, slowness and urgency. Today we are going to talk about the topic of corpus luteum and ruptured corpus luteum.
1. What is the corpus luteum?
Each menstrual cycle, a dominant follicle in the ovary matures and protrudes to the surface of the ovary, about 14 days before the next menstrual period It ruptures and releases the egg inside, a process known as “ovulation.”
After normal ovulation, the remaining empty follicle is like a deflated balloon, which begins to collapse and shrink, and becomes a “little yellow flower with blood vessels and hormones in the ovary” “(It’s really yellow), this is the corpus luteum.
The corpus luteum is not an “immortal body”, it has a certain lifespan, and it has a lot to do with pregnancy.
If the egg does not fuse with the sperm: The corpus luteum begins to degenerate on the 9th to 10th day after ovulation, and by about the 14th day it completely recedes and becomes a white body. Then menstruation is coming, the next new cycle begins, and so on.
(menstrual cycle diagram, source: Zhanku Hailuo, translated by Tencent Medical Dictionary)< /i>
If the released egg and sperm combine to form a fertilized egg and a successful pregnancy occurs, the corpus luteum will continue to grow under the action of human chorionic gonadotropin (HCG) secreted by embryonic trophoblasts , the formation of the corpus luteum of pregnancy, which does not begin to degenerate until the end of the third month of pregnancy.
Women who have pregnancy experience may also think of the commonly used drug “progesterone” when hearing the name “corpus luteum” – yes, progesterone is also called progesterone, which is a female A natural progesterone in the body, in the body of non-pregnant women, progesterone is mainly secreted by the corpus luteum; after 3 months of pregnancy, the placenta will also secrete progesterone in large quantities.
Second, why does a good corpus luteum suddenly rupture?
Ovarian corpus luteum rupture refers to the rupture of the corpus luteum due to increased intra-abdominal pressure caused by itself or external factors during the growth, development and maturation of the corpus luteum.
Its biggest threat to the body is abdominal bleeding – this blood does not flow out of the vagina, but in the abdominal cavity. It is a kind of internal bleeding, so it is difficult to detect. Severe hemorrhage can be life-threatening.
Luteal rupture may be caused by:
Spontaneous rupture: Usually, a small amount of bleeding can occur in the luteal body, but if the bleeding is large, the tension in the corpus luteum can be increased, and spontaneous rupture can occur. rupture [1].
Action of external force: When subjected to external force, such as being too “forced” in the room (this is most common), sudden change of position, strong abdominal impact, Behaviors that increase abdominal pressure, such as strenuous exercise, vigorous coughing, or defecation, can induce rupture of the mature corpus luteum[2][3][4].
The scenes of corpus luteum rupture in real life are even more varied: there are girls who turn hula hoop and are hospitalized with blood in the abdomen; I was rushing to catch the subway, had a sudden stomach pain to the point of fainting, 1000 ml of bleeding…
(Source: Metro Express)
It seems that there are no signs, but there are signs to follow.
3. How do I find out if I have a ruptured corpus luteum?
Luteal rupture is a common acute abdomen in gynecology. The most important thing is early detection, early diagnosis and early treatment.
In general, if there is no history of menopause, corpus luteum rupture tends to occur during the luteal phase (after ovulation to the day before menstruation), especiallyIt occurs 1-10 days before the next menstrual period.
At the time of the onset, girls will feel sudden and severe pain on one side of the stomach, and the pain intensifies, and may also be accompanied by a feeling of anal bulge, but no vaginal bleeding; it may also be accompanied by nausea, vomiting, Symptoms of sympathetic nervous excitement such as palpitations and cold sweats.
Image source: Zhanku Hailuo
The doctor will make a diagnosis based on the following test results:
Gynecological Exam: Uterine normal, medium in texture, but painful when palpated and pressed in the adnexal area of the affected area; posterior fornix (recess between the back wall of the vagina and the cervix) A positive puncture can draw blood that does not clot.
If there is bleeding in the abdominal cavity, girls will have obvious signs of peritoneal irritation (that is, abdominal tenderness, rebound tenderness, abdominal muscle tension, etc.), positive mobile dullness (this is the abdominal cavity) Common methods of checking for effusion).
Urine test for HCG recessive (to rule out pregnancy-related disorders).
Abdominal ultrasound: enlarged ovaries with mixed echoes in the affected area; fluid may be present in the uterine-rectal or uterine-vesical pit.
Image source: Zhanku Hailuo
Four. How to treat corpus luteum rupture?
The amount of bleeding from rupture of the corpus luteum varies greatly, ranging from tens of milliliters to some thousands of milliliters.
Patients with little bleeding may only have lower abdominal pain, and a little blood that flows out will be slowly absorbed by the body; while those with heavy bleeding may experience hemorrhagic shock, or even Danger to life.
As a result, corpus luteum rupture varies and so does treatment.
Patients with less intra-abdominal bleeding and milder disease are generally treated conservatively:
absolutely rest in bed, and it is strictly forbidden to go to the ground, to turn around quickly and to do heavy physical activity.
Use anti-inflammatory, hemostatic, rehydration and other drugs for symptomatic and supportive treatment, and blood transfusion if necessary, to correct the symptoms of anemia.
Vital signs, such as heart rate, blood pressure, pulse, respiration, oxygen saturation, and consciousness, should be closely observed during treatment.
For patients with more intra-abdominal bleeding, immediate first aid is required[5]:
If symptoms of hemorrhagic shock occur, get fluids and anti-shock therapy as soon as possible.
Start surgery at the same time as anti-shock: Laparoscopic surgery is the first choice, cleaning up blood in the abdominal cavity, performing ovarian repair, and electrocoagulation to achieve the purpose of hemostasis.
If the bleeding is particularly severe, or it is not suitable for laparoscopy, laparotomy is required. In severe cases, due to excessive bleeding to form a hematoma or other reasons, most of the ovaries cannot be preserved, and may even be To remove one ovary [6]!
Image source: Zhanku Hailuo
It should be noted that because the ovaries ovulate periodically, a girl who has had a ruptured corpus luteum once cannot rule out the possibility of recurrence in the future. If you experience severe abdominal pain and other symptoms again, you must go to the hospital in time to find out the cause.
Can luteal rupture be prevented?
To prevent corpus luteum rupture, it is recommended that girls eat as lightly as possible and maintain a balanced nutrition; quit smoking and drinking; do not sit for long periods of time and avoid being overweight; Learn to self-regulate and relieve stress in time.
In addition, please tell your boyfriend or husband that girls are creatures that need to be “handled with care” and that sex life must be gentle and not too rough. At the same time, take care of yourself and avoid overexertion; try to avoid strenuous exercise a week before your period.
References:
[1] Vats G, Gupta B, Rajaram S, et al. Hemoperitoneum from spontaneous rupture of corpus luteal cyst: a case report and literature review. Adv Cytol Pathol. 2017;2(5 ):147-148.
[2] Zhao Minmin, Tong Xiuqin. Research progress on factors related to ovarian corpus luteum rupture[J]. World Latest Medical Information Digest, 2019,19(06):108-109.
[3] Chen Xiaoyan, You Huarong, Wang Jie. Analysis of related factors and clinical characteristics of 263 cases of ovarian corpus luteum cyst rupture[J]. Hainan Medicine, 2011, (20): 87-89.< /p>
[4] Hu Xiaoying, Zhang Yi. Analysis of clinical data of 85 cases of ovarian corpus luteum rupture[J]. Zhejiang Clinical Medicine, 2015, (2).
[5] Liang Zhiqun, Wu Guiqun, Wu Xuemei, et al. Rescue and nursing experience of ovarian corpus luteum rupture and shock[J]. International Medical and Health Herald, 2006,12(12):128-129 .
[6] Cao Zhiying, Zhang Yueying. Analysis of diagnosis and misdiagnosis of 34 cases of acute ovarian luteal rupture[J]. Chinese Journal of Reproductive Health, 2008, 19(4): 220-221.
*The content of this article is for the popularization of health knowledge and cannot be used as a specific diagnosis and treatment suggestion, nor can it replace the face-to-face consultation of a licensed physician, and is for reference only.
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