OVERVIEW

What is ovarian corpus luteum rupture?

Ovarian corpus luteum rupture occurs when the corpus luteum on the ovarian surface, which has high tension, low elasticity, and abundant blood vessels, experiences vascular rupture due to various factors. If the bleeding fails to stop spontaneously, the pressure within the corpus luteum increases, leading to its rupture and hemorrhage ^[1,2].

Patients with ovarian corpus luteum rupture typically have no history of missed periods. It mostly occurs 1–10 days before menstruation, i.e., the latter half of the menstrual cycle. Over 60% of cases happen after sexual intercourse ^[1,3].

What is the corpus luteum?

During each menstrual cycle, one dominant ovarian follicle develops, matures, and protrudes from the ovarian surface. Around 14 days before the next menstrual period, this mature follicle ruptures and releases its egg, a process called "ovulation." The follicular fluid drains, the intrafollicular pressure drops, and the follicle wall collapses, with the remaining follicular tissue gradually forming the corpus luteum ^[1].

The "corpus luteum" is named for its yellow appearance in living tissue. It secretes estrogen and progesterone. If the egg is fertilized and implants, the corpus luteum supports pregnancy. If fertilization does not occur, the corpus luteum begins to degenerate 9–10 days after ovulation and fully regresses into a whitish "corpus albicans" around 14 days post-ovulation. Menstruation then begins, and a new follicle develops, starting a new cycle ^[1].

Is ovarian corpus luteum rupture serious? Can it be fatal?

The amount of bleeding from ovarian corpus luteum rupture varies greatly, ranging from tens to over a thousand milliliters, so the severity differs. Patients with minimal bleeding may only experience lower abdominal pain, which resolves with rest and medication. Those with significant bleeding (800–1000 mL or 20% of total blood volume) may develop hemorrhagic shock and even die ^[4].

Is ovarian corpus luteum rupture common?

The exact incidence is unclear, but it primarily affects women aged 20–40 with active ovarian function ^[5]. However, it is relatively rare compared to other gynecological emergencies like ectopic pregnancy or acute pelvic inflammatory disease, leading to higher rates of misdiagnosis and missed diagnosis ^[3].

Is ovarian corpus luteum rupture hereditary?

There is no clear genetic predisposition. Women of reproductive age (15–49 years) are all at risk ^[3].

SYMPTOMS

What are the common manifestations of ovarian corpus luteum rupture?

1. Lower abdominal pain:
   • The typical symptom is sudden pain on one side of the lower abdomen, which worsens in waves and is accompanied by varying degrees of sympathetic nervous system excitation symptoms such as nausea, vomiting, palpitations, and cold sweats ^[1].
   • There may be tenderness in the lower abdomen, and no masses are palpable during gynecological pelvic examination ^[1].
2. Vaginal bleeding: A few patients may experience symptoms such as a sensation of anal distension or vaginal bleeding ^[1,5].
3. Hemorrhagic shock: When bleeding is excessive (800–1000 mL or reaching 20% of total blood volume), symptoms of hemorrhagic shock such as rapid heart rate, cold and clammy extremities, and altered mental status may occur ^[1].

What are the potential consequences if ovarian corpus luteum rupture is not treated promptly?

Since corpus luteum rupture is a hemorrhagic condition, delayed treatment may lead to hemorrhagic shock and even carry a risk of death ^[3].

CAUSES

What are the causes of ovarian corpus luteum rupture?

The exact etiology of ovarian corpus luteum rupture remains unclear, but it is often associated with factors such as corpus luteum hematoma or cyst formation, excessive pressure during intercourse, strenuous exercise, and coagulation abnormalities ^[3].

1. Spontaneous factors:
   • Corpus luteum hematoma or cyst formation: The surface of a corpus luteum cyst has high tension, low elasticity, and abundant blood vessels. When internal pressure increases to a certain level, rupture occurs ^[1,4].
   • Coagulation disorders: Conditions such as hemophilia or idiopathic thrombocytopenia can lead to spontaneous bleeding within the corpus luteum, which fails to clot, increasing internal pressure and causing rupture ^[3].
2. External factors:
   • Intercourse: The corpus luteum is prone to rupture and bleeding under external force. Excessive intensity during intercourse may cause impact and compression on the lower abdomen, leading to rupture.
   • Strenuous exercise: During vigorous exercise, abdominal impact or a sudden increase in intra-abdominal pressure may trigger corpus luteum rupture.

Which women are more prone to ovarian corpus luteum rupture?

1. Women with coagulation disorders: Those with conditions such as hemophilia or idiopathic thrombocytopenia are at higher risk because bleeding within the corpus luteum fails to clot, increasing internal pressure.
2. Women experiencing external force on the lower abdomen: This group is more susceptible due to intense physical activity or vigorous intercourse, which may cause abdominal impact and increased intra-abdominal pressure.

DIAGNOSIS

How is ovarian corpus luteum rupture diagnosed? What tests are needed to diagnose ovarian corpus luteum rupture?

The diagnosis can be made based on clinical history, menstrual history, gynecological examination, culdocentesis, complete blood count (CBC), abdominal or transvaginal ultrasound, CT scan, and blood or urine human chorionic gonadotropin (hCG) test results.

1. Culdocentesis: The diagnosis of intra-abdominal bleeding in women is primarily based on culdocentesis, which can be used to check for suspected intra-abdominal bleeding ^[1].
2. Complete blood count (CBC): The purpose is to determine whether the patient has anemia. A CBC may show decreased red blood cells and hemoglobin levels ^[1,6].
3. Abdominal ultrasound: Used to diagnose this condition. An abdominal ultrasound may reveal an enlarged ovary with mixed echogenicity and pelvic or abdominal fluid accumulation ^[1].
   4. Transvaginal ultrasound: Can be used to check for suspected intra-abdominal bleeding. It provides clear imaging of female pelvic organs and better displays blood flow signals and spectral characteristics. Compared to abdominal ultrasound, it does not require a full bladder and offers timely and accurate advantages for diagnosing gynecological conditions ^[5]. Transvaginal ultrasound is not suitable for unmarried women or those without sexual experience.
4. CT scan: Can diagnose this condition, clearly displaying the patient's lesions and helping to obtain information about the affected area ^[3].
5. Blood or urine hCG test: Mainly used to rule out adverse pregnancy conditions (such as threatened abortion or ectopic pregnancy) that may cause vaginal bleeding. hCG test results are usually positive during pregnancy, while patients with this condition typically test negative ^[1].

Why is culdocentesis used to determine intra-abdominal bleeding in ovarian corpus luteum rupture? Is this procedure safe?

The posterior vaginal fornix is separated from the rectouterine pouch (cul-de-sac) in the pelvis only by the vaginal wall, a small amount of fat, and the parietal peritoneum. The rectouterine pouch is the lowest point in the abdominal and pelvic cavities when a woman is standing, making it prone to accumulating blood in cases of intra-abdominal bleeding. Therefore, culdocentesis is an important method for determining the presence of intra-abdominal bleeding ^[1].

This procedure is one of the most critical diagnostic methods in emergency surgery, with a long-proven safety and effectiveness record. However, theoretically, there are risks such as bleeding and infection. For patients suspected of having intra-abdominal bleeding, delayed diagnosis and treatment can be life-threatening. Therefore, patients and their families are advised not to refuse culdocentesis due to concerns about complications ^[1].

What conditions should ovarian corpus luteum rupture be distinguished from?

It should be differentiated from gynecological emergencies such as ectopic pregnancy (tubal pregnancy) abortion or rupture and acute pelvic inflammatory disease.

1. Ectopic pregnancy abortion or rupture: Both conditions present with severe abdominal pain and lower abdominal tenderness. However, patients with ectopic pregnancy abortion or rupture often have a history of missed periods, palpable lower abdominal masses, more significant bleeding, and earlier signs of hemorrhagic shock such as rapid heart rate, cold and clammy extremities, and mental confusion. Blood or urine hCG test results are positive. Differentiation can be made based on a clear history of missed periods, blood or urine hCG tests, CT scans, and transvaginal ultrasound ^[1,3,4].
2. Acute pelvic inflammatory disease: Both conditions may cause persistent lower abdominal pain. However, patients with acute pelvic inflammatory disease often show abnormally elevated white blood cell counts in CBC, along with fever (axillary temperature > 37.3°C), headache, and difficulty urinating. Clinical presentation, CBC, and abdominal or transvaginal ultrasound can aid in differential diagnosis ^[1].
3. Acute appendicitis: Both conditions involve severe abdominal pain. However, acute appendicitis is also accompanied by fever, chills, and fatigue. Differentiation can be made based on clinical presentation, CT scans, and ultrasound examinations ^[4,7].

TREATMENT

Which department should I visit for ovarian corpus luteum rupture?

Emergency department, obstetrics and gynecology.

1. In cases of acute severe lower abdominal pain or shock, prioritize visiting the emergency department.
2. If symptoms like rectal heaviness or vaginal bleeding occur, it is recommended to visit the obstetrics and gynecology department.

What are the treatment methods for ovarian corpus luteum rupture?

Treatment includes conservative therapy and surgery.

1. Conservative treatment: For patients with minimal internal bleeding and mild conditions, doctors will closely monitor vital signs (heart rate, blood pressure, oxygen saturation, consciousness, etc.). Patients must remain on strict bed rest (no standing or rapid movements) to prevent shock from bleeding and avoid pressure on the corpus luteum. Hemostatic drugs are administered, and blood transfusions may be given to correct anemia if necessary.
   • Hemostatic drugs: Such as aminomethylbenzoic acid, tranexamic acid, or vitamin K, which effectively stop bleeding. Possible side effects include rashes. These drugs are contraindicated for patients with a history of thrombosis or embolism ^[8].
   • Blood transfusion: Platelets, red blood cells, or plasma may be transfused to replenish blood volume, suitable for anemic patients. Rare side effects include skin itching, flushing, or rashes.
2. Surgical treatment: For patients with significant internal bleeding or shock symptoms, surgery may be performed alongside hemostasis and transfusion. Options include laparoscopic or open surgery for ovarian repair.
   • Laparoscopic surgery: Under general anesthesia, blood clots and accumulated blood in the pelvis are completely removed. If active bleeding persists in the corpus luteum tissue, sutures are applied to stop it ^[9].
   • Open surgery: After anesthesia, blood clots and accumulated blood are cleared via laparotomy, and active bleeding in the corpus luteum tissue is sutured.

What are the advantages and disadvantages of laparoscopic surgery compared to open surgery for ovarian corpus luteum rupture?

1. Advantages:
   • Minimal trauma and faster recovery ^[9];
   • Clearer visualization, aiding in detecting small lesions and preserving ovarian function;
   • Reduced postoperative organ adhesion, lowering long-term complications like infertility or adhesive intestinal obstruction.
2. Limitations:
   • Challenging for patients with a history of lower abdominal surgery;
   • In cases of anatomical variations, difficult exposure of the affected area, or other complications, conversion to open surgery may be necessary;
   • High demand for cardiopulmonary function; higher surgical risks for patients with cardiovascular or lung diseases ^[1];
   • Requires high technical skill from surgeons and nurses.

What precautions should be taken after ovarian corpus luteum rupture surgery? How to care for the patient?

1. Postoperative precautions:
   • Avoid sudden movements. Gradually resume diet and activity under medical guidance. Change wound dressings regularly (every 1–2 or 2–3 days) ^[10].
   • Maintain suitable indoor temperature and humidity. Family members should assist with perineal hygiene as instructed to prevent infection ^[10].
   • Avoid sexual intercourse and strenuous exercise for half a month post-surgery. Take prescribed medications on time ^[10].
2. Postoperative care:
   • Psychological care: Due to pain, patients may feel irritable. Learning about the condition from medical staff and engaging in relaxing activities (e.g., chatting, music) can alleviate anxiety ^[10].
   • Dietary care: Start with liquids (e.g., lotus root starch, rice soup, egg drop soup) on the first day, progress to semi-liquids (e.g., porridge, sesame paste) on the second day. If bloating subsides by the third day, switch to easily digestible, high-protein, high-vitamin foods (e.g., eggs, fish, chicken, spinach, bananas). Avoid gas-producing foods like milk, sweet potatoes, or soybeans ^[10].

Is follow-up required after ovarian corpus luteum rupture surgery? How is it conducted?

Generally, no follow-up is needed. However, since ovulation is cyclical, recurrence is possible. Seek immediate medical attention if severe abdominal pain reappears.

DIET & LIFESTYLE

Does ovarian corpus luteum rupture treatment affect fertility?

Treatment does not affect fertility ^[1]. Surgery does not damage ovarian tissue, nor does it interfere with the normal development of follicles in the ovary, so it will not impact fertility.

What dietary precautions should patients with ovarian corpus luteum rupture take?

There are no specific dietary restrictions; maintaining a healthy and balanced diet is sufficient.

1. When cooking, use less salt, less oil, and fewer high-sodium seasonings. Avoid pickled vegetables and cured meats ^[11];
2. Avoid relying solely on refined grains like white rice and flour. Substitute with whole grains, legumes, potatoes, or pumpkin for some of the staple foods to prevent constipation, which could increase abdominal pressure and compress the corpus luteum;
3. Balance meat and vegetable intake. Prioritize white meats like chicken, duck, and fish, and reduce fatty meat consumption. Eggs and milk are important sources of protein and other nutrients, boosting immunity and aiding recovery;
4. For vegetarians, consume more beans and bean products to supplement protein;
5. Eat plenty of fruits and vegetables, such as bananas, apples, corn, tomatoes, and carrots, to replenish vitamins and minerals and promote recovery;
6. Include iron-rich foods like egg yolks, animal liver, lean meat, celery, and spinach in daily meals to prevent or alleviate anemia.

What lifestyle precautions should patients with ovarian corpus luteum rupture take?

There are no special lifestyle restrictions; maintaining a healthy routine is sufficient.

1. Avoid smoking and drinking alcohol;
2. Exercise regularly and avoid prolonged sitting to prevent overweight and obesity. Aim for 3–5 exercise sessions per week, about 30 minutes each, combining aerobic and strength training at a moderate intensity without overexertion;
3. Learn to manage stress and emotional tension effectively.

PREVENTION

Can ovarian corpus luteum rupture be prevented?

Yes, it can.

1. Practice self-protection by avoiding abdominal compression during exercise or external impacts while walking.
2. Ensure safe sexual activity and avoid intense intercourse to prevent abdominal pressure and potential risks.
3. Schedule regular gynecological check-ups (once a year or every two years). Seek medical attention promptly if lower abdominal pain occurs in the latter half of the menstrual cycle.