Author: Yuan Yuan (Jiangxi Provincial Maternal and Child Health Hospital)
"Doctor, when I woke up this morning, my left stomach suddenly hurt badly, what is the reason?" Help me relieve the pain, I can't stand it! ”
Pushing the door into the clinic was a 26-year-old young girl, covering her left stomach, beads of sweat on her forehead, and a very painful expression on her face.
"Have you had sex lately?" Did you get up suddenly? Has there been a significant change in position? Are there any colds, etc.? ”
"None!"
"Is menstruation normal? When was the last menstrual period? ”
"I usually have regular menstruation and no painful menstruation, and I should have 5 to 7 days before my next menstrual period."
After some questioning, I basically ruled out pregnancy-related diseases, and then asked her to do some tests, such as color ultrasound, blood routine, blood HCG, posterior vault puncture, etc. Finally, based on her symptoms, physical examination and examination results, the initial consideration was a ruptured luteum.
In fact, I have met many patients in the outpatient clinic who have similar experiences to this girl, but there are differences between light, heavy, slow and urgent. Today we will talk about the topic of the luteum and the rupture of the luteum.
1. What is the yellow body?
During each menstrual cycle, an dominant follicle in the ovary matures and protrudes to the surface of the ovary, and this mature follicle ruptures about 14 days before the next menstrual period and releases the eggs inside, a process called "ovulation".
After normal ovulation, the remaining empty follicles are like a deflated balloon, which begins to collapse and shrink, turning into a "small yellow flower" (really yellow) with blood vessels and hormones in the ovaries, which is the corpus luteum.
(The process of changes in follicles and corpus luteum in women's ovaries)
The yellow body is not an "immortal body", it has a certain lifespan, and it has a lot to do with whether it is pregnant or not.
If the egg does not bind to the sperm: the corpus will begin to degenerate on the 9th to 10th day after ovulation, and by the 14th day or so, it will completely decay and become white. Then the menstruation is about to come, to enter the next new cycle, and so on.
(Schematic diagram of menstrual cycle, source: Zhan Ku Helo, translated by Tencent Medical Code)
If the released egg combines with sperm to form a fertilized egg and a successful pregnancy, the corpus luteum will continue to enlarge under the action of human chorionic gonadotropin (HCG) secreted by embryonic trophoblasts, forming a gestational corpus luteum, which does not begin to degenerate until the end of the third trimester of pregnancy.
Women with pregnancy experience, hearing the name "progesterone", may also think of the common drug "progesterone" for fetal preservation - yes, progesterone, is a natural progesterone in the female body, in the body of unpregnant women, progesterone is mainly secreted by the corpus luteum; and after 3 months of pregnancy, the placenta will also secrete a large amount of progesterone.
Second, why does the good yellow body suddenly rupture?
Rupture of ovarian corpus luteum refers to the rupture of the ovarian luteum due to the increase in intra-abdominal pressure due to its own or external factors during the growth, development and maturation of the corpus corpus luteum.
Its biggest threat to the body is abdominal bleeding – this blood does not flow out of the vagina, but inside the abdominal cavity, which is an internal bleeding, so it is difficult to detect. And heavy bleeding is serious and can be life-threatening.
Causes that can cause luteal rupture are:
Spontaneous rupture: Normally, a small amount of bleeding may occur in the yellow body, but if there is more bleeding, it will increase the tension in the yellow body, resulting in spontaneous rupture [1].
The effect of external forces: when subjected to external forces, such as too "force" during the room (this is the most common), sudden change of position, strong impact on the abdomen, strenuous exercise, coughing hard or defecation, etc., which increase abdominal pressure, can induce the rupture of the mature corpus luteum [2][3][4].
The scene of the rupture of the yellow body in real life is even more varied: some girls are hospitalized with blood shock in the abdomen; there are also people who go to Disney for a day of crazy play, walk 30,000 steps and rush to catch the subway, suddenly have stomach pain to faint, and bleed 1000 ml...
(Source: City Express)
It seems that there is no sign, but there are actually traces to follow.
3. How do I find out if I have a luteum rupture?
Luteal rupture is a common acute abdomen in gynecology, and 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 menstrual periods), especially 1 to 10 days before the next menstrual period.
At the onset of the disease, girls will feel sudden and severe pain on the side of the stomach, and it will be aggravated in bursts, may also be accompanied by distention, but there is no vaginal bleeding; it may also be accompanied by nausea, vomiting, palpitations, cold sweats and other symptoms of sympathetic excitement.
The doctor will make a diagnosis based on the following test results:
Gynaecological examination: the uterus is not abnormal, the texture is medium, but it is painful when palpated and pressed in the adnexal area of the affected area, and the posterior vault (the crypt between the posterior wall of the vagina and the cervix) is positive for puncture, which can draw out non-coagulated blood.
If there is bleeding in the abdominal cavity, girls will have obvious peritoneal irritation signs (that is, abdominal tenderness, rebound pain, abdominal muscle tension, etc.) and a positive mobile voiced tone (this is a common method of checking for fluid accumulation in the abdominal cavity).
Urine test HCG recessive (to exclude pregnancy-related disorders).
Abdominal color ultrasound: enlarged ovaries with mixed echoes at the affected site; there may be an effusion of fluid in the uterus rectum or uterine bladder depression.
4. How to treat luteal rupture?
The amount of bleeding from the rupture of the corpus luteum varies greatly, ranging from tens of milliliters to thousands of milliliters.
Patients with little bleeding may only present with lower abdominal pain, and a little blood flowing out will be slowly absorbed by the body, while people with large bleeding may have hemorrhagic shock and even life-threatening.
Therefore, the treatment of corpus luteum rupture varies accordingly.
Patients with less intra-abdominal bleeding and milder disease are generally treated conservatively:
Absolute bed rest, strictly prohibited from the ground, fast flip and heavy physical activity.
Symptomatic supportive treatment with anti-inflammatory, hemostatic, rehydration and other drugs, and if necessary, blood transfusions are performed to correct symptoms of anemia.
During treatment, vital signs such as heart rate, blood pressure, pulse, breathing, blood oxygen saturation, and consciousness should be closely observed.
For patients with more intra-abdominal bleeding, it is necessary to give emergency treatment immediately [5]:
If symptoms of hemorrhagic shock occur, fluids are rehydrated as soon as possible for anti-shock therapy.
Start surgery at the same time as anti-shock: laparoscopic surgery is preferred, cleaning up the blood in the abdominal cavity, performing ovarian repair, electrocoagulation of blood vessels, and achieving the purpose of hemostasis.
If the bleeding is particularly severe, or if laparoscopy is not suitable, open surgery is required, and in severe cases, due to excessive bleeding, a hematoma or other causes may cause most of the ovaries to be retained, and one side of the ovaries may even be removed [6]!
Image source: Tencent Medical Code
It should be noted that because the ovaries are cyclical ovulation, girls who have had a ruptured luteum do not rule out the possibility of recurrence in the future. If severe abdominal pain and other symptoms appear again, be sure to go to the hospital in time to find out the cause.
Can luteal rupture be prevented?
To prevent the rupture of the yellow body, it is recommended that girls usually eat as light as possible and maintain nutritional balance; quit smoking and alcohol; do not sit for a long time and avoid excessive weight; when the mental pressure is high and emotional tension, 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 "careful and light", and sex must be gentle and not too rough. At the same time, take care of yourself to avoid overwork and do as little strenuous exercise as possible the week before your period.
bibliography:
[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.
Zhao Minmin,Tong Xiuqin. Research progress on factors related to ovarian luteal rupture[J].World Latest Medical Information Abstracts,2019,19(06):108-109.
Chen Xiaoyan,You Huarong,Wang Jie. Relevant factors and clinical features of 263 cases of ovarian luteal cyst rupture[J].Hainan Medicine,2011,(20):87-89.
Hu Xiaoying,Zhang Wei. Clinical data analysis of 85 cases of ovarian luteal rupture[J]. Zhejiang Clinical Medicine,2015,(2).
Liang Zhiqun,Wu Guiqun,Wu Xuemei,et al. Rescue and nursing experience of ruptured ovarian luteum and shock[J].International Herald of Medicine and Health,2006,12(12):128-129.
Cao Zhiying, Zhang Yueying. Diagnosis and misdiagnosis analysis of 34 cases of acute ovarian luteal rupture[J]. Chinese Journal of Reproductive Health, 2008, 19(4): 220-221.
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