Ruptured Corpus Luteum among Women Undergoing Laparotomy for Hemoperitoneum in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Rupture of the corpus luteum, though generally self-limiting in women with normal coagulation, could lead to life-threatening bleeding in patients with prosthetic valves on anticoagulant therapy and described in only a few case reports in the literature. The aim of this study was to find out the prevalence of ruptured corpus luteum among women undergoing laparotomy for hemoperitoneum in a tertiary care centre. Methods: This descriptive cross-sectional study was conducted among women undergoing laparotomy for hemoperitoneum in a tertiary centre from 7 April 2017 to 31 March 2021 after obtaining ethical approval from the Institutional Review Committee [Reference number: 328(6-11-E)2/73/74]. All women who underwent laparotomy for hemoperitoneum during the study period were enrolled. Convenience sampling technique was used. Point estimate and 95% Confidence Interval were calculated. Results: Out of 447 women who underwent laparotomy for hemoperitoneum, ruptured corpus luteum was seen in 48 (10.74%) (7.87-13.61, 95% Confidence Interval). Out of which 36 (75%) had prosthetic valves. There was 1 (2.77%) mortality and 3 (8.33%) recurrences. Conclusions: The prevalence of rupture of the corpus luteum among women undergoing laparotomy for hemoperitoneum was similar to other studies done in similar settings. Early diagnosis, emergent reversal of coagulopathy and surgery if needed are the mainstay of management. Keywords: anticoagulant; corpus luteum; hemoperitoneum.

Ruptured Corpus Luteum among Women Undergoing Laparotomy for Hemoperitoneum in a Tertiary Care Centre: A Descriptive Cross-sectional Study.

Introduction: Rupture of the corpus luteum, though generally self-limiting in women with normal coagulation, could lead to life-threatening bleeding in patients with prosthetic valves on anticoagulant therapy and described in only a few case reports in the literature. The aim of this study was to find out the prevalence of ruptured corpus luteum among women undergoing laparotomy for hemoperitoneum in a tertiary care centre. Methods: This descriptive cross-sectional study was conducted among women undergoing laparotomy for hemoperitoneum in a tertiary centre from 7 April 2017 to 31 March 2021 after obtaining ethical approval from the Institutional Review Committee [Reference number: 328(6-11-E)2/73/74]. All women who underwent laparotomy for hemoperitoneum during the study period were enrolled. Convenience sampling technique was used. Point estimate and 95% Confidence Interval were calculated. Results: Out of 447 women who underwent laparotomy for hemoperitoneum, ruptured corpus luteum was seen in 48 (10.74%) (7.87-13.61, 95% Confidence Interval). Out of which 36 (75%) had prosthetic valves. There was 1 (2.77%) mortality and 3 (8.33%) recurrences. Conclusions: The prevalence of rupture of the corpus luteum among women undergoing laparotomy for hemoperitoneum was similar to other studies done in similar settings. Early diagnosis, emergent reversal of coagulopathy and surgery if needed are the mainstay of management. Keywords: anticoagulant; corpus luteum; hemoperitoneum.

Corpus luteum in ectopic ovarian tissue miming tubal pregnancy.

We report an extraordinarily rare case of a pregnant patient with history of multiple ovarian cyst surgery. The corpus luteum developed on an ectopic ovarian tissue, miming an tubal pregnancy. One week later after the diagnostic laparoscopy an intrauterine pregnancy was visualised. Therefore, ectopic ovarian tissue with normal follicular activity may appear after multiple ovarian surgery.

Minilaparotomic incision for haemorrhagic corpus luteum: a case report.

Corpus luteum cyst rupture with consequent hemoperitoneum is a common cause of admission to the emergency room. This condition is frequently misdiagnosed because of overlapping of clinical findings in acute gynecologic diseases. However, an incorrect identification may lead to delay in surgical treatment, which can Romabe a life-threatening condition. Ultrasound (US) is the first technique used for diagnosis that can confirm or dismiss the presence of intraperitoneal fluid. Secondly, the contrast-enhanced computed tomography (CT) is the quickest way to identify the site of active bleeding and to establish the correct management of the clinical condition. Herein, we report a case of a 19-years-old girl with acute abdominal pain correctly identified by diagnostic images and treated with mini-invasive surgery techniques in order to quickly act without clinic and aesthetic sequelae.

[Inferior vena cava thrombosis after laparoscopy]. / Thrombose der Vena cava Inferior nach Diagnostischer Laparoskopie.

HISTORY AND FINDINGS: A previously healthy 43-year-old woman was admitted because of pain in the lower abdomen. Abdominal and transvaginal ultrasound revealed a cystic structure in the right ovary, providing the indication for an exploratory laparoscopy. A hemorrhagic corpus luteum was enucleated. Laboratory tests had merely shown a raised C-reactive protein level and marginally elevated leukocytes. A family history of thrombotic episodes had been elicited. FURTHER COURSE, DIAGNOSIS AND TREATMENT: Although heparin had been applied increasing swelling developed in both thighs and lower legs at day six, indicating thrombosis of the inferior vena cava. Laboratory tests revealed a mutation in factor V (Leiden). Computed tomography showed complete thrombotic IVC occlusion. Thrombolytic treatment with recombinant tissue plasminogen was initiated, direct thrombus aspiration attempted and a filter inserted in the IVC. Low molecular heparin was infused, replaced by oral anticoagulation with phenprocoumon. Subsequent Doppler ultrasound examination demonstrated almost complete resolution of the thrombus, except for a few small residual thrombi. CONCLUSION: This case demonstrates that even minor laparoscopic interventions carry the risk of an IVC thrombosis as a late complication, indicating appropriate measures to prevent thrombosis.

Effects of luteectomy in early pregnancy on the maintenance of gestation and plasma progesterone concentrations in the viviparous temperate lizard Barisia imbricata imbricata.

BACKGROUND: Several studies have shown that the corpus luteum is the principal source of progesterone during the gravidity period in reptiles; however, its participation in the maintenance of gestation in the viviparous squamata is in dispute. The effects of ovariectomy or luteectomy vary according to the species and the time at which the procedure is performed. In this paper, we describe the effects of luteectomy during early pregnancy on the maintenance of gestation and progesterone concentrations in the temperate Mexican viviparous lizard Barisia imbricata imbricata. METHODS: Twenty-four lizards were subjected to three different treatments: luteectomy, sham luteectomy or non-surgical treatment, and blood samples were obtained before and after surgical treatment at different stages of gestation to determine the effects of luteectomy on the maintenance of gestation and progesterone concentrations. RESULTS: Spontaneous abortion was not observed in any of the females. However, luteectomy provoked abnormal parturition and a significant reduction in the number of young born alive. Parturition was normal in untreated females as well as those submitted to sham luteectomy. The surgical treatment also caused a significant reduction in progesterone concentrations in luteectomised females during early and middle gestation. However, no significant differences in hormone concentrations were observed among the three groups during late gestation or immediately post-parturition. CONCLUSIONS: Our observations indicate that the presence of the corpus luteum is not necesary for the maintenance of gestation, but that it does participate in parturition control. Moreover, the corpus luteum of the viviparous lizard B. i. imbricata produces progesterone, at least during the first half of pregnancy, and that an extra-ovarian source of progesterone must maintain gestation in the absence of luteal tissue.

Dynamics of circulating concentrations of gonadotropins and ovarian hormones throughout the menstrual cycle in the bonnet monkey: role of inhibin A in the regulation of follicle-stimulating hormone secretion.

In higher primates, increased circulating follicle-stimulating hormone (FSH) levels seen during late menstrual cycle and during menstruation has been suggested to be necessary for initiation of follicular growth, recruitment of follicles and eventually culminating in ovulation of a single follicle. With a view to establish the dynamics of circulating FSH secretion with that of inhibin A (INH A) and progesterone (P(4)) secretions during the menstrual cycle, blood was collected daily from bonnet monkeys beginning day 1 of the menstrual cycle up to 35 days. Serum INH A levels were low during early follicular phase, increased significantly coinciding with the mid cycle luteinizing hormone (LH) surge to reach maximal levels during the mid luteal phase before declining at the late luteal phase, essentially paralleling the pattern of P(4) secretion seen throughout the luteal phase. Circulating FSH levels were low during early and mid luteal phases, but progressively increased during the late luteal phase and remained high for few days after the onset of menses. In another experiment, lutectomy performed during the mid luteal phase resulted in significant decrease in INH A concentration within 2 hr (58.3+/-2 vs. 27.3+/-3 pg/mL), and a 2- to 3-fold rise in circulating FSH levels by 24 hr (0.20+/-0.02 vs. 0.53+/-0.14 ng/mL) that remained high until 48 hr postlutectomy. Systemic administration of Cetrorelix (150 microg/kg body weight), a gonadotropin releasing hormone receptor antagonist, at mid luteal phase in monkeys led to suppression of serum INH A and P(4) concentrations 24 hr post treatment, but circulating FSH levels did not change. Administration of exogenous LH, but not FSH, significantly increased INH A concentration. The results taken together suggest a tight coupling between LH and INH A secretion and that INH A is largely responsible for maintenance of low FSH concentration seen during the luteal phase.

The absence of corpus luteum formation alters the endocrine profile and affects follicular development during the first follicular wave in cattle.

We previously established a bovine experimental model showing that the corpus luteum (CL) does not appear following aspiration of the preovulatory follicle before the onset of LH surge. Using this model, the present study aimed to determine the profile of follicular development and the endocrinological environment in the absence of CL with variable nadir circulating progesterone (P(4)) concentrations during the oestrous cycle in cattle. Luteolysis was induced in heifers and cows and they were assigned either to have the dominant follicle aspirated (CL-absent) or ovulation induced (CL-present). Ultrasound scanning to observe the diameter of each follicle and blood collection was performed from the day of follicular aspiration or ovulation and continued for 6 days. The CL-absent cattle maintained nadir circulating P(4) throughout the experimental period and showed a similar diameter between the largest and second largest follicle, resulting in co-dominant follicles. Oestradiol (E(2)) concentrations were greater in the CL-absent cows than in the CL-present cows at day -1, day 1 and day 2 from follicular deviation. The CL-absent cows had a higher basal concentration, area under the curve (AUC), pulse amplitude and pulse frequency of LH than the CL-present cows. After follicular deviation, the CL-absent cows showed a greater basal concentration, AUC and pulse amplitude of growth hormone (GH) than the CL-present cows. These results suggest that the absence of CL accompanying nadir circulating P(4) induces an enhancement of LH pulses, which involves the growth of the co-dominant follicles. Our results also suggest that circulating levels of P(4) and E(2) affect pulsatile GH secretion in cattle.

Apoptosis in canine corpus luteum during spontaneous and prostaglandin-induced luteal regression.

Spontaneous luteal regression and prostaglandin-induced luteolysis in bitches were evaluated by measuring the apoptotic index for DNA fragmentation and the relative level of Bax gene expression in ovaries removed from nine untreated nonpregnant bitches at selected times during diestrus and in nine pregnant bitches after 1 day of administering abortive doses of a PGF-analog gel formulation given intravaginally at selected times during gestation. Nonpregnant diestrus was divided into three periods (early, mid and late) based on vaginal cytology and plasma progesterone concentration. Pregnant bitches were treated with a PGF-analog gel at corresponding stages of pregnancy (early, mid and late) and evaluated by ultrasound. Another eight pregnant bitches were similarly studied and serum progesterone concentrations were determined after 1, 2, 3 or 4 days of PGF-analog gel. Corpora lutea obtained by ovariohysterectomy were analyzed for apoptotic internucleosomal DNA fragmentation relative to that in a control cell line (U937), using an apoptotic DNA ladder kit and gel electrophoresis and for relative expression of the pro-apoptotic Bax gene by RT-PCR and electrophoresis. In nonpregnant bitches, the DNA fragmentation apoptotic index was greater in late than in early diestrus (P < 0.01). The index after 1 day of PGF-analog gel was higher in early pregnant bitches than in early diestrus bitches (P < 0.05); it was highest in midpregnancy (P < 0.05). The degree of apoptosis was related to the number of times PGF-analog gel was administered. Bax mRNA was detected in the corpus luteum (CL) and Bax expression increased from early to middiestrus in nonpregnant subjects (P < 0.05). Potential elevation in Bax due to PGF-analog gel treatment in pregnancy was only significant in relation to normal diestrus during early pregnancy (P < 0.01). In conclusion, we inferred that the effects of endogenous or exogenous prostaglandin on CL life span in bitches involved increases in apoptotic activity and that increased apoptosis was implicated in normal luteal regression in nonpregnant bitches.

Positron emission tomography in a premenopausal asymptomatic woman: a case report of increased ovarian uptake in a benign condition.

Positron emission tomography (PET) use is increasing; however, optimal utilization in gynecologic oncology remains unclear. PET is expensive, has limited anatomic detail, and it may be difficult to differentiate benign ovarian lesions from malignant lesions when PET is used. A 43-year-old female volunteer's PET scan revealed increased uptake in the left ovary. A subsequent extensive evaluation was entirely normal; however, the patient pursued excision with only a corpus luteum on final pathology. There is a dearth of information regarding PET scan ovarian abnormalities in asymptomatic premenopausal patients, as much of the literature focuses on women with a known ovarian lesion or cancer. Our case represents an increasingly common situation: evaluation and management of an asymptomatic woman with a positive PET scan. As more clinicians encounter PET scan abnormalities, it is imperative that the medical literature documents the limitations of this technology, especially in premenopausal women.

The role of luteal oxytocin in episodic secretion of prostaglandin F2alpha at luteolysis in the ewe.

The role of luteal oxytocin in the generation of luteolytic episodes of prostaglandin F2alpha at luteolysis was investigated. On day 10 of the cycle Dorset ewes underwent either surgical removal of the corpora lutea (lutectomy; n = 4) or sham operation (sham; n = 4). Lutectomised ewes were then administered progesterone by twice daily i.m. injection in corn oil (20 mg/day) until day 14 when treatment was ceased to simulate luteolysis. The concentration of 13, 14 dihydro-15-keto prostaglandin F2alpha (PGFM) was measured in peripheral blood samples collected at 20-min intervals for 8 h on days 12-16 of the cycle. Progesterone and oestradiol concentrations were similar in the two groups over the whole experimental cycle while oxytocin fell dramatically following lutectomy. No prostaglandin F2alpha release episodes were seen on day 12 or 13, while from days 14-16 both groups exhibited a similar episode frequency (lutectomy 0.9/ewe/8 h; sham 0.8/ewe/8 h). Analysis of episode characteristics revealed lower episode amplitude (p<0.05) but longer episode duration (p<0.05) in the lutectomy group. The results demonstrate that a normal frequency of prostaglandin F2alpha release episodes occurs independently of luteal oxytocin secretion. However, luteal oxytocin is involved in regulating the pattern of release, perhaps causing the release of episodes of the magnitude required for the successful completion of luteolysis.

Trilostane but not prostaglandin F2alpha (PGF2alpha) or cortisol aborts 90-day-pregnant lutectomized sheep.

Ewes were lutectomized and treatments were started 72 h later. Pregnant ewes were treated with vehicle; prostaglandin F2alpha (PGF2alpha); cortisol (C); trilostane (TR), a 3beta-hydroxy-steroid dehydrogenase inhibitor; PGF2alpha + C; TR + PGF2alpha; TR + C, or TR + PGF2 + C. TR, TR + PGF2alpha, TR + C, and TR + PGF2alpha + C aborted (P < or = 0.05) all ewes receiving TR. One ewe treated with PGF2alpha aborted (P > or = 0.05). The average time to abortion of TR-treated ewes was 50.8 h (P < or = 0.05) after initiation of treatments. All aborted ewes had retained placentas (P < or = 0.05) except one ewe in the TR + PGF2alpha, treatment group. TR was given every 12 h starting at 72 h postlutectomy until 96 h postlutectomy. TR reduced (P < or = 0.05) progesterone. Estradiol-17beta was increased (P < or = 0.05) 2 h after the first two TR treatments and declined 2 h later and was followed by a sustained increase (P < or = 0.05) in estradiol-17beta, which was coincident with the onset of abortions. Estradiol-17beta was increased (P < or = 0.05) by PGF2alpha but did not decrease (P > or = 0.05) placental secretion of progesterone. It is concluded that TR but not PGF2alpha is an abortifacient in 90-day-pregnant lutectomized ewes and that abortion occurs only when there is a decrease in circulating progesterone and an increase in circulating estradiol-17beta.

Effects of luteectomy on the maintenance of pregnancy, circulating progesterone concentrations and lambing performance in sheep.

In sheep, there have been few and conflicting data regarding the necessity of the corpus luteum (CL) for the maintenance of pregnancy. The aims of the present study were to examine the effect of luteectomy on and after Day 50 of pregnancy on maternal plasma progesterone concentrations and the progression of pregnancy, to determine the minimum placental progesterone support required for the maintenance of pregnancy, and to evaluate the effect of luteectomy on lambing performance. In Experiment 1, four ewes luteectomized on Day 50 of pregnancy aborted 2-7 days after surgery, whereas pregnancy progressed and parturition occurred between Days 143 and 149, with live lambs, in three of four ewes and in four ewes luteectomized on Days 60 and 70 of pregnancy respectively. The mean (+/- SEM) progesterone concentrations on the day before and one day after luteectomy decreased from 4.87+/-0.85 to 0.42+/-0.06 ng mL(-1) (P<0.01), from 4.57+/-0.51 to 0.80+/-0.12 ng mL(-1) (P<0.02) and from 6.05+/-0.52 to 1.67+/-0.11 ng mL(-1) (P<0.01), respectively, for the ewes luteectomized on Days 50, 60 and 70 of pregnancy. The fall in progesterone concentrations was 90%, 80% and 71%, respectively, for the ewes luteectomized on Days 50, 60 and 70 of pregnancy. In Experiment 2, pregnancy progressed in four ewes luteectomized on Day 70 and parturition occurred between Days 146 and 149, with live lambs. The mean progesterone concentrations declined (P<0.01) from 6.9+/-0.7 ng mL(-1) on the day before luteectomy to 2.1 = 0.3 ng mL(-1) the day after surgery. The concentrations of progesterone in blood collected every 3 h during a 24-h period were stable on Days 60 and 80 of pregnancy, but they were lower (P<0.03) on Day 80 than on Day 60 of pregnancy, for each time period examined. In Experiment 3, the gestation length and birthweights of single, twin and triplet lambs were not different between the control intact ewes (n = 111) and the ewes luteectomized on Days 70-80 of pregnancy (n = 71). Lamb mortality was not different between the two groups (7.2% v. 8.4%, control v. luteectomized). In conclusion, these results showed that (1) the sheep CL is necessary to maintain pregnancy until at least Day 60, (2) progesterone withdrawal induced by luteectomy on and after Day 50 of pregnancy must be of a critical magnitude to provoke abortion, (3) after Day 60 of pregnancy, the CL and the placenta together secrete more progesterone than required for pregnancy maintenance, (4) there is no apparent 24-hour rhythm in maternal plasma progesterone concentrations before and after luteectomy, and (5) luteectomy at mid pregnancy has no apparent effect on gestation length, lamb birthweight or lamb mortality.

Ovulation and luteal characteristics following removal of the ovine corpus luteum (lutectomy) at four times during the oestrous cycle.

The life span of the corpus luteum (CL) may depend on follicular development. To provide evidence relating to this hypothesis, each of 32 ewes was randomly assigned to have its CL removed on day 2, 3, 4 or 10 after oestrus. Twenty ewes were treated with 1000 IU of human chorionic gonadotrophin (hCG) 36 h after CL removal to induce ovulation; the other 12 ewes were not treated with hCG. Blood samples were collected daily to monitor the ovulatory response and the characteristics of the next cycle at the first sign of oestrus and up to day 21 after surgery or hCG administration. Every animal ovulated within 7 days of hCG administration, regardless of when its CL had been removed. It was concluded that the follicles found in the ovary as early as the second day after oestrus respond to endogenous or exogenous ovulatory stimuli affecting the life span of resulting CL.

MRI appearance of ruptured corpus luteum.

A 20-year-old woman was admitted complaining of lower abdominal pain. Transabdominal ultrasound revealed a fluid collection in the pouch of Douglas and an irregularly shaped ovary with cystic lesions. Malignant cystic mass of the right ovary was highly suspected from the ultrasound findings. Transvaginal peritoneal centesis yielded a bloody fluid, but the pregnancy test was negative. On the third day of admission, menstruation began. MR examination performed four days after the initial onset of pain showed a subacute hematoma just adjacent to the right ovary, and segmental interruption of the right ovarian cortex. Based on these MR findings and the patient's history, subacute hemorrhage from the right ovarian corpus luteum was suspected, and this was confirmed with surgical exploration.

Lack of suppressive action of luteal factors from sheep corpus luteum on LH response to exogenous LHRH in ovariectomized, pregnant and post-partum ewes.

In vivo studies have provided evidence of a non-steroidal factor from ovine corpora lutea (CL) of pregnancy called LH-release inhibiting factor (LH-RIF), which specifically inhibits tonic LH release without affecting FSH secretion. To study the possible pituitary site of action of LH-RIF and other factors from sheep CL of pregnancy, the LH response to LHRH was investigated in ovariectomized (OVX) ewes pretreated with ovine luteal extract (oLE) from CL of mid-pregnancy, and in pregnant and post-partum ewes from which the CL were removed at mid-pregnancy. In view of the fact that human follicular fluid (hFF) contains a non-steroidal factor, called gonadotrophin surge-attenuating factor, which attenuates the LHRH-induced LH release, it was clearly important to examine the LHRH-induced LH release in OVX ewes pretreated with oLE or hFF In experiment 1, the LH and FSH responses (the maximum LH and FSH concentrations, the time to maximum LH and FSH concentrations and the area under the LH and FSH response curves) to a single i.v. injection of 5 microg of the LHRH agonist buserelin was not significantly different between ewes pretreated with oLE and ewes pretreated with BSA. Although the LHRH-induced LH and FSH release was slightly attenuated in OVX ewes pretreated with hFF as compared with OVX ewes pretreated with BSA, the maximum LH and FSH concentrations and the area under the LH and FSH response curves were not significantly different between the two groups of ewes. In experiment 2, the LH responses to a single i.v. injection of 0.5 microg LHRH on days 80 and 100 of pregnancy were not significantly different between intact ewes and ewes from which the CL were removed on day 70 of pregnancy. In both groups of ewes the maximum LH concentration and the area under the LH response curve were significantly lower (P <0.02) on day 100 than on day 80 of pregnancy. In experiment 3, the LH responses to a single i.v. injection of 50 microg LHRH on day 140 of pregnancy and on day 10 post-partum were not significantly different between intact ewes and ewes from which the CL were removed on day 70 of pregnancy. In both groups of ewes the maximum LH concentration and the area under the LH response curve were significantly lower (P <0.01) on day 140 of pregnancy than on day 10 post-partum. These experiments provide evidence for a lack of suppressive action of luteal secretory products from the ovine CL of pregnancy on the pituitary LH response to LHRH in OVX, pregnant and post-partum ewes.

Successful pregnancy after early luteectomy.

A 31-year-old women, para 1, was admitted with acute lower abdominal pain. Examination revealed a tender right adnexal mass confirmed by endovaginal ultrasonography. She reported a regular menstrual cycle of 30-31 days and was on day 31 of her cycle on admission. All laboratory results were normal and a urinary pregnancy test was negative. After 2 days a laparotomy was performed and an oophorectomy was carried out because of a bleeding ruptured right ovarian cyst. Histologic examination reported a haemorrhagic corpus luteum. Eight weeks after laparotomy a viable intra-uterine pregnancy was observed and finally a 3850-g healthy male was delivered. An oophorectomy at a corrected gestational age of 30 days did not disturb the course of the pregnancy.