An Unusual Presentation of a Corpus Luteum Rupture

Area of Science:

• Cardiology
• Gynecology
• Hematology

Background:

• Rheumatic heart disease (RHD) is prevalent in India, often leading to mitral valve replacement (MVR).
• Anticoagulant therapy post-MVR increases the risk of drug-induced coagulopathy.
• Gynecological hemorrhage is a rare but serious complication in women of reproductive age on anticoagulants.

Observation:

• A 30-year-old woman with MVR on anticoagulants presented with congestive cardiac failure.
• Massive hemoperitoneum was diagnosed via ultrasound-guided paracentesis.
• Bleeding from a corpus luteal cyst, indicative of ovulatory bleeding, was identified as the cause.

Findings:

• The patient's ascites and hemoperitoneum were attributed to normal ovulatory bleeding.
• This rare complication underscores the interplay between cardiac management and gynecological events.
• Coagulopathy-related hemorrhage can manifest with significant intra-abdominal bleeding.

Implications:

• Highlights the need for vigilance regarding gynecological bleeding in women on anticoagulation post-MVR.
• Suggests considering ovulatory events as a potential cause of hemoperitoneum in at-risk patients.
• Emphasizes multidisciplinary management for complex cardiac and gynecological cases.