Early Pregnancy Complications: CT Scan and Ruptured Corpus Luteum

During the early stages of pregnancy, an abdominal CT scan was performed, and there was a rupture of a corpus luteum cyst?

Hello doctor, my last menstrual period was on September 25.
I usually track my basal body temperature.
On October 13, it was 36.47°C, on October 14, it was 36.71°C, and by October 17, it reached 36.98°C (I have been tracking my temperature for four months and have never reached such a high temperature during the high-temperature phase).
On the evening of October 19, after dinner, I suddenly experienced pain around my navel, which felt strange and sharp in waves.
I went to the emergency room, but the doctor couldn't find the cause.
They first ordered blood and urine tests to confirm I wasn't pregnant, then performed an abdominal X-ray and administered pain relief.
After the X-ray, the doctor mentioned that I had some fecal impaction and suspected a bowel obstruction (although I had a bowel movement that afternoon).
They gave me an enema, but after 20 minutes, I still couldn't pass anything, only expelled the enema solution, and the pain persisted.
The doctor administered morphine, and after some relief, due to the ongoing pain, they arranged for a chest X-ray and an abdominal CT scan (at 4:00 AM on October 20).
After administering contrast, I had an allergic reaction and received two doses of antihistamines.
The scan revealed some fluid accumulation and bleeding in my abdomen, so I was admitted to the hospital and put on a fasting regimen, receiving antibiotics every six hours until my discharge on October 23.
By noon on October 20, I started to have bowel movements and passed gas, and after having a bowel movement, my abdominal pain significantly decreased, with only slight tenderness upon palpation (around the navel).
After a gynecological examination, I was informed that I had a ruptured corpus luteum cyst, which was considered mild, and that the internal bleeding could be absorbed by the body (though I didn't feel any pain in my lower abdomen, nor did I have any menstrual-like bleeding).
After discharge, the doctor prescribed antibiotics for me to continue taking.
By October 29, my temperature had been elevated for 16 consecutive days.
During a follow-up visit, a pregnancy test confirmed I was pregnant.
An ultrasound indicated that the internal bleeding had been absorbed, with only a small amount of fluid remaining.
Initially, the CT scan suggested I was about 3 to 4 weeks pregnant, and it was too early to detect.
I consulted another gynecologist who advised against continuing the pregnancy due to radiation exposure and suggested I return to my original hospital.
The doctor ordered blood tests (over two days), and on November 1, during a follow-up visit, the reports showed that my hCG levels were over 800 (on October 29) and over 1600 (on October 31), indicating that the baby was growing and should be fine.
The ultrasound showed the embryo was round (1 cm) and well-positioned in the center of the uterus, suggesting that it could be viable.
They gradually adjusted the radiation dose from the CT scan, which indicated the following: Scan Range CTDlvol (mGy) DLP (mGy-cm) PHANTOM (cm) Helical I189.250-I604.250 3.84 183.99 Body 32 Helical I189.250-I604.250 4.94 232.62 Body 32 total 420.61.
The doctor mentioned that they were also hesitant and suggested I consult a few more doctors.
Can you help me determine whether the baby can be kept?

Ya Miao, 30~39 year old female. Ask Date: 2013/11/02

Dr. Cao Guotao reply Obstetrics and Gynecology

Hello, under normal circumstances, small babies have about a 1 to 2% chance of size abnormalities.
Of course, the radiation dose from a CT scan is relatively high, but if it’s just a simple X-ray, the radiation exposure is much lower, so there should be no concerns.
Therefore, it is really difficult for a physician to provide a completely harmless answer, as there is still a 1 to 2% chance of size abnormalities in small babies under normal conditions.
However, I still recommend that you consult a medical center for their opinion.
Wishing you good health.

Reply Date: 2013/11/02

More Info

In early pregnancy, complications can arise that may lead to concerns about the health of both the mother and the developing fetus. One such complication is the rupture of a corpus luteum cyst, which can cause abdominal pain and internal bleeding. In your case, it appears that you experienced significant abdominal pain, which led to a series of diagnostic tests, including a CT scan, to assess the situation.

The corpus luteum is a temporary endocrine structure that forms in the ovary after ovulation. It produces hormones, primarily progesterone, which are crucial for maintaining the early stages of pregnancy. If the corpus luteum ruptures, it can lead to internal bleeding and pain, but in many cases, the body can absorb the blood, and the situation resolves without further complications. Your doctors have indicated that the rupture was mild and that the internal bleeding could be self-resolving, which is a positive sign.

Regarding the use of a CT scan during early pregnancy, it is important to note that while CT scans involve exposure to radiation, the risk to the fetus is generally considered low, especially if the scan is not focused on the pelvic area. However, it is always advisable to minimize radiation exposure during pregnancy whenever possible. The decision to perform a CT scan is typically based on the necessity of obtaining critical diagnostic information that cannot be acquired through other means, such as ultrasound.

In your case, the follow-up ultrasound indicated that the embryo was developing normally, with a heart rate and appropriate growth for the gestational age. The presence of a small amount of fluid is not uncommon and can often resolve on its own. The levels of human chorionic gonadotropin (hCG) you reported also suggest that the pregnancy is progressing well, as hCG levels typically double every 48 to 72 hours in a healthy early pregnancy.

Given that your healthcare providers have reassured you about the viability of the pregnancy and the absence of significant complications, it is reasonable to continue monitoring the pregnancy with regular check-ups and ultrasounds. If you experience any new symptoms, such as increased pain, heavy bleeding, or other concerning signs, it is crucial to seek medical attention promptly.

In summary, while the initial complications you faced were concerning, the subsequent evaluations indicate that your pregnancy is likely to be viable. It is essential to maintain open communication with your healthcare providers, follow their recommendations, and attend all scheduled appointments to ensure the health and well-being of both you and your baby. If you have lingering concerns, seeking a second opinion from another obstetrician or maternal-fetal medicine specialist may provide additional reassurance.

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