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Possible laroscopic removal of Corpus Luteum
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Possible laroscopic removal of Corpus Luteum

History: My wife is a healthy 36 yr old & is very fit & very health conscience.  “Due date” is Aug 15th (according to last period)/Aug 20th (according to the first sonogram). She’s had 1 or 2 ovarian cysts over the past 5-6 years that have enlarged causing spotting/pain & have caused monitoring by our docs, but have always gone away & not required any kind medical intervention/surgery.  

Current: All tests/sonograms/doctor’s visits have had positive results except for  1. During the regular 1st prenatal visit to the OB/Gyn on Jan 08th it was discovered that the corpus luteum (C.L.) was larger than normal & was ~7.3 cm. We were instructed to limit physical activity (which she/we did) to avoid possible torsion & to check it in 4 weeks. Went back on Feb 4th & the C.L. had only shrunk to 6.7cm (had only shrunk .5 cm). So  far, the C.L.  hasn’t caused any pain/problems that we know of.  The doctor explained that there was a ‘window’ for surgery (?14-16?) weeks which was the “best time” for surgery as far as the fetus is concerned) so we scheduled surgery to lock down the date just in case it was needed. He was “hopeful” it wouldn’t be necessary. We are crossing our fingers that the C.L. will shrink but are a bit worried at the prospects of surgery. The doctor explained that if needed, he’d do a laroscopy to remove the cyst that would require my wife to be under general anesthesia. We are scheduled to go back for another sonogram on Feb. 19th & have surgery penciled in on Feb. 21st.  Questions:  
-How typical is it that the C.L. behaves like this – i.e. is “too big” doesn’t shrink? -Surgery is always a “risk vs. reward” – how much is the risk compared to the reward (both to the baby & my wife)? -Doc has been doing this for over 25 years. Wouldn’t it be prudent to request a second opinion? -Couldn’t we wait out the shrinkage a bit longer til the end of the safe window of surgery? -General thoughts on our situation? Many thanks in advance for any advice/feedback. Kirk
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Hello Kirk,

Anesthesia during pregnancy is quite safe and very unlikely to result in any untoward outcome.  

I definitely would seek a second opinion.  I have doubts that the cyst that has been seen is the corpus luteum.  There are some types of ovarian cysts associated with pregnancy (e.g., theca lutein cysts) that will resolve on their own postpartum.  Also, if your wife is asymptomatic (the likelihood of torsion decreases as pregnancy advances given the enlarging uterus) and the cyst is not concerning for a malignancy or enlarging, expectant mgmt is probably most prudent.  
Best regards,

Dr. Downing
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