A Case of Severe Ovarian Hyperstimulation Syndrome (original) (raw)
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Severe ovarian hyperstimulation syndrome leading to ICU admission
Saudi Journal of …, 2010
Severe ovarian hyperstimulation is a rare complication of ovulation induction therapy. In this report, we are presenting a case of 33-year female, who required intensive care unit admission due to respiratory failure secondary to massive pleural effusion and ascites. With the positive history of in vitro fertilization, the patient was diagnosed to have severe ovarian hyperstimulation syndrome. Besides the medical treatment, abdominal paracentesis for the drainage of massive ascites and tube thoracostomy were performed, resulting in gradual improvement.
A Early Development of Severe Ovarian Hyperstimulation Syndrome following Ovulation Induction
JMS SKIMS
Ovarian Hyperstimulation is a rare but potentially fatal complication of ovarian stimulation during treatment of infertility. Worldwide the incidence of this syndrome is increasing due to liberal use of invitro fertilization for management of infertility. The syndrome is characterized by cystic ovarian enlargement and abnormal capillary permeability due to secretion of vasogenic substances by ovaries. The syndrome is classified into early and late variants with early variants usually mild to moderate in severity. We present a case of severe ovarian hyperstimulation syndrome (OHSS) developing early in a 25-year female while undergoing In-vitro fertilization (IVF). Six days after ovulation induction, the woman developed ascites, bilateral pleural effusion and acute renal failure with ultrasound abdomen revealing bilateral cystic enlargement of ovaries. JMS 2011;14(1):30-32
Severe ovarian hyperstimulation syndrome in a twin pregnancy after intracytoplasmic sperm injection
Journal of Obstetrics and Gynaecology Research, 2007
Severe ovarian hyperstimulation syndrome (OHSS) is characterized by increased capillary permeability and fluid retention in the third space. It is generally a complication of assisted reproduction therapy (ART) with exogenous gonadotropins, but cases with natural onset of OHSS have been reported. The massive extravascular exudation can cause tense ascites, pleural and pericardial effusion, hypovolemic shock, oliguria, electrolyte imbalance (hyponatremia and hyperkalemia), and hemoconcentration, with a tendency for hypercoagulability and risk of life-threatening thromboembolic complications. The patient can rarely develop multi-organ failure (adult respiratory distress syndrome, renal failure) and death. With increasing use of ART, this syndrome may be seen more frequently in the intensive care unit (ICU), requiring multidisciplinary care. We report the management of two cases of severe OHSS, which required admission to the ICU in our hospital.
Ovarian hyperstimulation syndrome (OHSS)-our clinical experience
2015
Introduction: Ovarian hyperstimulation syndrome (OHSS) is a serious complication of the luteal phase/early pregnancy, usually iatrogenic, after ovulation induction or ovarian hyperstimulation in the context of intrauterine insemination and in vitro fertilization (IVF). It is usually a self limiting disorder but may be more severe and persist longer than usual, if pregnancy is successful. Renal and hepatic dysfunction, thrombosis, hydrothorax, cerebral infarct and adult respiratory distress syndrome (ARDS) are the leading causes of morbidity and mortality seen in severe cases. Materials and methods: This is a retrospective study of two years which included women with clinical signs and symptoms suggestive of OHSS. Diagnosis was confirmed by the investigations. Conservative medical management was the main stay of treatment with daily monitoring of the clinical and biochemical parameters. Surgical management like paracentesis, pleuracentesis, diagnostic laparoscopy and therapeutic term...
Ovarian hyperstimulation syndrome. The new approaches for diagnosis, treatment and prevention
2015
Ovarian hyperstimulation syndrome (OHSS) is the most serious consequence of induction of ovulation, as part of assisted conception techniques. Although the ultimate physiologic mechanism of OHSS is not yet known, there are well-known risk factors that must be considered during the administration of medications to treat infertility. The clinical course of OHSS may involve, according to its severity and the occurrence of pregnancy, electrolytic imbalance, neurohormonal and hemodynamic changes, pulmonary manifestations, liver dysfunction, hypoglobulinaemia, febrile morbidity, thromboembolic phenomena, neurological manifestations and adnexal torsion. Specific approaches such as paracentesis, pleural puncture, surgical approach of OHSS and specific medication during OHSSwere evaluated sporadically. Moreadequate treatment methods wouldrequire abetter understanding of the underlying pathophysiological mechanisms, to promote an etiopathogenic therapeutic approach. The following review aims ...
International Journal of Infertility & Fetal Medicine
Background: Severe ovarian hyperstimulation syndrome (OHSS) is a serious complication of controlled ovarian stimulation which requires a multipronged management to achieve a favorable outcome. Case description: A 24-year-old infertile lady with polycystic ovarian syndrome (PCOS) presented with the complaints of vomiting, abdominal pain, and abdominal distension following ovulation induction with follicular-stimulating hormone. Ultrasound suggested bilateral enlarged ovaries with moderate free fluid in the Pouch of Douglas. A diagnosis of OHSS was made, and oral cabergoline with prophylactic anticoagulation was initiated along with supportive management. However, the patient continued to deteriorate and was shifted to intensive care unit and started on human albumin infusion. Despite all measures, the patient developed tachypnea with tense ascites and oliguria which necessitated ultrasound-guided abdominal paracentesis twice. The patient started improving following paracentesis, was diagnosed to have quadruplet pregnancy, and discharged in stable condition. Two of four embryos did not thrive, and eventually, the patient delivered two healthy babies by cesarean section. Conclusion: Management of severe OHSS requires multimodality treatment. Surgical intervention in the form of paracentesis should be strongly considered in patients with tense ascites, leading to respiratory compromise and oliguria, which is refractory to medical management. Clinical significance: The case report highlights the need for extreme caution during controlled ovarian hyperstimulation in patients with PCOS. The case also aims to guide in the management of a case of severe OHSS, which may require a combination of therapies including paracentesis for a favorable outcome.
Ovarian Hyperstimulation Syndrome in Natural Conception
Current Trends in diagnosis & Treatment, 2018
Background: Ovarian hyperstimulation syndrome (OHSS) generally results due to exogenous administration of gonadotropins for ovulation induction in females seeking treatment for infertility. OHSS can lead to life-threatening complications, therefore, its early diagnosis and management are very important. Case report: We hereby report a rare case of OHSS in a spontaneously and naturally conceived pregnancy. Our patient is a 28-year old gravida 3 para 2 live 2 female with a period of gestation of 14 weeks, who presented to us with complaints of abdominal pain, mild distension, nausea, vomiting, and mild degree of breathlessness. All the possibilities that would have caused OHSS in a pregnancy were ruled out with adequate investigations. Ultrasound (USG)-guided aspiration of cyst was done and the cytology was negative for malignancy. The patient and her attendants voluntarily demanded termination of pregnancy for the health interest of the mother. Termination of pregnancy was done. The postabortal period was uneventful. The follow-up scan after 4 weeks revealed bilateral ovaries near normal in size, shape, and volume. No ascites was found this time. Conclusion: As after the termination of pregnancy B-human chorionic gonadotropin (HCG) levels dropped down and ovaries were found to be normal in the follow-up scan, our diagnosis goes more in favor of OHSS. Thus, although OHSS is a characteristic outcome of women who underwent some sort of ovarian induction or assisted reproductive technologies, one must be aware of its occurrence in a spontaneous conception too.