Development and management of ovarian hyperstimulation syndrome in spontaneous singleton pregnancy (original) (raw)
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Spontaneous Ovarian Hyperstimulation Syndrome in Second Pregnancy of a Healthy Pregnant Woman
ACTA MEDICA IRANICA, 2020
pontaneous ovarian hyperstimulation syndrome (OHSS) is an uncommon type of OHSS that is characterized by gastrointestinal symptoms and complications of accommodation of body fluids in third spaces in the absence of medical ovarian stimulations. This syndrome is mostly seen in multiple or molar pregnancies with an underlying medical condition such as hypothyroidism. Treatment of spontaneous OHSS depends on the patient’s clinical condition. Appropriate management will warrant a successful pregnancy. The aim of this report is to introduce a case of spontaneous ovarian hyperstimulation syndrome in second pregnancy of a healthy pregnant woman. The patient was a 8 weeks pregnant female who referred to gynecology and obstetrics clinic because of gradual abdominal distension, abdominal pain and nausea from one month ago. The patient didn't have any history of the specific predisposing factors of OHSS such as thyroid gland dysfunction or multiple pregnancies. Abdominal sonography showed ...
Ovarian Hyperstimulation Syndrome in Spontaneous Pregnancy
Background: Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of supraphysiologic ovarian stimulation but infrequently has been described in spontaneous pregnancy. Aim: To present a case of a woman in spontaneous pregnancy complicated by OHSS. Results: A 32-year-old gravida 1, para 1 with spontaneous conception, was diagnosed with moderate OHSS at the 11th week of gestation and was managed conservatively. The woman delivered vaginally at term a health female infant.
Onset of Spontaneous Ovarian Hyperstimulation Syndrome in the Third Trimester: Case Report
Cureus, 2022
Ovarian hyperstimulation syndrome (OHSS) is a rare and occasionally fatal complication of ovulation induction. However, OHSS has occurred without interventional ovulation induction and in spontaneous ovulatory cycles. In most reported cases, physiological production of human chorionic gonadotropin was high, as in cases of multiple gestation, molar pregnancy, polycystic ovarian syndrome, and hypothyroidism. We report a very rare case of spontaneous OHSS in a healthy 36-year-old woman, gravida 5 para 2 + 2, 35 weeks pregnant, who had become pregnant naturally. According to our research, this is the first report of a case that occurred in the third trimester.
Ovarian Hyperstimulation Syndrome
The Professional Medical Journal
It is known that most cases of Ovarian Hyperstimulation Syndrome (OHSS) areassociated with the therapies for ovulation induction. However, OHSS may rarely be associatedwith a spontaneous ovulatory cycle, usually in the case of multiple gestations, hypothyroidism orpolycystic ovarian syndrome. We report a case of moderate OHSS in spontaneously conceivedtwin pregnancy in a 24 years old woman. The clinical picture showed amenorrhea,nausea,vomiting, abdominal pain and moderate ascites. After examinations, imaging and laboratoryinvestigations, the diagnosis was established. The patient was managed expectantly with nocomplications. Although spontaneous ovarian hyperstimulation is a rare entity, it is important thatthe physician recognizes this condition. Prompt diagnosis and successful management is likelyto avoid serious complications, which may develop rapidly.
Endocrinology: Ovarian hyperstimulation syndrome associated with spontaneous pregnancy
Human Reproduction, 1996
Ovarian stimulation in a patient who suffered from partial (non-classical) 17a-hyroxylase 17,20 lyase deficiency of the adrenal cortex and gonads is described. Diagnosis was based on measurements of high concentrations of steroid metabolites proximal to the enzymatic block (progesterone, 17-hydropregnenolone and 17-hydroprogesterone); with further rise following adrenocorticotrophic hormone (A-CTH) stimulation, and low steroid concentrations distal to the block. Her basal plasma oestradiol values were low and did not rise even during repeated treatment cycles with maximal ovarian stimulation. However, clinical presentation of ovarian hyperstimulation syndrome (OHSS) developed despite very low oestradiol concentrations, thus seriously questioning the role of oestradiol in the pathogenesis of this condition. The poor correlation between clinical presentation of OHSS and plasma oestradiol values, as presented in this case, supports other data which conclude that oestradiol measurements alone are not sufficient to alert the physician to the possible development of OHSS.
Human Reproduction, 2004
The main aim of this study was to assess the obstetric complications for those pregnancies that are complicated by ovarian hyperstimulation syndrome (OHSS) and continue beyond the first trimester. We checked also for other related serious events that occurred during the first trimester. METHODS: We included only patients whose pregnancies continued beyond the first trimester and compared them with IVF-treated patients displaying moderate ovarian response. RESULTS: We studied 165 patients with OHSS (101 singletons and 64 twins) and 156 IVF control patients (85 singletons and 71 twins). Two serious complications, gestational diabetes mellitus (GDM) and pregnancy-induced hypertension (PIH), were noted in both groups. However, the incidence of these two complications did not differ significantly between the groups. In the OHSS group, GDM presented with an incidence of 9.9% for singletons and 9.4% for twins, and 12.9% and 7.0%, respectively, for the control group. PIH presented as 6.9% for singletons and 10.9% for twins in the OHSS group, and 8.2% and 7.0%, respectively, for the control groups. During the first trimester laparoscopies for suspected ovarian torsion were performed in 13 patients, and in 10 patients the diagnosis were confirmed. CONCLUSIONS: Although patients with OHSS-complicated pregnancies previously reported a relatively high risk of GDM and PIH, the occurrence rates do not differ from a matched control group of normally responding patients who conceived after IVF.
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.
2015
Spontaneous OHSS in a term pregnancy is extremely rare. The aim of this study is to present a case of spontaneous ovarian hyperstimulation syndrome (OHSS) in a term pregnancy. A 29-year-old primigravida woman conceived spontaneously and was observed up until 35 weeks of gestation. During this time the patient had a normal pregnancy with normal ovaries. She applied to the current clinic during the 37th week of gestation with complaints of rapid weight gain, abdominal disturbance, and pain. Ultrasound examination showed large bilateral ovaries with multiple follicles and mild ascites. At 39 weeks of gestation, the ovaries were the same as detected previously, and a caesarean section was performed due to fetal macrosomia. A healthy female foetus weighing 4060 gr was delivered. The enlarged bilateral ovaries containing multiple follicles were drilled with electrocautery. The ovaries returned to a near normal state for two weeks after the birth. There are no reported cases of spontaneous...
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...
Early and late ovarian hyperstimulation syndrome: early pregnancy outcome and profile
Human Reproduction, 2005
BACKGROUND: Ovarian hyperstimulation syndrome (OHSS) in IVF/ICSI cycles may occur either as an early (early onset) or a late pattern (late onset). This observational study was designed to identify whether the onset pattern of OHSS is associated with the occurrence of pregnancy and the early pregnancy outcome. METHODS: Among 4376 consecutive IVF/ICSI cycles, 113 patients were hospitalized for OHSS after IVF/ICSI treatment and were included in the study. The setting was the Dutch-speaking Brussels Free University Hospital, between June 2000 and September 2002. RESULTS: Early OHSS occurred in 53 patients, and late OHSS complicated 60 patients. A total of 96.7% of the late OHSS cases occurred in a pregnancy cycle and were more likely to be severe than the early cases (P < 0.05). Although in the early group there initially was a 41.5% positive HCG rate per cycle, the clinical pregnancy rate fell to 28,3% as a result of a significantly (P < 0.05) increased preclinical pregnancy loss rate compared with the non-OHSS patients (31.8 versus 88.3%, respectively). The ongoing pregnancy rate per cycle was 14.4% in the early and 26.4% in the late group. Multiple pregnancy rates were high in both groups (40 and 45.5%, respectively), but only in the late group did the incidence reach significance compared with the non-OHSS population (45.5 versus 29.1%, P 5 0.02). Estradiol levels and number of follicles on the day of HCG were significantly higher in the early OHSS group. However, there was no difference in estradiol values on the day of hospital admittance between the two groups. In addition, the number of follicles on the day of HCG administration appears to be a better prognostic indicator for the occurrence of severe OHSS than the estradiol values (87% of the severe cases had 14orfolliclesofadiameter14 or follicles of a diameter 14orfolliclesofadiameter11 mm, whereas only 50% of them had an estradiol value $3000 ng/l). CONCLUSIONS: The early OHSS pattern is associated with exogenously administered HCG and a higher risk of preclinical miscarriage, whereas late OHSS may be closely associated with the conception cycles, especially multiple pregnancies, and is more likely to be severe. Further clarification of these two different clinical entities could have implications for research protocols as well as for preventive and management strategies for OHSS.