Ovarian hyper stimulation syndrome in a spontaneous singleton pregnancy: a case report

Authors

  • Anuj Kumar Sharma Department of Obstetrics and Gynaecology, RNT Medical College, Udaipur, Rajasthan, India
  • Radha Rastogi Department of Obstetrics and Gynaecology, RNT Medical College, Udaipur, Rajasthan, India
  • Kalpesh Patel Department of Obstetrics and Gynaecology, RNT Medical College, Udaipur, Rajasthan, India
  • K. G. Vivek Department of Obstetrics and Gynaecology, Base Hospital Barrackpore, West Bengal, India

DOI:

https://doi.org/10.18203/2320-1770.ijrcog20220204

Keywords:

Secondary OHSS, Thromboprophylaxis, hCG, GnRH analogues, Dopamine agonist

Abstract

Ovarian hyper stimulation syndrome (OHSS) is extremely rare in spontaneous pregnancies. Spontaneous OHSS can result from glycoprotein hormones stimulating follicle-stimulating hormone receptors (FSHR). Our case reinforces the importance of a prompt diagnosis and management in all pregnant patients presenting with acute abdomen and ovarian masses. We report a case of spontaneous singleton pregnancy at 12-week POG presented with abdominal distension and enlarged ovaries. Patient was successfully managed with supportive treatment comprise of intravenous (IV) Albumin, thromboprophylaxis, dopamine agonist and insulin sensitizer. Spontaneous OHSS should be included in the differential diagnosis of acute abdomen in pregnant women. Since spontaneous OHSS can be associated with life-threatening complications, it requires early diagnosis for successful management. The etiology should be determined in order to focus the treatment and avoid future complications.

 

Author Biographies

Anuj Kumar Sharma, Department of Obstetrics and Gynaecology, RNT Medical College, Udaipur, Rajasthan, India

Senior Resident

Department of Obstetrics and Gynaecology,

RNT Medical College, Udaipur

Radha Rastogi, Department of Obstetrics and Gynaecology, RNT Medical College, Udaipur, Rajasthan, India

Sr. Professor and Unit Head

Department of Obstetrics and Gynaecology,

RNT Medical College, Udaipur

Kalpesh Patel, Department of Obstetrics and Gynaecology, RNT Medical College, Udaipur, Rajasthan, India

Resident

Department of Obstetrics and Gynaecology,

RNT Medical College, Udaipur

K. G. Vivek, Department of Obstetrics and Gynaecology, Base Hospital Barrackpore, West Bengal, India

Department of Obstetrics & Gynaecology

Base Hospital Barrackpore

West Bengal (India) - 700120

References

Naredi N, Singh SK, Lele P, Nagraj N. Severe ovarian hyperstimulation syndrome: Can we eliminate it through a multipronged approach? MJAFI 2018;74(1):44-50.

Dey AK, Dubey A, Mittal K, Kale S. Spontaneous ovarian hyperstimulation syndrome – understanding the dilemma, Gynecol. Endocrinol. 2015;20(2015):1-3.

Lee TH, Liu CH, Huang CC, Wu YL, Shih YT, Ho HN, et al. Serum antimullerian hormone level and estradiol levels as predictors of ovarian hyperstimulation syndrome in assisted reproductive technology cycles. Hum reprod. 2008;23:160-7.

Jayaprakasan K, Herbert M, Moody E, Stewart JA, Murdoch AP. Estimating the risks of ovarian hyperstimulation syndrome (OHSS): implications for egg donation for research. Hum Fertil (Camb). 2007;10(3):183-7.

De Leener A, Montanelli L, Van Durme J, Chae H, Smits G, Vassart G, et al. Presence and absence of follicle-stimulating hormone receptor mutations provide some insights into spontaneous ovarian hyperstimulation syndrome physiopathology. J Clin Endocrinol Metab. 2006;91(2):555-62.

Toftager M, Bogstad, Bryndorf T, Løssl K, Roskær J, Holland T, et al. Risk of severe ovarian hyperstimulation syndrome in GnRH antagonist versus GnRH agonist protocol: RCT including 1050 first IVF/ICSI cycles. Hum Reprod. 2016;31(6):1253-64.

Várnagy A1, Bódis J, Mánfai Z, Wilhelm F, Busznyák C, Koppán M. Low-dose aspirin therapy to prevent ovarian hyperstimulation syndrome. Fertil Steril. 2010;93(7):2281-4.

Palomba S1, Falbo A, Carrillo L, Villani MT. MET formin in High Responder Italian Group. Metformin reduces risk of ovarian hyperstimulation syndrome in patients with polycystic ovary syndrome during gonadotropin-stimulated in vitro fertilization cycles: a randomized, controlled trial. Fertil Steril. 2011;96(6):1384-90.

Engmann L, DiLuigi A, Schmidt D, Nulsen J, Maier D, Benadiva C. The use of gonadotropin-releasing hormone (GnRH) agonist to induce oocyte maturation after cotreatment with GnRH antagonist in high-risk patients undergoing in vitro fertilization prevents the risk of ovarian hyperstimulation syndrome: a prospective randomized controlled study. Fertil Steril. 2008;89(1):84-91.

Alvarez C1, Martí-Bonmatí L, Novella-Maestre E, Sanz R, Gómez R, Fernández-Sánchez M et al. Dopamine agonist cabergoline reduces hemoconcentration and ascites in hyperstimulated women undergoing assisted reproduction. J Clin Endocrinol Metab. 2007;92(8):2931-7.

Venetis CA, Kolibianakis EM, Toulis KA, Goulis DG, Papadimas I, Basil C. Tarlatzis BC. Intravenous albumin administration for the prevention of severe ovarian hyperstimulation syndrome: a systematic review and metaanalysis. Fertil Steril. 2011;95(1):188-96.

Naredi N, Karunakaran S. Calcium gluconate infusion is as effective as the vascular endothelial growth factor antagonist cabergoline for the prevention of ovarian hyperstimulation syndrome. JHRS. 2013;6(4):248-52.

Lainas TG, S fontouris IA, Zorzovilis IZ, Petsas GK, Lainas GT, Iliadis GS, et al. Management of severe OHSS using GnRH antagonist and blastocyst cryopreservation in PCOS patients treated with long protocol. Reprod Biomed Online. 2009;18(1):15-20.

Downloads

Published

2022-01-28

Issue

Section

Case Reports