Spontaneous ovarian hyperstimulation syndrome following evacuation of a partial mole: a case report
DOI:
https://doi.org/10.18203/2320-1770.ijrcog20260201Keywords:
Ovarian hyperstimulation syndrome, Human chorionic gonadotropinAbstract
Ovarian hyperstimulation syndrome (OHSS) is usually an iatrogenic complication of ovarian stimulation, while spontaneous OHSS is rare and linked to conditions with high human chorionic gonadotropin (hCG), such as molar pregnancy. Herein, this case reports an 18-year-old woman who developed spontaneous OHSS two months after suction evacuation of a partial mole, presenting with abdominal pain, vomiting, and distension. Her β-hCG had fallen from 59,027 to 1,463 mIU/ml. Ultrasonography showed bilaterally enlarged multicystic ovaries (~8–9 cm), ascites, and an empty uterus; laboratory parameters were normal. Pregnancy, ovarian torsion, and persistent mole were excluded, confirming spontaneous OHSS. She was treated conservatively with cabergoline 0.5 mg daily for 10 days, with resolution of symptoms in 4–5 days, and discharged on combined oral contraceptives. β-hCG remained normal over 2 years of follow-up. This case underscores the rarity of spontaneous OHSS post-molar evacuation and the importance of early recognition and conservative management for favorable outcomes.
Metrics
References
Golan A, Ron-El R, Herman A, Soffer Y, Weinraub Z, Caspi E. Ovarian hyperstimulation syndrome: an update review. Obstet Gynecol Surv. 1989;44:430-40. DOI: https://doi.org/10.1097/00006254-198906000-00004
Navot D, Bergh PA, Laufer N. Ovarian hyperstimulation syndrome in novel reproductive technologies: prevention and treatment. Fertil Steril. 1992;58:249-61. DOI: https://doi.org/10.1016/S0015-0282(16)55188-7
De Leener A, Montanelli L, Van Durme J, Delbaere A, Smits G, et al. Presence and absence of follicle-stimulating hormone receptor mutations provide insights into the pathophysiology of spontaneous ovarian hyperstimulation syndrome. Hum Reprod Update. 2011;17(3):387-99.
Delbaere A, Smits G, De Leener A, Costagliola S, Vassart G. Understanding ovarian hyperstimulation syndrome. Endocrine. 2005;26(3):285-90. DOI: https://doi.org/10.1385/ENDO:26:3:285
McClure N, Healy DL, Rogers PA, Sullivan J, Beaton L, Haning RV Jr, et al. Vascular endothelial growth factor as capillary permeability agent in ovarian hyperstimulation syndrome. Lancet. 1994;344(8917):235-6. DOI: https://doi.org/10.1016/S0140-6736(94)93001-5
Abramov Y, Barak V, Nisman B, Schenker JG. Vascular endothelial growth factor plasma levels correlate to the clinical picture in severe ovarian hyperstimulation syndrome. Fertil Steril. 1997;67:261-5. DOI: https://doi.org/10.1016/S0015-0282(97)81908-5
Rachad M, Chaara H, Zahra Fdili F, Bouguern H, Melhouf A. Ovarian hyperstimulation syndrome in a spontaneous pregnancy with invasive mole: report of a case. Pan Afr Med J. 2011;9:23. DOI: https://doi.org/10.4314/pamj.v9i1.71198
Razavi M, Hasanzadeh M. Ovarian hyperstimulation syndrome in two spontaneous pregnancies. Int J Med. 2014;2(2):45-8. DOI: https://doi.org/10.5812/rijm.14245
Sridev S, Rao KA. Spontaneous ovarian hyperstimulation syndrome associated with hypothyroidism: a rare entity. J Reprod Sci. 2013;20(2):89-92.
Chen CD, Wu MY, Chao KH, Ho HN, Yang YS. Update on prevention and management of ovarian hyperstimulation syndrome. Taiwan J Obstet Gynecol. 2011;50(1):2-10. DOI: https://doi.org/10.1016/j.tjog.2011.01.014
Alvarez C, 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. DOI: https://doi.org/10.1210/jc.2007-0409
Youssef MA, van Wely M, Hassan MA, Al-Inany HG, Mochtar M, Khattab S, et al. Can dopamine agonists reduce the incidence and severity of OHSS in IVF/ICSI treatment cycles? A systematic review and meta-analysis. Hum Reprod Update. 2010;16(5):459-66. DOI: https://doi.org/10.1093/humupd/dmq006
Tang H, Hunter T, Hu Y, Zhai SD, Sheng X, Hart RJ. Cabergoline for preventing ovarian hyperstimulation syndrome. Cochrane Database Syst Rev. 2012;(2):CD008605. DOI: https://doi.org/10.1002/14651858.CD008605.pub2
Davies MJ, Fletcher TL, Cox Bauer CM. Spontaneous Ovarian Hyperstimulation Syndrome in a Partial Molar Pregnancy With Early Onset Severe Pre-eclampsia at 15 Weeks Gestation. Mil Med. 2020;185(9-10):e1836-9. DOI: https://doi.org/10.1093/milmed/usaa008