Katarzyna Stolorz1, Krzysztof Nowosielski1,2*, Izabela Ulman Włodarz1, Patrycja Sodowska3 and Krzysztof Sodowski1,3
1Department of Gynecology and Obstetrics, Specialistic Teaching Hospital in Tychy, Poland
2Department of Sexology and Family Planning, Medical College in Sosnowiec, Poland
3Clinical Department of Gynecology and Obstetrics, Municipial Hospital in Ruda Slaska, Poland
Received: 21 December, 2015;Accepted: 28 January, 2016;Published: 29 January, 2016
Krzysztof Nowosielski, Department of Sexology and Family Planning, Medical College in Sosnowiec, Poland, Tel: +48-502-027-943; E-mail:
Stolorz K, Nowosielski K, Włodarz IU, Sodowska P, Sodowski K (2016) Ovarian Hyperstimulation Syndrome in Spontaneous Pregnancy. J Gynecol Res Obstet 2(1): 005-009.
© 2015 Stolorz K, et al. This is an open-access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
Ovarian hyperstimulation syndrome; Spontaneous pregnancy; Management
OHSS: Ovarian Hyperstimulation Syndorme; VEGF: Vascular Endothelial Growth Factor; hCG: Human Chorion Gonadotropine; CRL: Crown–Rump Length; RBC: Red Blood Cells; HGB: Hemoglobin; HCT: Hematocrit; WBC: White Blood Cells; PLT: Platelets; CA125: Cancer Antigen 125; PCOS: Polycystic Ovary Syndrome; SNPs: Single Nucleotide Polymorphism; FSHR: Follicle-Stimulating Hormone Receptor; TSH: Thyrotropin; LH: Lutropin; IL-2 Interleukin 2; SOCS-1: Suppressor Of Cytokine Signaling-1; PBMCs: Peripheral Blood Mononuclear Cells; HES: Hydroxyethyl Starch; mTOR: Mammalian Target Of Rapamycin; MI: Myo-Inositol; COX-2 Cyclooxygenase-2; Cb2: Cabergoline;
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.
Conclusion: Although the ovarian hyperstimulation syndrome is characteristic for patients undergoing ovarian stimulation or assisted reproductive technologies it may also occur in spontaneous pregnancy. Multidisciplinary approach has to be taken in managing of those patients.
Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of supraphysiologic ovarian stimulation but infrequently has been described in spontaneous pregnancy. OHSS is classified as mild, moderate, severe, and critical [1,2]. The symptoms of OHSS is believed to be a result of action of vasoactive peptides (mostly vascular endothelial growth factor – VEGF) released from the granulosa cells in hyperstimulated ovaries. The clinical manifestations of OHSS are: ovarian enlargement, ascites, oliguria, abdominal pain, electrolyte imbalance, hemoconcentration, and even thrombosis in severe cases. The syndrome are nearly always associated with exogenous gonadotropin stimulation (after a luteinizing hormone surge) or exposure to human chorion gonadotropine (hCG) analogues. It is also observed after clomiphene citrate treatment or protocols in in vitro fertilization procedures. Additionally, it was described as spontaneous syndrome in a virgin girl, in multiple pregnancy, polycystic ovary syndrome, gonadotropic pituitary adenoma, fetal trisomy and in few patients with gestational trophoblastic disease [3-12]. Spontaneous OHSS is generally reported to develop between 8 and 14 weeks of gestation, differing from iatrogenic OHSS usually starting between 3 and 5 weeks. We describe a case of a 32-year-old patient in her first physiological pregnancy with non-iatrogenic causes of ovarian hyperstimulation syndrome.
A 32-year-old gravida 1, para 1 with spontaneous conception, was admitted to the Department of Gynecology and Obstetrics, Specialistic Teaching Hospital in Tychy at 11+0 gestation weeks. The patient complained of low abdominal pain and dyspnea. The medical and gynecological history of the patient was irrelevant - regular menstrual cycles and no past medical treatment or illness. The patient conceived spontaneously and denied having taken any ovulation inducing agent. Upon admission the patient appeared unwell but her vital signs were stable: a pulse rate of 90/min, temperature of 36.5˚C, and blood pressure of 110/70 mmHg. Abdominal examination revealed local tenderness in the area of adnexa with no rebound tenderness. No clinical evidence of ascites and no symptoms of peritonitis were discovered. Transvaginal ultrasound scans were performed showing a single live intrauterine gestation with a fetal crown–rump length (CRL) of 41 mm, which corresponded to 11+0 weeks of gestation, no chorion abnormalities, bilaterally enlarged multicystic ovaries with right ovary measuring 75 x 53mm, left ovary 60 x 42mm (Figure 1) and trace amounts of liquid.
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