HEMOPERITONEUM FROM HYPERSTIMULATED OVARY IN EARLY PREGNANCY: A DIAGNOSTIC DILEMMA AND REVIEW OF LITERATURE

Dr. Neetu Sangwan, Dr. Smiti Nanda, Dr. Daya Sirohiwal, Dr. Meenakshi Chauhan, Dr. Vani Malhotra

Abstract


Abstract

Background:Ovarian hyperstimulation syndrome (OHSS) is a potentially life threatening complication of assisted reproductive techniques. In OHSS, bilateral ovaries are enlarged, multicystic and distended cysts may rupture leading to hemoperitoneum.

Case:A 25-years-old, gravida 2 para 1 presented with 5 weeks amenorrhoea, pain abdomen and slight bleeding per vaginum. On examination, there was marked pallor, tachycardia, hypotension, abdominal distension with tenderness and fullness in all fornices. Outside ultrasound report showed ruptured ectopic pregnancy. She was taken up for emergency laparotomy. Very surprisingly, laparotomy revealed bilateral enlarged multicystic ovaries, bulky soft uterus, normal fallopian tubes and hemoperitoneum. Besides, right ovary was engorged and fragile with actively bleeding ruptured hemorrhagic cysts. Hemostasis could not be achieved so right salpingo-ophorectomy was done. Left ovary was also multicystic, hemorrhagic with a rent of 2*1cm with no active bleeding and hence left ovary could be saved.

Conclusion:In a female presenting with hemodynamic instability in early pregnancy, careful history should be taken regarding failure of conception and intake of ovulation induction therapy. Hemoperitoneum from hyperstimulated ovaries should be considered as one of the differentials especially in cases with history of infertility and surgery should be performed by experienced person.

Keywords: Hyperstimulated ovaries; Hemoperitoneum; Amenorrhoea; Salpingo-ophorectomy


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