Dr B Shivraj Dr Chandru Dr Natarajan Dr Venkat ramanan Case scenario 21 year female married 3 years with primary infertility was planned for ART by ICSI She underwent ovarian stimulation by ID: 933792
Download Presentation The PPT/PDF document "Oocyte retrieval causing massive exsangu..." is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Oocyte retrieval causing massive exsanguinating hematuria – a case report-Dr. B. Shivraj , Dr. Chandru, Dr. Natarajan, Dr. Venkat ramanan
Case scenario :21 year female , married 3 years, with primary infertility , was planned for ART by ICSI. She underwent ovarian stimulation by hCG injection. Oocyte retrieval was successful and uneventful.
Conclusion : Mild OHSS –Gr 1 - Abdominal distention and discomfortGr 2 - Grade 1 disease + nausea, vomiting or diarrhea, as well as ovarian enlargement of 5-12 cmModerate OHSS - Gr 3 – f/o mild OHSS + USG evidence of ascitesSevere OHSS Gr 4 – f/s/o moderate OHSS + e/o ascites +/- hydrothorax /dyspnoeaGr 5 - All of the above + change in the blood volume –hemoconcentration - coagulation abnormalities, and diminished renal perfusion and function
Discussion :Patient was discharged uneventfully . Day 4 – patient presented to ER with frank , gross hematuria and abdominal pain.Wash given and evaluated. Fall in hb 4g% noted. CT Urogram normal KUB with inflammed ovaries and pelvic congestion. Reccurrent clot retention Cystoscopy and bladder.
Introduction : OHSS is a rare entity and presents with multivariate presentations. Occuring during routine ART for infertility.
ENLARGED OVARIES
Pathophysiology
- vascular
hyperpermeability
& resulting shift of fluids into the 3rd space.Pelvic congestionSusceptible to infectionHematuria
Take home points :
Iatrogenic
Self resolving
Delayed presentation
Supportive management