Ovarian Hyperstimulation Syndrome: A Case Report

A 31-year-old female who having been experienced abdominal swelling for 14 days after In Vitro Fertilization and Embryo Transfer was admitted on Aug 14th, 2003. Since July 18th, controlled ovarian induction was performed and 10000U of HCG was injected on July 26th. 11 eggs were retrievaled on July 28th and three embryes were transfered into the uterus on July 31 st.On Aug 1st, She began to have a bloated feeling gradually, when she lay down she felt uncomfortable but without obvious dyspnea.The amount of urine decreased and inappetence occurred but the symptoms such as bellyache nausea vomitting and diarrhoea didn't occur.Physical examinations were performed, ascites and pleural fluid was detected. It was sonant below the 9th rib at the right side and the 8th rib at the left side. We did not find any positive signs when examinated the heart and lung. When percuss the abdomen, it was sonant except the part around the bellybutton. Vaginal examinations weren't done because the result of pregnancy test was positive result. Her lab examination results were as follows: on Aug 14th, quantitative assay of blood HCG was 935.2mlu/ml, Blood Routine: Hgb110g/1, HCT0.319. Ultrasonogical reports on the same day were as follows: there were much of ascites, 2.2cm deep on left and 1.8cm deep on right, the sizes of both sides of ovaries increased, the right sized 5.5 X 3.3 cm2 and left sized 7.1 X 5.7 cm2. It was diagnosised as severe ovarian hyperstimulation syndrome.The patient was encouraged to drink enough syrup and eat the foods rich of protein.24hours'amount of input and output were recorded and weight and abdominal circumference was examinated every day. Albumin and dextran were infused intravenously to compensate the blood volume. The type and volume of intravenous liquids were adjusted according to the conditions of the patient. The low doses of Lasix was used to increase the amount of urine only when the HCT examination showed the blood is diluted. On Aug 18th, the patient complained that she could not bear the bloated feelings, urgent ultrasound B scanning revealed that the ascites deep 3.5cm in left and 4.3cm in right ,right ovary sized 7.7x5.9 cm2 and left one sized 11.1x6.7 cm2. Abdominal paracentesis was performed with the guidance of ultrasound B and 1500ml ascites were drained off and the patient felt much better.Since then the patient was recovered day after day. The output excess more than input on Aug 24th.Ultrasound scanning revealed tripregnancy in Aug 29th and one embryo was reducted through vaginal. Ascite were absorbed and the size of ovary was normal on Sep 20th. The twin was very well in rountine prenatal care and were delivered.