| BackgroundControlled ovarian hyperstimulation(COH) is one of the basic links in assisted reproductive technology. It can induce development and maturation of multiple folliculars and increase pregnancy rate. But it also brings many complications, especially ovarian hyperstimulation syndrome(OHSS), which showed an upward trend in recent years. It can be as high incidence as 0.5-3.3%according to various reports. Although OHSS is a self-limiting disease, generally the prognosis is good if it is timely diagnosed and treated. But it can also cause blood concentration, water, electrolyte disturbance, serous effusion, and organ dysfunction. Some even lead to acute abdomen caused by ovarian torsion, ovarian incarceration, and oothecorrhexis.ObjectiveTo study the occurrence causes, clinical characters, methods for early diagnosis and rational treatment for acute abdomen due to OHSS after COH. Methods15 acute abdomen in 617 cases of OHSS from 1999 to 2009 were retrospectively reviewed. The etiology, occurrence rate, clinical characters, relationship with pregnancy, relationship with the severity of OHSS and treatment were analized.ResultThe total occurrence rate of acute abdomen in 617 OHSS was 2.43%(15/617). The major etiology of acute abdomen is ovarian torsion(12/15), including 3 complete ovarian torsions and 9 incomplete ovarian torsions.The other was ovarian incarceration(1/15),oothecorrhexis(1/15) and retention of urine(1/15). Three patients with complete ovarian torsions were treated by unilateral adnexectomys. Other patients with incomplete ovarian torsions had conservative treatment, except one patient unwent luteinized cyst puncture operation. Syndrom was not relieved after 36 hours conservative treatment in that patient. In the case of ovarian incarcerated, the left ovary increased, displacemented and incarcerated in the left iliac back of knee. The patient underwent bilateral ovarian follicle puncture and left ovary reposition. In the case of spontaneous rupture of luteinized cysts, two ovaries were polycystic and increased, with active bleeding from two broken holes.4500ml bloody ascites were sucked and the corpora luteum ruptures were repaired. The other case of urinary retention was relieved after discharging 800 ml urine by catheterization.8 cases were confirmed pregnancy in 15 cases of acute abdomen. In 12 cases of ovarian torsion,7 cases were pregnant. Except for 1 abortion, all other 7 cases had good pregnancy outcome.ConclusionsOvarian torsion was major etiology of acute abdomen due to OHSS after COH. OHSS companied by pregnancy was high-risk factor of ovarian torsion. B-ultrasomotonography is an effective method for early diagnosis. Timely diagnosis and treatment does not affect the outcome of pregnancy... |
