Nowosielski, K., Stolorz, K., Włodarz, I. U., Sodowska, P., & Sodowski, K. (2016). Ovarian Hyperstimulation Syndrome in Spontaneous Pregnancy. Journal of Gynecological Research and Obstetrics. https://doi.org/10.17352/jgro.000007
Nowosielski K, Stolorz K, Włodarz IU, Sodowska P, Sodowski K. Ovarian Hyperstimulation Syndrome in Spontaneous Pregnancy. Journal of Gynecological Research and Obstetrics. 2016. doi:10.17352/jgro.000007
Nowosielski, K., et al. "Ovarian Hyperstimulation Syndrome in Spontaneous Pregnancy." Journal of Gynecological Research and Obstetrics, 2016.
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RRM Academy Synopsis
Ovarian hyperstimulation may occur in a spontaneous pregnancy
A case report describes a 32-year-old woman who conceived spontaneously and developed moderate ovarian hyperstimulation syndrome at 11 weeks. The syndrome may arise in a pregnancy conceived without ovulation-inducing drugs. She was treated in hospital for 3 weeks and delivered a girl vaginally at 39 weeks.
Key Findings
The woman, in her first pregnancy, denied taking any ovulation-inducing agent and was admitted at 11+0 weeks of gestation with low abdominal pain and dyspnea.
Ultrasound showed enlarged ovaries, right 75 x 53mm and left 60 x 42mm. In hospital they grew to 93 x 70mm and 84x61mm with ascites, a picture of moderate OHSS.
Care included bed rest, oral fluids, paracetamol, vaginal progesterone, low molecular weight heparin and intravenous albumin. The patient did not agree to cabergoline.
She went home after 3 weeks of hospitalization with normal ovaries. At 39 weeks she delivered a female infant weighing 3505 g with an Apgar score of 10.
The authors report that she had none of the primary risk factors for OHSS.
Interpretation
The paper is a single case report, a description of one woman's course, with a literature review. The report documents the syndrome in a woman who denied using stimulation drugs. Spontaneous cases are generally reported between 8 and 14 weeks of gestation. Stimulation-related cases usually start between 3 and 5 weeks. The authors cite reports of FSH receptor mutations that make the ovary unusually sensitive to the pregnancy hormone hCG. They note that larger studies are needed to explore gene links. Severe OHSS occurs in 0.2%-1.2% of stimulated cycles, according to the authors.
RRM Context
OHSS is best known as a complication of ovarian stimulation. This case shows the syndrome arising from a woman's own hormones. The molecular reports the authors review point to receptor sensitivity to hCG as a possible cause. Restorative reproductive medicine looks for the cause of a condition in the patient's body.
Our editorial summary of this paper, not the article's abstract.
Abstract
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 hyper stimulation 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.
