Assisted Reproductive Technology

Transvaginal ultrasonographically guided aspiration of oocytes is used universally during in vitro fertilization. Previously, laparoscopic oocyte collection had been used, carrying the occasional complications of laparoscopic surgery, including those related to general anesthesia. Complications related to ultrasound-guided retrieval of oocytes are rare and include ovarian hyperstimulation syndrome, pelvic infections, intraperitoneal bleeding, and adnexal torsions. 1 1 and 15 However, the acute abdomen has developed hours to weeks after the procedure and has required prompt surgical intervention.

Ovarian hyperstimulation syndrome can be a life-threatening complication of induction of ovulation. The incidence in the moderate-to-severe form is 1 to 2 percent. Symptoms include abdominal distention, ovarian enlargement, and weight gain in the mildest form. In the most severe form, patients have massive third-spacing of fluids into the abdominal cavity, which can lead to ascites, electrolyte imbalances, pleural effusions, and hypovolemia. Clinically, one sees increased coagulability and decreased renal perfusion. The decreased renal perfusion leads to increased salt and water reabsorption in the proximal tubule, leading to oliguria. Abdominal and pelvic examinations are contraindicated due to extremely fragile ovaries that are at high risk of rupture or hemorrhage. Patients are also at high risk for ovarian torsion because of the size of their ovaries. Electrolyte studies, renal function tests, a complete blood count, coagulation studies, and blood for type and cross match should be obtained. An electrocardiogram to evaluate potential hyperkalemic changes should also be obtained. The gynecologist should be consulted for admission. Treatment is conservative, and diuretics are contraindicated. Volume repletion may be necessary.

CHAPTER REFERENCES

1. Gold BS, Kitz DS, Lecky JH, Neuhaus JM: Unanticipated admission to the hospital following ambulatory surgery. JAMA 262:3008, 1989.

2. Meeks GR, Waller GA, Meydrech EF, Flautt FH: Unscheduled hospital admission following ambulatory gynecologic surgery. Obstet Gynecol 80:446, 1992.

3. Bateman BG, Kolp LA, Hoeger K: Complications of laparoscopy: Operative and diagnostic. Fertil Steril 66:30, 1996.

4. Hulka J, Peterson HB, Phillips JM, Surrey MW: Operative laparoscopy: American Association of Gynecologic Laparoscopists' 1993 membership survey. J Am Assoc Gynecol Laparosc 2:133, 1995.

5. Saidi MH, Vancaillie TG, White AJ, et al: Complications of major operative laparoscopy: A review of 452 cases. J Reprod Med 41:471, 1996.

6. Chapron CM, Pierre F, Lacroix S, et al: Major vascular injuries during gynecologic laparoscopy. J Am Coll Surg 185:461, 1997.

7. Hulka JF, Peterson JB, Phillips JM, Surrey MW: Operative hysteroscopy: American Association of Gynecologic Laparoscopists 1991 membership survey. J Reprod Med 38:572, 1993.

8. Richards PL, Balch CM, Aldrete JS: Abdominal wound closure. Ann Surg 197:238, 1983.

9. Martyak SN, Curtis LE: Abdominal incision and closure. Am J Surg 131:476, 1976.

10. Poole GB: Mechanical factors in abdominal wound closure: The prevention of fascial dehiscence. Surgery 97:631, 1985.

11. Hakim-Elahi E, Tovell HMM, Burnhhill MS: Complications of first trimester abortion: A report of 170,000 cases. Obstet Gynecol 76:129, 1990.

12. Jacot FRM, Poulin C, Bilodeau AP, et al: A five-year experience with second-trimester induced abortions: No increase in complication rate as compared to the first trimester. Am J Obstet Gynecol 168:633, 1993.

13. Dicker D, Ashkenazi J, Feldberg D, et al: Severe abdominal complications after transvaginal ultrasonographically guided retrieval of oocytes for in-vitro fertilization and embryo transfer. Fertil Steril 59:1313, 1993.

14. Govaerts I, Devreker F, Delbaere A, et al: Short-term medical complications of 1500 oocyte retrievals for in-vitro fertilization and embryo transfer. Eur J Obstet Gynecol Reprod Biol 77:239, 1998.

15. Bergh T, Lundkvist O: Clinical complications during in-vitro fertilization treatment. Hum Reprod 7:625, 1992.

Pregnancy Guide

Pregnancy Guide

A Beginner's Guide to Healthy Pregnancy. If you suspect, or know, that you are pregnant, we ho pe you have already visited your doctor. Presuming that you have confirmed your suspicions and that this is your first child, or that you wish to take better care of yourself d uring pregnancy than you did during your other pregnancies; you have come to the right place.

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