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.
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