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Res Rep Gynaecol Obstet 2017 | Volume 1 Issue 4
November 02-03, 2017 | Chicago, USA
Embryology and In vitro Fertilization
World Congress on
Abstract:
An uncommon presentation of ovarian hyper
stimulation syndrome is isolated pleural effusion reporting
a case of late onset of ovarian hyper stimulation with
unilateral pleural effusion and respiratory distress as a sole
manifestation after embryo transfer.
Introduction:
OHSS is one of the most grave and iatrogenic
complication of controlled ovarian stimulation, clinical
manifestation varying from mild to severe, it accounts for
33% of stimulated cycle. Pulmonary manifestation accounts
for 7.2% of severe OHSS. But the Isolated finding of pleural
effusion without ascites as the main presenting symptom
of OHSS is not frequently reported and its pathogenesis is
also unknown or remains a mystery. Awareness about the
disease can lead to early pickup of such cases and better
management. The article reports an unusual case of isolated
pleural effusion after controlled ovarian stimulation after IVF
and review of literature.
Case History:
A 28 years old female married for eight years,
no issue bilateral block on laparoscopy there was mild
endometriosis no spill. So was taken for IVF. Patient had no
past history of COPD, asthma, TB, no family history of chronic
illness. Pt was down regulated with oral pills and lupride, D2
FSH-3.77, LH-2.93, E2-29.9. She was stimulated with 150
IU of recombinant for five days and then HMG 150 IU for
another five days. At the time of HCG injection E2- 4440, and
8oocyte were retrieved. Pt was comfortable and discharged.
D3 transfer was done three grades A embryo was transferred,
pt discharged home comfortably. Seven days post ET patient
had complain of right side chest tightness, shortness of
breath, especially while lying on right side (orthopnea) dry
cough. On examination her abdomen was soft no evidence
of ascitis, pulse rate was 102/min, blood pressure 100/70
mm of Hg, O2 saturation was 92%, and diminished air
entry on right side. Her WBC count was 15,000cells/Ul,
her renal function test and liver function test was normal.
Chest x-ray showed moderate to severe pleural effusion
right side. Ultrasound showed no evidence of ascitis, slightly
enlarged ovary. Patient was managed conservatively with a
multidisciplinary approach and intensive care monitoring.
She was placed in propped-up position along with antibiotic
, antacid, nebulisation and chest physiotherapy looking over
the amount of fluid and patient distress pleural tapping was
done and 600 ml of straw colour fluid was aspirated, send
for cytology and culture which was sterile and was exudates.
Due to distress retapping was done after two days , patient
recovered in another two days, unfortunately her beta HCG
did not came to be positive, but she was discharged is good
condition.
Discussion:
OHSS usually result from stimulation of ovaries
by Gonadotropin with the initial onset following the
administration of exogenous HCG. In my case patient was
young with low BMI presented six days after transfer (late
onset) and was managed conservatively.
Conclusion:
It demonstrates that pleural effusion may
be the only manifestation of OHSS and implies a careful
management of patients with pulmonary complaints after
treatment with exogenous gonadotropin, so the awareness
about this isolated extra-ovarian problem is very important
for early and better management.
e:
sangeetasinha1988@yahoo.co.inIsolated unilateral symptomatic pleural effusion-an atypical presentation of ovarian hyper stimulation
syndrome-a case report
Sangeeta Sinha
and
Rajesh Sinha
Srijjan Bhilai Center, India