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Bedoschi G, Ingold C, Navarro PA. Fertility Preservation and Ovarian Hyperstimulation Syndrome Management in Cancer Care: A Pathophysiological Perspective on Gonadotropin-Releasing Hormone Agonists and Antagonists. PATHOPHYSIOLOGY 2024; 31:288-297. [PMID: 38921726 PMCID: PMC11206524 DOI: 10.3390/pathophysiology31020021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2023] [Revised: 03/02/2024] [Accepted: 06/04/2024] [Indexed: 06/27/2024] Open
Abstract
This narrative review delves into the evolving landscape of fertility preservation techniques, with a particular focus on their use in patients undergoing oncology treatment that carries a risk of ovarian insufficiency. Advances in established methods such as cryopreservation of oocytes and embryos are highlighted, and the increasing use of gonadotropin-releasing hormone (GnRH) agonists is discussed. The review also addresses the complexities and controversies associated with these approaches, such as the 'flare-up' effect associated with GnRH agonists and the potential of GnRH antagonists to reduce the risk of ovarian hyperstimulation syndrome. Despite advances in fertility preservation, the report highlights the challenges we face, including the need for personalized treatment protocols and the management of associated risks. It calls for continued research and collaboration between healthcare professionals to refine these techniques and ultimately improve reproductive outcomes for patients facing the prospect of fertility-impairing treatment.
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Affiliation(s)
- Giuliano Bedoschi
- Department of Gynecology and Obstetrics, Reproductive Medicine Division, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14048-900, Brazil;
| | - Caroline Ingold
- Department of Collective Health, Sexual, Reproductive Health and Population Genetics, Faculdade de Medicina do ABC, Santo André 09060-870, Brazil;
| | - Paula Andrea Navarro
- Department of Gynecology and Obstetrics, Reproductive Medicine Division, Ribeirão Preto Medical School, University of São Paulo, Ribeirão Preto 14048-900, Brazil;
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2
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Tabbara F, Hariri M, Hitti E. Ovarian torsion: A retrospective case series at a tertiary care center emergency department. PLoS One 2024; 19:e0297690. [PMID: 38446824 PMCID: PMC10917280 DOI: 10.1371/journal.pone.0297690] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2023] [Accepted: 01/08/2024] [Indexed: 03/08/2024] Open
Abstract
Ovarian torsion (OT) is a gynecological emergency that can have diverse clinical presentations makings its diagnosis especially challenging. Few studies exist in the literature describing the clinical presentation as well as the management of OT in the emergency department (ED). This study aims to describe the clinical presentation, physical examination, emergency management, radiographic and intraoperative findings, histopathology reports and the time-to-intervention metrics of OT cases presenting to the emergency room of our tertiary care center. Data was collected by a retrospective chart review of all OT cases that presented to our ED over a period of 1 year. A total of 20 cases were included in the final analysis. The incidence of OT in the ED was 157.4 per 100 000 visits of women in the reproductive age group. All patients were women of reproductive age, with a mean age of 27.3 years. A total of 15 patients (78.9%) presented within 24 hours of symptom onset. The most common presenting symptom was abdominal pain (95%, 19/20) with most localizing to the right lower quadrant (60%, 12/20), followed by nausea and vomiting (90%, 18/20). Almost all patients (95%, 19/20) required opioids for pain management. The majority (80%, 16/20) were diagnosed by ultrasound prior to surgery, whereas (20%, 4/20) went straight to surgery based on a high index of clinical suspicion. Among those who underwent ultrasound, ovarian cyst was present in (75%, 12/16) while (68.9%, 11/16) showed ovarian enlargement and (50%, 8/16) showed abnormal ovarian blood flow. All patients except one patient underwent operative management. Out of the 19 patients who underwent surgery, the majority of patients (94.7%, 18/19) had viable ovaries with the exception of 1 patient (5.3%) who required a salpingo-oophorectomy post ovarian detorsion. A total of 13 cases included histopathologic review of specimens out of which 6 (46.2%) had a mature cystic teratoma. The mean time from door to ultrasonography was 1.4 hours and from door to surgery was 11.4 hours. Our study provides valuable insights into the incidence, clinical presentation, physical examination, emergency management, ultrasonographic and intraoperative findings, histopathology reports as well as the time-to-intervention metrics of OT patients presenting to the ED.
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Affiliation(s)
- Faysal Tabbara
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
| | - Moustafa Hariri
- QU Health, Vice President for Medical and Health Sciences, Qatar University, Doha, Qatar
| | - Eveline Hitti
- Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon
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Didar H, Najafiarab H, Keyvanfar A, Hajikhani B, Ghotbi E, Kazemi SN. Adnexal torsion in pregnancy: A systematic review of case reports and case series. Am J Emerg Med 2023; 65:43-52. [PMID: 36584539 DOI: 10.1016/j.ajem.2022.12.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 12/16/2022] [Accepted: 12/18/2022] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVES This study aimed to investigate clinical presentations, surgical procedures and findings, complications, and predisposing factors of adnexal torsion in pregnant women. METHODS We searched PubMed/Medline, Embase, and Web of Science from January 2000 to March 2022. All case reports and case series with full-text English language reporting adnexal torsion in pregnant women were included. Medical history, clinical presentations, surgical procedures and findings, complications related to adnexal torsion, and predisposing factors were independently extracted by two investigators. RESULTS A total of 182 articles reporting 662 pregnant women with adnexal torsion were included. Most of the adnexal torsions occurred during the first trimester (54.63%), while others occurred during the second (26.36%) and third (19.00%) trimesters. The most common symptom of adnexal torsion was sudden-onset pain (80.60%). Enlargement of the adnexa was the most prevalent ultrasound finding in a twisted adnexa (95.20%). Additionally, about half of the patients had decreased blood flow in Doppler ultrasound (53.80%). Laparoscopic surgery was the favorite option (56.88%), while cystectomy and detorsion were the most commonly performed procedure (29.06%). Expectant management was reported in only 2.99% of the patients. In addition, the most common complications were preterm labor (27.58%) and emergent cesarean sections (25.28%). CONCLUSIONS Clinicians should think of adnexal torsion when pregnant women complain of sudden-onset pain. Then, using ultrasound, adnexal enlargement or masses should be explored seriously. They should take invasive and urgent therapy to preserve ovaries and prevent complications.
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Affiliation(s)
- Hamidreza Didar
- Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Hanieh Najafiarab
- Preventative Gynecology Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Amirreza Keyvanfar
- Infectious Diseases and Tropical Medicine Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Bahareh Hajikhani
- Department of Microbiology, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Elena Ghotbi
- Department of Obstetrics and Gynecology, School of Medicine, Imam Hossein Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Seyyedeh Neda Kazemi
- Clinical Research Development Center, Imam Hossein Educational Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran; Department of Obstetrics and Gynecology and Female Infertility Unit, Tehran University of Medical Sciences, Tehran, Iran.
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Oliveira e Souza L, Innecco Arêas JV, Rezende Campos MC, Innecco Arêas I, Martins Resende BA. Spontaneous ovarian hyperstimulation syndrome in a pregnant woman with hypothyroidism: a case report. F S Rep 2021; 2:433-439. [PMID: 34934984 PMCID: PMC8655400 DOI: 10.1016/j.xfre.2021.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 07/17/2021] [Accepted: 07/19/2021] [Indexed: 01/19/2023] Open
Abstract
Objective To study a rare case of spontaneous ovarian hyperstimulation syndrome in a naturally conceived pregnancy associated with overt hypothyroidism. Design Case report. Setting Endocrinology private practice. Patient(s) A 32-year-old woman who was 13 weeks pregnant with bilaterally enlarged ovaries presumed to be secondary to hypothyroidism. Intervention(s) Administration of levothyroxine and titration of the dose. Main Outcome Measure(s) Regression of signs and symptoms of spontaneous ovarian hyperstimulation syndrome after 12 weeks of therapy. Result(s) The patient was diagnosed with severe hypothyroidism, as confirmed by her elevated thyroid-stimulating hormone level. Ultrasound evaluation revealed ovarian enlargement secondary to multiple contiguous cysts with anechoic content. The patient was administered levothyroxine 175 μg/day. Results of hormonal studies demonstrated thyroid function normality at week 12 after treatment. Incomplete regression of ovarian cysts was also noticed within this period. At week 37, the patient developed preeclampsia, and cesarean delivery was recommended. An 8-month postpartum ultrasound evaluation revealed complete regression of the cysts. Conclusion(s) Spontaneous ovarian hyperstimulation syndrome secondary to hypothyroidism may be the cause of ovarian enlargement, and levothyroxine replacement seems an appropriate primary therapeutic option. Proper endocrinological assessment of patients is recommended as it may avoid unfavorable outcomes.
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Affiliation(s)
- Lucas Oliveira e Souza
- Department of Medicine, Minas Gerais Faculty of Medical Sciences, Belo Horizonte, Brazil
- Reprint requests: Lucas Oliveira e Souza, M.S., Al. Ezequiel Dias, 275 Centro, Belo Horizonte, Brazil.
| | | | | | - Isabela Innecco Arêas
- Department of Medicine, Minas Gerais Faculty of Medical Sciences, Belo Horizonte, Brazil
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Bernigaud O, Fraison E, Thiberville G, Lamblin G. Ovarian torsion in a twin pregnancy at 32 weeks and 6 days: A case-report. J Gynecol Obstet Hum Reprod 2021; 50:102117. [PMID: 33737247 DOI: 10.1016/j.jogoh.2021.102117] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/07/2021] [Accepted: 03/14/2021] [Indexed: 10/21/2022]
Abstract
BACKGROUND Ovarian torsion during pregnancy is a rare event and occurs mostly during the first trimester. This is the first case describing the diagnosis and management of an ovarian torsion at 33 weeks in a twin pregnancy with a normal term delivery. CASE SUMMARY The patient presented with irregular uterine contraction due to an acute abdominal pain in the right iliac fossa. A cyst was discovered during the ultrasound scan on the right ovary and a torsion was highly suspected. A small laparotomy facing the ovarian mass after an ultrasound guidance was chosen. The patient finally delivered at 37 weeks. CONCLUSION The clinic holds a preponderant place in the diagnosis of ovarian torsion. Our surgical approach by laparotomy under ultrasound guidance was less risky than by laparoscopy.
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Affiliation(s)
- Oriane Bernigaud
- Department of Obstetrics and Gynecology, CHU Lyon, Hôpital Femme Mère Enfant, 59 Bd Pinel, 69500, Bron, France
| | - Eloise Fraison
- Department of Obstetrics and Gynecology, CHU Lyon, Hôpital Femme Mère Enfant, 59 Bd Pinel, 69500, Bron, France; Department of Reproductive Medicine, CHU Lyon, Hôpital Femme Mère Enfant, 59 Bd Pinel, 69500, Bron, France.
| | - Gabriel Thiberville
- Department of Obstetrics and Gynecology, CHU Lyon, Hôpital Femme Mère Enfant, 59 Bd Pinel, 69500, Bron, France
| | - Gery Lamblin
- Department of Obstetrics and Gynecology, CHU Lyon, Hôpital Femme Mère Enfant, 59 Bd Pinel, 69500, Bron, France
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Abstract
A 32-year-old woman underwent a medical termination in the second trimester of a spontaneously conceived triploid pregnancy after developing early-onset preeclampsia with subsequent haemolysis, elevated liver enzymes, and low platelet count (HELLP) syndrome. Placental histology was normal (non-molar) and unusually, she developed ovarian hyperstimulation syndrome (OHSS) 4 weeks later. She was managed conservatively following multidisciplinary team input to exclude malignant pathology. The rarity of late-onset spontaneous OHSS could have resulted in inappropriate surgical management. In the absence of supportive treatment there is also a risk of the condition progressing to a critical stage. Follow-up ultrasonography after termination of pregnancy should be considered for women with evidence of ovarian hyperstimulation, particularly if other risk factors for OHSS are present. Delayed-onset OHSS should be considered in women presenting with bilateral cystic ovarian enlargement after triploid pregnancy.
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Affiliation(s)
- Sarah Wali
- Department of Obstetrics and Gynaecology, Imperial College Healthcare NHS Trust, London, UK
| | - Marianne Wild
- Department of Obstetrics & Gynaecology, Homerton University Hospital NHS Foundation Trust, London, UK
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7
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Patel S, Nath P. Spontaneous Ovarian Hyperstimulation Syndrome: Looking Beyond the Ovary. FERTILITY & REPRODUCTION 2020. [DOI: 10.1142/s2661318220500127] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022] Open
Abstract
We report a case of a 22-year-old single female with spontaneous ovarian hyperstimulation syndrome (s-OHSS) referred for transvaginal aspiration of follicles. Investigations revealed primary hypothyroidism, mild hyperprolactinaemia and unelevated levels of both follicle stimulating hormone (FSH) and estradiol. Supplementation with L-thyroxine lead to euthyroid status and gradual resolution of signs and symptoms of ovarian hyperstimulation syndrome (OHSS) over 4 months.
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8
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Yang L, Wang R, Wang F, Wang F, Zou L. Ovarian hyperstimulation syndrome in a frozen-thawed embryo transfer pregnancy: a rare case report. BMC Pregnancy Childbirth 2020; 20:313. [PMID: 32434545 PMCID: PMC7238628 DOI: 10.1186/s12884-020-03014-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2019] [Accepted: 05/13/2020] [Indexed: 11/24/2022] Open
Abstract
Background Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication of ovarian stimulation. Prevention and early recognition of OHSS are important to ensure patient safety. Case presentation In this case, we reported a patient who underwent controlled ovarian hyperstimulation (COH) and in vitro fertilization (IVF). All embryos were cryopreserved to reduce possible OHSS. However, OHSS still occurred after the patient had a frozen-thawed embryo transfer (FET) with hormone replacement therapy (HRT) and obtained a dichorionic diamniotic triplet pregnancy. After multifetal pregnancy reduction (MFPR) and supportive treatment, all the symptoms regressed. Conclusions Prompt recognition of OHSS, especially in patients who have no history of ovulation induction and fresh embryo transfer, is very important. Multiple pregnancies may lead to severe OHSS because of the high level of human chorionic gonadotropin (hCG) in the early stages. We suggest that a single embryo transfer may be necessary and beneficial for patients.
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Affiliation(s)
- Lihua Yang
- Department of Reproductive Medicine, Jinhua People's Hospital, Jinhua, 321000, Zhejiang, China.
| | - Rong Wang
- Department of Reproductive Medicine, Jinhua People's Hospital, Jinhua, 321000, Zhejiang, China
| | - Fang Wang
- Department of Reproductive Medicine, Jinhua People's Hospital, Jinhua, 321000, Zhejiang, China
| | - Feifeng Wang
- Department of Reproductive Medicine, Jinhua People's Hospital, Jinhua, 321000, Zhejiang, China.
| | - Libo Zou
- Department of Reproductive Medicine, Jinhua People's Hospital, Jinhua, 321000, Zhejiang, China
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9
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Abstract
The aim of this study was to analyze clinical manifestations of 565 ovarian hyperstimulation syndrome (OHSS) inpatients in the largest Obstetrics and Gynecology hospital in China from year 2010 to 2017, to get more understanding of epidemiologic features of this disease, and to provide some insight on the diagnosis, treatment, and preventions of OHSS. It is a clinical retrospective study. In the 565 cases that developed OHSS over an eight-year period between 2010 and 2017 were reviewed, we assessed patients' general characteristics, clinical manifestations, treatment, prognosis, and the relationship between different indicators and the severity of OHSS. Totally 12 kinds of ovulation induction protocols (Protocol 1: CC; Protocol 2: Gn; Protocol 3: hCG; Protocol 4: GnRh-a; Protocol 5: CC & Gn; Protocol 6: CC & hCG; Protocol 7: Gn & hCG; Protocol 8: GnRh-a & Gn; Protocol 9: CC & Gn & hCG; Protocol 10: GnRh-a & CC & Gn; Protocol 11: Letrozole & Gn & hCG; Protocol 12:GnRh-a & Letrozole & Gn) were analyzed and the Odds Ratio (OR) of each protocol were calculated. Five hundred and sixty-five patients were reviewed in our study. In all these patients, the number of hospitalizations, mean age, primary infertility rate, and pregnancy rate did not differ through the last 8 years. From which we may infer that the incidence rate of OHSS may not change over the last 8 years. Older patients tend to develop into more severe stage easily. The pregnancy rate was much lower in mild stage patients, but no difference was found between patients in moderate, severe and critical stage. Oocytes retrieval is strongly associated with severity. PCOS history, irregular menstrual cycle and infertility type do not seem to affect the severity of OHSS. Twelve kinds of ovulation induction protocols were analyzed, OR of different protocols were calculated, what is noteworthy is that patients who used GnRh easily developed more severe OHSS than the patients who received oocytes retrieval. We suggest that we may choose ovulation induction protocols according to the OR table while treating women with high-risk factors.
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Affiliation(s)
- Dan-Feng Du
- Department of Gynecology, OB/GYN Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
| | - Meng-Fei Li
- Department of Gynecology, OB/GYN Hospital, Fudan University, Shanghai, China
| | - Xue-Lian Li
- Department of Gynecology, OB/GYN Hospital, Fudan University, Shanghai, China
- Shanghai Key Laboratory of Female Reproductive Endocrine-Related Diseases, Shanghai, China
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10
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Gui J, Zhang J, Xu WM, Ming L. Spontaneous ovarian hyperstimulation syndrome: Report of two cases. World J Clin Cases 2019; 7:4384-4390. [PMID: 31911922 PMCID: PMC6940325 DOI: 10.12998/wjcc.v7.i24.4384] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2019] [Revised: 11/01/2019] [Accepted: 11/23/2019] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Spontaneous ovarian hyperstimulation syndrome (sOHSS) is extremely rare. It can be divided into four types according to its clinical manifestations and follicle stimulating hormone receptor mutations.
CASE SUMMARY Here we report two cases of sOHSS in Chinese women, one with a singleton gestation developing sOHSS in the first trimester who conceived naturally and the other with a twin pregnancy developing sOHSS in the second trimester after a thawed embryo transfer cycle. Both patients were admitted to the hospital with abdominal distension, ascites, and enlarged ovaries. Conservative treatment was the primary option of management. The first patient had spontaneous onset labor at 40 wk of gestation and underwent an uncomplicated vaginal delivery of a male newborn. The second patient delivered a female baby and a male baby by caesarean section at 35 wk and 1 d of gestation.
CONCLUSION Patients with a history of ovarian hyperstimulation syndrome should be closely monitored. Single embryo transfer might reduce the risk of this rare syndrome.
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Affiliation(s)
- Juan Gui
- Reproductive Center, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province China
- Assisted Reproduction and Embryogenesis Clinical Research Center of Hubei Province, Wuhan 430060, Hubei Province, China
| | - Jie Zhang
- Reproductive Center, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province China
| | - Wang-Ming Xu
- Reproductive Center, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province China
- Assisted Reproduction and Embryogenesis Clinical Research Center of Hubei Province, Wuhan 430060, Hubei Province, China
| | - Lei Ming
- Reproductive Center, Renmin Hospital of Wuhan University, Wuhan 430060, Hubei Province China
- Assisted Reproduction and Embryogenesis Clinical Research Center of Hubei Province, Wuhan 430060, Hubei Province, China
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Halimeh R, Tomassian S, El Hage M, Metri N, Bersaoui M, Daou R, Anastasiadis E. Laparoscopic Adnexal Detorsion in a 20-Week Pregnant Patient: A Case Report and Literature Review. Case Rep Obstet Gynecol 2019; 2019:1093626. [PMID: 31815026 PMCID: PMC6877964 DOI: 10.1155/2019/1093626] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2019] [Revised: 08/28/2019] [Accepted: 09/21/2019] [Indexed: 11/17/2022] Open
Abstract
Adnexal torsion is a cause of severe pelvic pain in reproductive aged women and during pregnancy. Adnexal torsion occurs when there is a complete turn of the ovary, tube, or both resulting in impaired blood flow to the ovary. The diagnosis of adnexal torsion is sometimes challenging due to the enlarged effect of the uterus, the displacement of abdominal and pelvic structures and the nonspecific symptoms in pregnancy. Therefore, prompt diagnosis is essential for better maternal and neonatal outcomes. The gold standard for confirmation and treatment of ovarian torsion is surgery. Laparoscopy and Laparotomy are surgical options with defined risks and benefits. Therefore, choosing the best surgical technique and surgical procedure are of utmost importance to decrease the chances of adverse events intra and postoperatively. Little literature exists regarding the laparoscopic approach of an ovarian torsion during the second trimester. Our case is a 20-week pregnant patient who had a 1080 degree rotation of the left adnexa. She required laparoscopy for adnexal detorsion and had good intraoperative, postoperative, maternal, and neonatal outcomes following management.
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Affiliation(s)
- Rawad Halimeh
- Obstetrics and Gynecology Department, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Serge Tomassian
- Faculty of Medicine and Medical Sciences, University of Balamand, El-Koura, Lebanon
| | - Maria El Hage
- Faculty of Medicine and Medical Sciences, University of Balamand, El-Koura, Lebanon
| | - Nicole Metri
- Faculty of Medicine and Medical Sciences, University of Balamand, El-Koura, Lebanon
| | - Marianne Bersaoui
- Obstetrics and Gynecology Department, Saint George Hospital University Medical Center, Beirut, Lebanon
| | - Rafi Daou
- Faculty of Medicine, University of London, St. Georges, Nicosia, Cyprus
| | - Elie Anastasiadis
- Obstetrics and Gynecology Department, Saint George Hospital University Medical Center, Beirut, Lebanon
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Morotti E, Battaglia C. Oligosypthomatic ovarian hyperstimulation syndrome in a spontaneous uneventful pregnancy. A case report. Gynecol Endocrinol 2019; 35:657-660. [PMID: 30806108 DOI: 10.1080/09513590.2019.1579791] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
Spontaneous hyperstimulation syndrome (spOHSS) is a rare event in pregnancies following natural conception. Only a few cases are reported in the scientific literature and result associated with massive ovarian enlargement with multiple cysts, dehydration, and fluid accumulation in the "third space". We report a novel case of spOHSS in a naturally conceived singleton pregnancy. The spOHSS was characterized by massive ovarian enlargement with multiple cysts. No dehydration and no signs of ascites were observed. The pregnancy uneventful evolved up to term.
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Affiliation(s)
- Elena Morotti
- a Department of Obstetrics and Gynecology , Alma Mater Studiorum-University of Bologna , Bologna , Italy
| | - Cesare Battaglia
- a Department of Obstetrics and Gynecology , Alma Mater Studiorum-University of Bologna , Bologna , Italy
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13
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Ovarian hyperstimulation syndrome: A review for emergency clinicians. Am J Emerg Med 2019; 37:1577-1584. [PMID: 31097257 DOI: 10.1016/j.ajem.2019.05.018] [Citation(s) in RCA: 37] [Impact Index Per Article: 7.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 05/07/2019] [Accepted: 05/07/2019] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION A great deal of literature has recently evaluated the prevention and management of ovarian hyperstimulation syndrome (OHSS) in the outpatient setting, but there remains a dearth of research evaluating OHSS in the emergency department (ED) and its management. OBJECTIVE This narrative review evaluates the underlying pathophysiology and clinical manifestations of OHSS and discusses approaches to patient care in the ED based on current literature. DISCUSSION OHSS is an iatrogenic complication caused by an excessive response to controlled ovarian stimulation during assisted reproductive cycles (ART). OHSS complicates up to 30% of ART cycles, and many of these patients seek initial care in the ED. Risk factors for the development of OHSS include age < 35, history of polycystic ovarian syndrome or previous OHSS, and pregnancy. Emergency physicians will be faced with several complications including ascites, abdominal compartment syndrome, renal dysfunction, acute respiratory distress syndrome, thromboembolic disease, and hemodynamic instability. Critical patients should be evaluated in the resuscitation bay, and consultation with the primary obstetrics/gynecology team is needed, which improves patient outcomes. This review provides several guiding principles for management of OHSS and associated complications. CONCLUSIONS OHSS occurs in up to 30% of IVF cycles and carries a high morbidity. Effective care of the OHSS patient begins with early diagnosis while evaluating for other diseases and complications. Understanding these complications and an approach to the management of OHSS is essential to optimizing patient care.
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14
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Graillon T, Castinetti F, Chabert-Orsini V, Morange I, Cuny T, Albarel F, Brue T, Dufour H. Functioning gonadotroph adenoma with severe ovarian hyperstimulation syndrome: A new emergency in pituitary adenoma surgery? Surgical considerations and literature review. ANNALES D'ENDOCRINOLOGIE 2019; 80:122-127. [DOI: 10.1016/j.ando.2018.11.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/19/2018] [Revised: 10/27/2018] [Accepted: 11/10/2018] [Indexed: 10/27/2022]
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Celik S, Soyer-Calıskan C, Hatirnaz S, Celik H, Tosun M, Hatirnaz ES. Lifesaving dose increment of cabergoline in life-threatening spontaneous ovarian hyperstimulation syndrome resistant to all interventions. Gynecol Endocrinol 2019; 35:287-289. [PMID: 30560702 DOI: 10.1080/09513590.2018.1525703] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
OBJECTIVE Spontaneous ovarian hyperstimulation syndrome (SOHSS) is an extremely rare complication that deserves a multidisciplinary approach together with a thorough investigation for the correct diagnosis of the underlying pathology. The aim of this study was to present a case of severe SOHSS resistant to all interventions and to discuss the available interventions to overcome such a rare and serious clinical situation. CASE REPORT We report a case of severe, life-threatening spontaneous OHSS with a normal nine weeks singleton pregnancy in a 25-year-old nulliparous woman, which resulted with pregnancy termination and continuation of disease progression until the dose of cabergoline was increased to 1.5 mg/day. CONCLUSION This case report emphasizes that patients with life-threatening SOHSS resistant to all medical and surgical interventions may benefit from higher doses of cabergoline. Although spontaneous OHSS is extremely rare, it is potentially a life-threatening clinical entity in its severe form and needs time management and detailed examination of the underlying causes.
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Affiliation(s)
- Samettin Celik
- a Maternity Hospital, A Branch of Training and Research Hospital , Samsun , Turkey
| | - Canan Soyer-Calıskan
- a Maternity Hospital, A Branch of Training and Research Hospital , Samsun , Turkey
| | - Safak Hatirnaz
- b IVF Center , Medicana International Hospital , Samsun , Turkey
| | - Handan Celik
- c Department of Obstetrics and Gynecology , Ondokuzmayıs University , Samsun , Turkey
| | - Miğraci Tosun
- c Department of Obstetrics and Gynecology , Ondokuzmayıs University , Samsun , Turkey
| | - Ebru S Hatirnaz
- b IVF Center , Medicana International Hospital , Samsun , Turkey
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Magnetic resonance imaging findings in ovarian torsion post in vitro fertilization. Radiol Case Rep 2018; 13:1154-1158. [PMID: 30233749 PMCID: PMC6138859 DOI: 10.1016/j.radcr.2018.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2018] [Revised: 07/18/2018] [Accepted: 08/03/2018] [Indexed: 11/21/2022] Open
Abstract
Patients who get pregnant after being treated with in vitro fertilization (IVF) are at significantly increased risk of ovarian torsion compared to the general population and also in comparison to patients who get pregnant normally [1,2]. The risk is further increased in patients who develop ovarian hyperstimulation syndrome [1]. This possibility should be considered in this group of patients presenting with acute abdominal pain and immediate management should be commenced. Here, we report 2 patients who received treatment for infertility with IVF and developed ovarian torsion and we discuss their management including the imaging workup. The first case is a 34-year-old woman at 11 + 3 weeks of gestation after IVF who presented with a 12-hour acute right lower abdominal pain with nausea and vomiting. She underwent an ultrasound examination and then further evaluated with magnetic resonance imaging which showed asymmetric enlargement of the right ovary and stromal edema and a diagnosis of ovarian torsion was made. The patient underwent laparoscopic detortion and the ovary was salvaged. The second case is a 33-year-old woman at 9 weeks of gestation after IVF who presented with intermittent abdominal pain, vaginal bleeding, and nausea and vomiting for 5 days but became worse on the fifth day. Ultrasound and subsequently magnetic resonance imaging were performed which confirmed hyperstimulation syndrome. Abnormal location of the left ovary anterior to the uterus with higher volume as well as the clinical progression raised the possibility of ovarian torsion and prompted a diagnostic laparoscopy which showed right ovarian torsion and detortion was performed.
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Mintziori G, Goulis DG. In vitro fertilization/intracytoplasmic insemination and thyroid function: reviewing the evidence. Metabolism 2018; 86:44-48. [PMID: 29604363 DOI: 10.1016/j.metabol.2018.03.021] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2017] [Revised: 03/18/2018] [Accepted: 03/22/2018] [Indexed: 01/07/2023]
Abstract
Recent findings, that specific G protein-coupled TSH receptors (TSHR) and the nuclear thyroid hormone receptors (THRs) are widely expressed in reproductive tissues, reveal the close links between hypothalamus-pituitary-thyroid and hypothalamus-pituitary-gonadal axes. It has been suggested that thyroid function as well as thyroid autoimmunity (TAI) have an impact on Assisted Reproduction Technology (ART) reproductive outcome. Lately, it became evident that ovarian stimulation (OS) may also have an impact on thyroid function. This narrative review describes the mutual interaction between thyroid function and OS, by reviewing the current evidence, assessing the pathophysiological links and arriving at practical recommendations.
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Affiliation(s)
- Gesthimani Mintziori
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece.
| | - Dimitrios G Goulis
- Unit of Reproductive Endocrinology, 1st Department of Obstetrics and Gynecology, Medical School, Aristotle University of Thessaloniki, Thessaloniki, Greece
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