RUPTURED HETEROTOPIC PREGNANCY WITH COMPLICATED TRAUMA AND ACCOMPANYING OVARIAN HYPERSTIMULATION SYNDROME

Year 2016, Volume: 8 Issue: 1, 30 - 33, 22.03.2016

Raziye Desdicioğlu

Abstract

Heterotopic gestation, although very rare in natural conceptions, is a condition with a high mortality rate of which the incidence increases with assisted reproductive techniques. Ovarian hyperstimulation syndrome (OHSS) is also a serious complication of ovulation induction by enhancing morbidity.
In this case report, we present a 36 year-old woman with a heterotopic pregnancy following ovulation induction and her admission to emergency department with a complaint of severe abdominal pain after trauma. Physical examination has revealed the presence of OHSS accompanying intraabdominal bleeding.
Delay in the diagnosis of heterotopic pregnancy can cause life threatening complications. Even, the reason for the admission to the hospital is not related to the pregnancy, heterotopic pregnancies should be kept in mind while evaluating the patients with an history of ovulation induction procedures. In addition, it should not be forgotten that the exact diagnosis will be more difficult especially in the presence of OHSS.

Keywords

Heterotopic pregnancy, ovarian hyperstimulation syndrome, intraabdominal bleeding

TRAVMA İLE KOMPLİKE OLMUŞ RÜPTÜRE HETEROTOPİK GEBELİK VE EŞLİK EDEN OVERYAN HİPERSTİMULASYON SENDROMU

Abstract

Heterotopik gebelik, spontan konsepsiyonlarda nadir olmasına rağmen yardımcı üreme teknikleri ile sıklığı artan, mortalitesi yüksek bir klinik* durumdur. Overyan hi-perstimülasyon sendromu da (OHSS) ovulasyon indüksiyonun morbidite artırıcı bir komplikasyonudur.
Bu olgu sunumunda, 36 yaşında ovulasyon induksiyonu sonrasında heterotopik gebelik olmuş ve travma sonrası şiddetli karın ağrısı ile acile başvuran kadın hastayı anlattık. Hastanın değerlendirilmesinde de OHSS tablosu ve intraabdominal kanama varlığı tespit edilmiştir.
Heterotopik gebeliğin tanısında gecikmeler hayatı tehdit eden komplikasyonlara neden olabilir. Bu vakamızda olduğu gibi kliniğe başvuru şikayeti gebelikle ilişkili olmasa da, ovulasyon indüksiyonu yapılmış her hastada heterotopik gebelik akla getirilmelidir. Bunlara ek olarak, özellikle eşlik eden OHSS gibi bir durum varlığında, tanı koymanın daha zor olabileceği unutulmamalıdır.

Dr. Raziye DESDİCİOĞLU
Dr. Melahat YILDIRIM
Dr. Hilal AĞIŞ
Dr. Özge GEL
Dr. Ayşe Filiz AVŞAR

Keywords

Heterotopik gebelik, overyan hiperstimülasyon sendromu, intraabdominal kanama

References

• 1. Tandon R, Goel P, Saha PK, Devi L. Spontaneous heterotopic pregnancy with tubal rupture: a case report and review of the literature. J Med Case Rep 2009;10:8153.
• 2. Bello GV, Schonholz D, Moshirpur J, Jeng DY, Berkowitz RL. Combined preg-nancy:the Mount Sinai experience. Obs-tet Gynecol Surv 1986;41:603-13.
• 3. Boothroyd C, Karia S, Andreadis N, Rombauts L, Johnson N, Chapman M. Australasian CREI Consensus Expert Panel on Trial evidence (ACCEPT) group. Consensus statement on prevention and detection of ovarian hyperstimulation syndrome. Aust N Z J Obstet Gynaecol 2015;55: 23-34.
• 4. Klemetti R, Sevön T, Gissler M, Hem-minki E. Complications of IVF and ovu- lation induction. Hum Reprod 2005;20: 3293-300.
• 5. Varras M, Akrivis C, Hadjopoulos G, An-toniou N. Heterotopic pregnancy in a natural conception cycle presenting with tubal rupture: a case report and review of the literature. Eur J Obstet Gynecol Reprod Biol. 2003;106:79-82.
• 6. Thakur R, El-Menabawey M. Combined intra-uterine and extra-uterine pregnancy associated with mild hyperstimulation syndrome after clomiphene ovulation induction. Hum Reprod. 1996; 11:1583-4.
• 7. Ghandi S, Ahmadi R, Fazel M. Heterotopic pregnancy following induction of ovulation with clomiphene citrate. Iran J Reprod Med. 2011;9:319-21.
• 8. Somers MP, Spears M, Maynard AS, Syverud SA. Ruptured heterotopic pregnancy presenting with relative bradycardia in a woman not receiving reproductive assistance. Ann Emerg Med 2004;43:382-5.
• 9. Moosburger D, Tews G. Severe ovarian hyperstimulation syndrome and combined intrauterine and tubal pregnancy after in-vitro fertilization and embryo transfer. Hum Reprod. 1996; 11:68-9
• 10. Clayton HB, Schieve LA, Peterson HB, Jamieson DJ, Reynolds MA, Wright VC. A comparison of heterotopic and intrauterine-only pregnancy outcomes after assisted reproductive technologies in the United States from 1999 to 2002. Fertil Steril 2007; 87:303-9.