Citation Information :
Khandelwal N, Chopra S, Sharma M, Singh T, Sinha U. Rare Triad of Spontaneous Ovarian Hyperstimulation Syndrome, Ovarian Torsion and Intestinal Obstruction in Pregnancy: Diagnosed with Ultrasound. J Postgrad Med Edu Res 2018; 52 (4):183-186.
Ovarian hyperstimulation syndrome (OHSS) is a known iatrogenic complication of assisted reproductive techniques. Spontaneous OHSS in the absence of ovulation induction is very rare, which can be more rarely complicated by ovarian torsion. Prompt diagnosis of ovarian torsion is desirable to preserve the viability of ovary. However, the background of OHSS can make it difficult to diagnose ovarian torsion. A careful evaluation of ovary on ultrasound can make a diagnosis of ovarian torsion. Intestinal obstruction is also rare in pregnancy. We describe a rare case of spontaneous OHSS in pregnancy presenting with torsion and intestinal obstruction, which was diagnosed on ultrasound.
Cardoso CG, Graça LM, Dias T, Clode N, Soares L. Spontaneous ovarian hyperstimulation and primary hypothyroidism with a naturally conceived pregnancy. Obstetrics & Gynecology. 1999 May 1;93(5):809-811.
Nappi RG, Di Naro E, D'aries AP, Nappi L. Natural pregnancy in hypothyroid woman complicated by spontaneous ovarian hyperstimulation syndrome. American journal of obstetrics and gynecology. 1998 Mar 1;178(3):610-611.
Borna S, Nasery A. Spontaneous ovarian hyperstimulation in a pregnant woman with hypothyroidism. Fertility and sterility. 2007 Sep 1;88(3):705-e1.
Edwards-Silva RN, Han CS, Hoang Y, Kao LC. Spontaneous ovarian hyperstimulation in a naturally conceived pregnancy with uncontrolled hypothyroidism. Obstetrics & Gynecology. 2008 Feb 1;111(2):498-501.
Zalel Y, Orvieto R, Ben-Rafael Z, Homburg R, Fisher O, Insler V. Recurrent spontaneous ovarian hyperstimulation syndrome associated with polycystic ovary syndrome. Gynecological Endocrinology. 1995 Jan 1;9(4):313-315.
Chae HD, Park EJ, Kim SH, Kim CH, Kang BM, Chang YS. Case report: ovarian hyperstimulation syndrome complicating a spontaneous singleton pregnancy: a case report. Journal of assisted reproduction and genetics. 2001 Feb 1;18(2):120-123.
Agrawal NR, Gupta G, Verma K, Varyani N. Spontaneous ovarian hyperstimulation syndrome in a triplet pregnancy. Case reports in critical care. 2012.
Lazaridis A, Maclaran K, Behar N, Narayanan P. a rare case of small bowel obstruction secondary to ovarian torsion in an Ivf pregnancy: ep1. 384. Bjog: An International Journal of Obstetrics and Gynaecology. 2013 Jun 1;120:173.
Royal College of Obstetricians and Gynaecologists. The Management of Ovarian Hyperstimulation Syndrome. Green-top Guideline No. 5. Sep 2006.
Wallach EE, Navot D, Bergh PA, Laufer N. Ovarian hyperstimulation syndrome in novel reproductive technologies: prevention and treatment. Fertility and Sterility. 1992 Aug 1;58(2):249-261.
Spitzer D, Wirleitner B, Steiner H, Zech NH. Adnexal torsion in pregnancy after assisted reproduction–case study and review of the literature. Geburtshilfe und Frauenheilkunde. 2012 Aug;72(08):716-720.
Speroff L, Fritz MA, editors. Clinical gynecologic endocrinology and infertility. lippincott Williams and wilkins; 2005: 1183.
Hasson J, Tsafrir Z, Azem F, Bar-On S, Almog B, Mashiach R, et al. Comparison of adnexal torsion between pregnant and nonpregnant women. American journal of obstetrics and gynecology. 2010 Jun 1;202(6):536-e1.
Chang HC, Bhatt S, Dogra VS. Pearls and pitfalls in diagnosis of ovarian torsion. Radiographics. 2008 Sep;28(5):1355- 1368.
Rashmi HD, Raghavendra TR, Komala HK, Vinutha DK, Chaithra GV. Anesthetic management of a patient with torsion of ovarian cyst in the third trimester of pregnancy. International Journal of Medical Science and Public Health. 2015;4(10): 1473-1476.