Critical ovarian hyperstimulation syndrome leading to severe malnutrition: shedding some lights on an extremely rare case report from Vietnam and narrative review.

backgroundOvarian hyperstimulation syndrome (OHSS) is a self-limited iatrogenic complication of controlled-ovarian stimulation. The condition occurs spontaneously or secondary to exogenous gonadotropins which may cause a severe condition. Herein, we outline an extremely rare complication of a such entity leading to severe malnutrition. Additionally, the patient underwent resected surgery of ovarian hyperstimulated tissue in pregnancy. PRESENTATION CASE: A 34-year-old nulliparous pregnant with a history of polyendocrine metabolic ovarian syndrome (PMOS) received an ovarian stimulation protocol at a private clinic setting. The patient was scheduled for in vitro fertilization (IVF) due to infertility during 15 months. However, on the day 4-5 of trigger, the patient was detected with co-existence of OHSS and spontaneous pregnancy. The pregnant woman was hospitalized at 25-26 weeks of gestational age (GA) for critical OHSS complicating in asthenia and malnutrition following the expectant management of OHSS at 16 weeks of GA. Ultrasound scan revealed multiple anechogenic enlarged cysts extending to the bilateral diaphragm and a great amount of intraabdominal fluid accumulation. During hospitalization, the woman was unable to feed herself, thus leading to severe loss of weight, amyotrophy, and anemia rapidly. Her condition was completely worsened. Seriously, a significant disturbance of bowel motility was noted. The electrocytes disturbance was remarkable. Serum albumin decreased gradually. Therefore, the patient underwent laparotomy to reduce the abdominal fluid and cytoreductive surgery owing to critical OHSS. After surgical intervention, the serum laboratory returned progressively to normal value and the clinical symptoms were steadily subsided. The patient was discharged and continued her pregnancy. Ultrasound showed a complete regression of the ovarian cysts; however, the fetal growth restriction (FGR) was recorded. The patient underwent a planned cesarean delivery at 36 weeks 3 days of GA due to severe FGR and fetal-pelvic disproportion. Both mother and neonate were discharged uneventfully.

conclusionIn the patient with PMOS, co-existence of OHSS and spontaneous pregnancy at the beginning of ovarian stimulation should be recognized. In general, a rapid progression of OHSS associated with adverse outcomes relating to gastro-intestinal complications are extremely scarce. FGR ought to be taken into account in a pregnancy with OHSS. Surgical intervention with a multidisciplinary management could improve materno-neonatal outcomes. Thus, this endeavor insight could be considered in critical cases with potentially life-threatening complications.