Spontaneous Ovarian Hyperstimulation Syndrome in Second Pregnancy of a Healthy Pregnant Woman

Abstract

Spontaneous ovarian hyperstimulation syndrome (OHSS) is an uncommon type of OHSS that is characterized by gastrointestinal symptoms and complications of accommodation of body fluids in third spaces in the absence of medical ovarian stimulations. This syndrome is mostly seen in multiple or molar pregnancies with an underlying medical condition such as hypothyroidism. Treatment of spontaneous OHSS depends on the patient’s clinical condition. Appropriate management will warrant a successful pregnancy. The aim of this report is to introduce a case of spontaneous ovarian hyperstimulation syndrome in second pregnancy of a healthy pregnant woman. The patient was a 8 weeks pregnant female who referred to gynecology and obstetrics clinic because of gradual abdominal distension, abdominal pain and nausea from one month ago. The patient didn't have any history of the specific predisposing factors of OHSS such as thyroid gland dysfunction or multiple pregnancies. Abdominal sonography showed enlarged ovaries with prominent follecules as well as free fluid in the entire abdomen. Elevated levels of HCG (312850 mlU/ml) and carcinoembryonic antigen (106 U/ml) were the remarkable laboratory findings. We successfully controlled the patient by conservative management and the size of ovaries returned back to normal by 17th weeks of gestation. On sonographic follow-ups, untill delivery, the patient was symptom-free and a healthy infant was born. While spontaneous OHSS is a rare and life-threatening condition, conservative management including albumin and anticoagulant administration as well as paracentesis of body third space fluids, will be a promising approach in the stable patients.