1/3. Postparacentesis bilateral massive vulvar edema in a patient with severe ovarian hyperstimulation syndrome.OBJECTIVE: To report a case of bilateral massive vulvar edema following lower abdominal paracentesis in a patient with ovarian hyperstimulation syndrome. DESIGN: Case report. SETTING: University teaching hospital. PATIENT(S): A 32-year-old woman with primary infertility. Intervention(S): The patient underwent ovarian stimulation with leuprolide acetate, highly purified FSH, and hCG. Because of the development of severe ovarian hyperstimulation syndrome, bilateral paracentesis through the lower abdominal quadrants was performed. MAIN OUTCOME MEASURE(S): Treatment of ovarian hyperstimulation syndrome. RESULT(S): Development of bilateral massive vulvar edema 24 hours after lower abdominal paracentesis. CONCLUSION: This case report suggests that lower abdominal paracentesis could be the cause of vulvar edema development in ovarian hyperstimulation syndrome, probably due to a fistulous tract created between the peritoneal cavity and the subcutaneous tissues.- - - - - - - - - - ranking = 1keywords = ovarian hyperstimulation syndrome, hyperstimulation syndrome, ovarian hyperstimulation, hyperstimulation (Clic here for more details about this article) |
2/3. Massive vulvar edema in ovarian hyperstimulation syndrome. A case report.BACKGROUND: Bilateral vulvar edema associated with severe ovarian hyperstimulation syndrome is described for the first time. CASE: A 28-year-old woman underwent gonadotropin-releasing hormone analogue and gonadotropin treatment for in vitro fertilization and embryo transfer. On day 18 of the cycle, the patient reported mild abdominal discomfort that became severe during the following four days. One the 22nd day of the cycle, bilateral ovarian enlargement and ascites were present. The vulva showed massive edema and fissures. ovarian hyperstimulation syndrome (OHSS) therapy consisted of human albumin, lactated Ringer's solution and heparin. The vulvar edema was treated with topical hydrocortisone ointment, ice packs and topical gentamycin twice a day. After one week of treatment, the vulva was normal. CONCLUSION: We think that the vulvar edema in this case was the result of decreased oncotic pressure and increased hydrostatic pressure, as occur during OHSS.- - - - - - - - - - ranking = 1.0065348762678keywords = ovarian hyperstimulation syndrome, hyperstimulation syndrome, ovarian hyperstimulation, hyperstimulation (Clic here for more details about this article) |
3/3. Unilateral vulvar edema associated with paracentesis in patients with severe ovarian hyperstimulation syndrome. A report of nine cases.BACKGROUND: Severe ovarian hyperstimulation syndrome is a life-threatening complication of ovulation induction. The clinical picture includes ovarian enlargement, accumulation of ascites and pleural effusion, increased coagulability and electrolyte disorders. Accumulation of ascites increases the intraabdominal pressure so that breathing difficulties ensue. paracentesis is the only treatment that can immediately prevent respiratory deterioration. CASES: Nine women with severe ovarian hyperstimulation syndrome were treated by paracentesis for the drainage of massive ascites. Unilateral vulvar edema developed in all cases in which the lower abdomen was the puncturing site. This phenomenon was not observed when paracentesis was carried out through the upper abdomen. The edema resolved spontaneously over the subsequent 10 days. CONCLUSION: Apparently the puncturing needle created a fistulous tract through which the ascitic fluid was forced, by the increased intraabdominal pressure, into the subcutaneous tissues, presenting as unilateral vulvar edema. This can be prevented by using one of the abdominal hypochondriac regions as the puncturing site. This phenomenon is self-limited and causes only mild discomfort without late sequelae.- - - - - - - - - - ranking = 1.1348023144017keywords = ovarian hyperstimulation syndrome, hyperstimulation syndrome, ovarian hyperstimulation, hyperstimulation (Clic here for more details about this article) |