Fertility and sterility · 2008
Ovarian hemorrhage after transvaginal ultrasonographically guided oocyte aspiration: a potentially catastrophic and not so rare complication among lean patients with polycystic ovary syndrome.
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Liberty Gad, Hyman Jordana Hadassah, Eldar-Geva Talia, Latinsky Boris, Gal Michael, Margalioth Ehud J
Аннотация
OBJECTIVE: To report the first case series of ovarian hemorrhage after transvaginal ultrasonographically guided oocyte aspiration (TVOA).
DESIGN: Retrospective analysis.
SETTING: In vitro fertilization unit of a tertiary university hospital.
PATIENT(S): Patients who underwent TVOA during a 6-year period.
INTERVENTION(S): Surgical intervention due to active bleeding from the ovary.
MAIN OUTCOME MEASURE(S): Prevalence and risk factors.
RESULT(S): Among 3,241 patients undergoing TVOA, 7 were diagnosed as having ovarian hemorrhage afterward. All patients were thin, with a body mass index of 19-21 kg/m(2), and 4 had polycystic ovary syndrome (PCOS). The prevalence of ovarian bleeding among lean patients with PCOS was 4.5%. The odds ratio for bleeding in lean patients with PCOS vs. all other patients was 50 (95% confidence interval 11-250). The interval between the TVOA and surgical intervention ranged from 5 to 18 hours (mean +/- SD, 11.4 +/- 5 hours). The Delta decrease in hemoglobin levels was 3.2-9 g/dL (mean 6.1 +/- 1.8). In 6 of the 7 patients, laparoscopically guided electrocoagulation was sufficient to achieve hemorrhagic control.
CONCLUSION(S): Although acute hemorrhage is a rare event after TVOA, lean patients with PCOS specifically are at much higher risk for this complication.
DESIGN: Retrospective analysis.
SETTING: In vitro fertilization unit of a tertiary university hospital.
PATIENT(S): Patients who underwent TVOA during a 6-year period.
INTERVENTION(S): Surgical intervention due to active bleeding from the ovary.
MAIN OUTCOME MEASURE(S): Prevalence and risk factors.
RESULT(S): Among 3,241 patients undergoing TVOA, 7 were diagnosed as having ovarian hemorrhage afterward. All patients were thin, with a body mass index of 19-21 kg/m(2), and 4 had polycystic ovary syndrome (PCOS). The prevalence of ovarian bleeding among lean patients with PCOS was 4.5%. The odds ratio for bleeding in lean patients with PCOS vs. all other patients was 50 (95% confidence interval 11-250). The interval between the TVOA and surgical intervention ranged from 5 to 18 hours (mean +/- SD, 11.4 +/- 5 hours). The Delta decrease in hemoglobin levels was 3.2-9 g/dL (mean 6.1 +/- 1.8). In 6 of the 7 patients, laparoscopically guided electrocoagulation was sufficient to achieve hemorrhagic control.
CONCLUSION(S): Although acute hemorrhage is a rare event after TVOA, lean patients with PCOS specifically are at much higher risk for this complication.