Continuous Abdominal Paracentesis for Successful Management of Severe Ovarian Hyperstimulation Syndrome

To present a case of severe OHSS treated with continuous abdominal paracentesis. Case: A 30 yo with history of primary infertility related to female factor underwent a procedure of IVF. Basal hormone FSH 5.75, LH 3.20, E2 33.42, PRL 40.64 and AMH was 3.38 ng/mL. Ovulation induction was initiated on day 3 of the cycle with 225 IU/day rFSH. On day 8 of the stimulation, administration of the antagonist was started and ovulation triggering by 10, 000 IU of hCG. Estradiol level on the day of hCG was 2, 400 pg/mL and a total of 20 mature follicles were aspirated. Three days later, three eight-cell embryos were transferred and luteal phase was supported by vaginal administered progesterone. Nine days after retrieval, patient suffered from nausea, vomiting, abdominal distention, shortness of breath and weight gain. Blood pressure was 110/70 mmHg with a pulse of 92 beats/minute and respiratory rate of 24 breaths/minute. Physical examination found ascites and abdominal circumference was 90 cm. Ultrasound examination revealed bilateral enlarged ovaries and ascites. Laboratory values were WBC 17, 64, HCT 35, 9 %, sodium 135 mmol/L, kalium 3, 7 chloride 105 mmol/L, SGOT 22 IU/L, SGPT 21 IU/L, creatinine 0.6 mg/dL, albumin 2.8 g/dL, D-Dimer 6, 049 ng/mLFEU and urine output of 500 mL/day. Patient were hospitalized and continuous abdominal paracentesis of 1000 mL/day was performed under ultrasonographic guidance. With this procedure, ascitic fluid was drained efficiently and the patient’s clinical and laboratory findings improved gradually in six days. Chemical pregnancy was confirmed by 761, 42 mIU/mL of serum -HCG 14 days after ovum retrieval. Conclusion: Continuous paracentesis may represent an alternative to multiple paracentesis in management of early severe ovarian hyperstimulation syndrome.