Çoğul gebeliğin eşlik ettiği ciddi bir ovaryan hiperstimülasyon sendromu olgusu
Küçük Resim Yok
Tarih
2009
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Erişim Hakkı
info:eu-repo/semantics/openAccess
Özet
Amaç: Kontrollü ovulasyon induksiyonu sonrasında çoğul gebeliği olan bir olguda gelişen ciddi ovaryan hiperstimülasyon sendromu (OHSS) ve sonuçlarını literatür bilgileriyle birlikte tartışmak. Olgu sunumu: Kontrollü ovulasyon induksiyonu sonrası oosit aspirasyonu ve embryo transferi gerçekleştirilen olguda yaklaşık 15 gün sonra, karında şişlik, nefes almada zorluk ve idrar çıkışında azalma şikayetleri başladı. Pelvik ultrasonografisinde her iki overin hiperstimule görünümde olması, batında yaygın serbest sıvı saptanması üzerine ciddi OHSS tanısıyla kliniğimize yatırıldı. Hastanın hemogram bulgusu, Hb: 14.9 gr/dl, Htc: % 44.2, WBC: 13,100 idi. Diğer biyokimyasal değerleri normal sınırlarda kaydedildi. ?-HCG titresinin yüksekliğine bağlı olarak gebelik pozitif olarak değerlendirildi. Olgumuz intravenöz kolloid replasman tedavisine yanıt vermedi. Toplam 10,000 cc parasentez ve 5000 cc torasentez yapıldı. Sıvı destek tedavisine rağmen genel durumunda bozulma devam etti. Bunun üzerine 8 hafta 1 gün ile uyumlu olan üçüz gebeliği sonlandırıldı. Gebeliğin sonlandırılmasını takiben genel durumu hızla düzelen ve bulguları normale dönen olgu sağlıklı olarak taburcu edildi. Sonuç: Rutin tedavilere yanıt vermeyen ve genel durum bozukluğu artarak devam eden OHSS olgularında gebeliğin sonlandırılması öncelikli olarak düşünülmelidir.
Objective: To discuss the necessity of the termination of the triple pregnancy causing severe ovarian hyperstimulation syndrome after controlled ovulation induction. Case report: Approximately 15 days later, after the aspiration of the oocytes and transferation of the embryos, patient complained abdominal distention, shortness of breath, decreased urine output. The ultrasound examination showed hyperstimulated ovaries and extensive abdominal ascites. The patient was diagnosed as severe OHSS and then hospitalized. On admission, blood count was: Hb: 14.9 g/dl, Htc: 44.2%, WBC: 13,100, renal and liver function test were normal. Also β-HCG was positive. .Although I.V. colloid replacement was appropriately supported; OHSS was still life–threatening complication for this patient. In addition 10,000 cc paracentesis and 5000 cc toracentesis and I.V. colloid replacement was performed, vital signs did not improve. The termination of the triple pregnancy at 8th week of gestation was offered against the life of the mother .The family accepted termination and immediately it was performed. After the termination of pregnancy, patient vital signs and laboratory findings returned to normal condition and she was discharged. Conclusion: Termination of pregnancy should be considered in cases with OHSS who do not respond to routine treatments and have deteriorated general condition.
Objective: To discuss the necessity of the termination of the triple pregnancy causing severe ovarian hyperstimulation syndrome after controlled ovulation induction. Case report: Approximately 15 days later, after the aspiration of the oocytes and transferation of the embryos, patient complained abdominal distention, shortness of breath, decreased urine output. The ultrasound examination showed hyperstimulated ovaries and extensive abdominal ascites. The patient was diagnosed as severe OHSS and then hospitalized. On admission, blood count was: Hb: 14.9 g/dl, Htc: 44.2%, WBC: 13,100, renal and liver function test were normal. Also β-HCG was positive. .Although I.V. colloid replacement was appropriately supported; OHSS was still life–threatening complication for this patient. In addition 10,000 cc paracentesis and 5000 cc toracentesis and I.V. colloid replacement was performed, vital signs did not improve. The termination of the triple pregnancy at 8th week of gestation was offered against the life of the mother .The family accepted termination and immediately it was performed. After the termination of pregnancy, patient vital signs and laboratory findings returned to normal condition and she was discharged. Conclusion: Termination of pregnancy should be considered in cases with OHSS who do not respond to routine treatments and have deteriorated general condition.
Açıklama
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Genel ve Dahili Tıp
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Genel Tıp Dergisi
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19
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1
