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Severe Spontaneous Ovarian Hyperstimulation Syndrome with Pregnancy:A Case Report

Introduction & Objective: Ovarian hyperstimulation syndrome has been described after treatment with exogenous gonadotropins, clomiphen citrate and GuRh s, but spontaneous form of this syndrome is very rare. This is a case report of spontaneous ovarian hyperstimulation syndrome associated with a case of spontaneous pregnancy and ovarian torsion. Case: The patient was a 30-year -old woman who was admitted due to abdominal pain from 1 week ago at 11 weeks gestation .In physical examination her abdomen was severely distended and diffusely tender and both ovaries were enlarged about 15 cm each and were tender. Ultrasonography revealed a single alive intrauterine fetus, 10 weeks gestation, with bilateral multilocular ovarian cysts with smooth surfaces and clear contents. Laboratory results showed low albumin and elevated CA125 (295 U/ml). She received 100g albumin and due to dyspnea a paracentesis was done. After 2 weeks she was readmitted with a complaint of right lower quadrant pain and tenderness and underwent laparotomy with diagnosis of right ovarian torsion. The ovary untwisted and several large cysts were aspirated. She had a normal vaginal delivery of a normal healthy female infant weighing 3100g at 40 weeks gestation. Conclusion: Ovarian torsion and rupture should be considered in these patients. if surgery needed , untwisting of ovarian even if it is chemic and control of bleeding seems to be enough.