重度卵巢过度刺激综合征38例晚期妊娠结局分析

目的:探讨重度卵巢过度刺激综合征(OHSS)患者的晚期妊娠结局。方法:回顾分析我院行体外受精-胚胎移植(IVF-ET)而发生重度OHSS的晚期妊娠患者的临床资料,与同期未发生OHSS的IVF晚期妊娠患者的妊娠结局比较。结果:38例重度OHSS患者中单胎18例、双胎20例;IVF组232例中相应为119例、113例。OHSS组单胎早产率为5.56%、双胎早产率45%,IVF组相应为5.04%、43.36%。OHSS组与IVF组的单胎与双胎分娩比率、早产比率差异均无统计学意义(P>0.05)。OHSS组单胎妊娠期糖尿病(GDM)发病率为5.56%,双胎为5%;IVF组分别为5.04%、5.31%。OHSS组单胎妊娠期高血压疾病(PIH)发病率为11.11%,双胎为10%;IVF组分别为9.24%、9.73%。OHSS组GDM及PIH的发生率与IVF组比较,差异无统计学意义(P>0.05)。结论:重度OHSS的发生未对晚期妊娠结局产生明显不良影响。     

自然妊娠并发重度卵巢过度刺激综合征二例分析

妊娠期偶可见到的卵巢瘤样病变 ,可使卵巢增大 ,巨大者直径可达 2 0～ 30cm ,有时很像赘生性肿瘤 ,但产后可自行消失 ,并非肿瘤 ,而为瘤样病变。此种改变包括有 6种类型 :(1)高反应性黄素化 (hyperreactiveluteinalis) :多与血中高水平的人绒毛膜促性腺激素 (hCG)有关 ,故多见于葡萄胎、绒毛膜癌、双胎妊娠等 ,也可见于单胎妊娠。此时双侧卵巢切面可见多发性的黄素化滤泡囊肿 ,卵巢体积中等大或巨大 ,最大直径可达 35cm ,偶有囊内出血而有腹痛 ,或有多毛 ,很少有其他症状。 (2 )妊娠期大型孤立的滤泡囊肿黄素化 (largesolitaryluteinizedfolliclecystofpregnancy) :为单个巨型黄素化囊肿 ,平均直径 2 5cm。此种情况须与囊性颗粒细胞瘤鉴别。 (3)异位蜕膜 (ectopicdecidua) :卵巢表面有许多灰白或紫色大小不等的蜕膜结节或囊肿 ,大体上酷似肿瘤 ,腹膜上也可有类似结节 ,像肿瘤种植结节。 (4)妊娠黄体瘤 :卵巢内实性多发性妊娠黄体瘤 ,体积可很小 ,也可增大直径达 2 0cm。 (5 )卵巢颗粒细胞增生 :体积小 ,为多发性 ,局限在萎缩的滤泡内。 (6 )卵巢门细胞增生。在医源性卵巢过度刺激综合征 (OHSS)所见到的卵巢改变 ,也为多囊性黄素化滤泡囊肿 ,即上述 6种类型中的第 1种类型的瘤样病变。但第 1种类型的瘤样     

中、重度卵巢过度刺激综合征219例临床分析

目的研究辅助生殖技术中卵巢过度刺激综合征（ovarian hyperstimulation syndrome,OHSS）的临床特点、治疗和预防。方法对安徽医科大学第一附属医院生殖中心2007年3月至2010年12月行体外受精-胚胎移植（in vitro fertilization-embryo transfer,IVF-ET）和卵细胞浆内单精子注射（intracytoplasmic sperm injection,ICSI）中发生中、重度OHSS的219例患者的临床资料进行回顾性分析。结果在219例患者中,OHSS发生率的为4.2%（219/5176）,其中重度OHSS42例（19.2%）,中度OHSS177例（80.8%）。早发组重度OHSS发生率（18例,8.2%）与晚发组（24例,11.0%）比较,差异有统计学意义（P〈0.001）;取卵后发生OHSS的时间为1～19d,早发组平均发生时间为（2.2±1.8）d,晚发组为（12.4±3.4）d（P〈0.001）。主要表现为腹胀、恶心、呕吐和少量腹水患者占80.8%（177/219）;合并胸水、少尿、血液浓缩、水电解质及酸碱平衡紊乱者占19.2%（42/219）;仅1.4%（3/219）出现呼吸困难,均给予支持对症治疗后痊愈。住院治疗率31.5%（69/219）,全胚胎冷冻患者住院率（8.7%,19/219）与非全胚胎冷冻（22.8%,50/219）比较,差异有统计学意义（P〈0.05）。新鲜移植共124例,总妊娠数53例（42.7%,53/124）,其中早发组33例（33.3%,33/99）,晚发组20例（80%,20/25）;多胎妊娠29例,早发组14例（14.1%,14/99）,晚发组15例（60%,15/25）。新鲜移植妊娠率与全胚胎冷冻后冷冻胚胎移植妊娠率（44.4%,20/45）比较,差异无统计学意义（P〉0.05）;多胎妊娠的患者病程较长（P〈0.05）。结论早发组与晚发组患者临床特征有较大差异。对有高危因素或早发OHSS患者行胚胎冷冻保存及冻融胚胎移植或单胚胎移植可有效的预防OHSS。     

重度卵巢过度刺激综合征3例分析

重度卵巢过度刺激综合征３例分析林金菊叶碧绿赵军招李澄棣（温州医学院附属第一医院）卵巢过度刺激综合征（ｏｖａｒｉａｎｈｙｐｅｒｓｔｉｍｕ－ｌａｔｉｏｎｓｙｎｄｒｏｍｅ，ＯＨＳＳ）是促超排卵最严重的并发症。现将我院发生的３例重度ＯＨＳＳ报道如下。１病例简...     

自然妊娠并发卵巢过度刺激综合征1例分析

患者21岁。因停经74d,下腹胀痛1周于2009-05-25入院。平素月经尚规则,周期7/30～35,轻度痛经,末次月经2009-03-12,停经37d尿妊娠试验阳性,停经42d出现     

重度卵巢过度刺激综合征并发上消化道大出血一例

患者 2 4岁 ,因多囊卵巢综合征、双侧输卵管阻塞致原发不孕 4年 ,于 2 0 0 1年 12月 3 1日 (治疗周期前的中黄体期 )采用长方案行超排卵治疗 ,方法为使用促性腺激素释放激素激动剂 ,月经第 4天用促卵泡激素 15 0ＩＵ/ｄ共 9ｄ ,第 10天Ｂ超检查见径线大于 16ｍｍ的卵泡有 10个 ,大于 14ｍｍ的卵泡 3个 ,小于 10ｍｍ的卵泡数个 ,盆腔积液 48ｍｍ ,停药 1ｄ ;第 11天晚 9时注射人绒毛膜促性腺激素 (ｈＣＧ) 5 0 0 0ＩＵ ,3 6ｈ后Ｂ超介导下经阴道取卵 ,获卵数左侧 17个、右侧 18个 ,见盆腔积液 65ｍｍ ,术中抽出积液 10 0 0ｍｌ。取卵后第 3天…     

足月妊娠伴自发性卵巢过度刺激综合征1例

目的:报道1例自然妊娠合并自发性卵巢过度刺激综合征(sOHSS)病例。方法:回顾性分析我院1例自然妊娠合并sOHSS患者的临床资料,并复习相关文献。结果:该患者于孕39周行子宫下段剖宫产术,同时行双侧卵巢楔形切除术+双侧卵巢打孔术。术中快速病理检查及术后常规病理检查结果示双侧卵巢黄素化囊肿。术后患者双侧卵巢迅速恢复正常。最终诊断为妊娠合并sOHSS。结论:妇产科医生需对sOHSS有充分的认识,需与卵巢肿瘤性疾病进行鉴别,以免因误诊而采取不适当的治疗。     

自然受孕并发卵巢过度刺激综合征病例分析

1　病历摘要患者 2 8岁 ,孕 2产 0 ,住院号 10 2 70 5。 1998年 6月 2 1日因停经 74天 ,下腹隐痛 1周 ,发现盆腔囊块 1天 ,拟诊 :双侧卵巢囊肿合并早孕。末次月经 1998年 4月 8日 ,在自然周期停经 48天时查尿ｈＣＧ阳性 ,Ｂ超示宫内未见明显胚囊声像图 ,附件未见异常 ,至停经 5 8天时复查Ｂ超示宫内早孕。患者入院前 1周出现下腹隐痛 ,无阴道出血 ,孕前无服药史 ;前次妊娠于 1996年 2月孕 5 0余天行人流术。入院查体 :Ｔ 36 8℃ ,Ｐ 86 /ｍｉｎ ,ＢＰ 13/8ｋＰａ ,体重5 4ｋｇ ,身高 1 6 3ｍ ,一般情况良好 ,心肺听诊无异常 ,腹围76ｃｍ ,…     

Obstetric outcome of in vitro fertilized pregnancies complicated by severe ovarian hyperstimulation syndrome: a multicenter study

Objective: To assess the outcome of pregnancies conceived with the use of IVF that are complicated by severe ovarian hyperstimulation syndrome (OHSS).

Design: A retrospective nationwide multicenter study.

Setting: Sixteen of 19 tertiary care medical centers in Israel.

Patient(s): All patients undergoing IVF who were hospitalized for severe OHSS between January 1987 and December 1996.

Main Outcome Measure(s): Pregnancy rate (PR) and rates of multiple gestation, miscarriage, ectopic pregnancy, obstetric complications, and intervention.

Result(s): A total of 163 patients who had severe OHSS after IVF treatment were identified, of whom 142 (87.1%) had undergone ET. The clinical PR was 73.2%; 42.3% were singletons, 33.6% were twins, 17.3% were triplets, and 6.7% were quadruplets. The miscarriage rate was 29.8%, whereas the incidence of ectopic pregnancy was 1.9%. Forty-four percent of all births were premature, and 62.1% of all newborns had low birth weight. The most common antenatal complications were pregnancy-induced hypertension (13.2%), gestational diabetes (5.9%), and placental abruption (4.4%). The rate of cesarean section was 44.1%.

Conclusion(s): Among patients who have severe OHSS after IVF treatment, the pregnancy rate and the rates of multiple gestation, miscarriage, prematurity, low birth weight, pregnancy-induced hypertension, gestational diabetes, and placental abruption are significantly higher than those reported previously for pregnancies conceived with the use of assisted reproductive techniques.     

A spontaneous and severe case of ovarian hyperstimulation syndrome after delivery

Ovarian hyperstimulation syndrome (OHSS) is almost exclusively associated with ovulation induction with gonadotropins or, occasionally, clomiphene citrate. Severe ovarian hyperstimulation after delivery has never been reported previously. Herein we report a case of OHSS after delivery by Cesarean section. The left ovary was subjected to wedge section and three-quarters of the tissue was removed. A cyst on the right ovary was enucleated and fluid within the cysts was sucked away. The patient was treated by intravenous albumin infusion.     

Spontaneous and severe ovarian hyperstimulation syndrome after delivery: A case report

Ovarian hyperstimulation syndrome (OHSS) is almost exclusively associated with ovulation induction with gonadotropins or, occasionally, clomiphene citrate. Severe ovarian hyperstimulation after delivery has never been reported previously. Herein, a case of OHSS after Cesarean operation is presented. The left ovary was subjected to wedge section and three-quarters of the tissue was removed. Cysts on the right ovary were enucleated and fluid within the cysts was sucked away. The patient was treated by intravenous albumin infusion.     

Liver dysfunction in severe ovarian hyperstimulation syndrome

We report the case of a 32-year-old woman suffering from severe liver dysfunction in the course of ovarian hyperstimulation syndrome (OHSS). Complications occurred after successful fertilization subsequent to ovarian stimulation with human menopausal gonadotropin followed by ovulation induction with human chorionic gonadotropin. Because of nausea, vomiting, abdominal distention and enlarged ovaries on an ultrasound examination, she was admitted on the diagnosis of OHSS. During the course of hospitalization severe hepatic injury developed. An increase of more than 100-fold in blood aminotransferase activity was observed. Applied treatment resulted in gradual reduction of ovarian size and resolution of ascites, as well as pleural and pericardial effusions. The patient was discharged from hospital after 46 days. Follow-up examinations at the 13th and 32nd weeks of gestation did not reveal any abnormalities. Pregnancy developed without complications and the woman went into spontaneous labor, giving birth to a viable child at 38 weeks' gestation. Taking into account the above case and previously published reports, the issue of liver dysfunction may have a great impact on the understanding both the pathology and the treatment of OHSS.     

卵母细胞体外成熟预防卵巢过度刺激综合征的应用

目的:探讨卵母细胞体外成熟预防卵巢过度刺激综合征(ovarian hyperstim- ulation syndrome,OHSS)的效果。方法:51例IVF长方案超排卵过程中出现OHSS早期征象时,按患者意愿分成两组,实验组于当天注射人绒毛膜促性腺激素(hCG)36h后取卵,经体外培养成熟行体外受精、胚胎移植;对照组则继续按常规用药方案及受精方案行胚胎移植。测定两组出现OHSS早期征象当日的E_2、统计FSH用药天数、用药量、受精率及临床妊娠率。结果:实验组与对照组在出现OHSS早期征象当日的血E_2水平、受精率、优质胚胎率、临床妊娠率无统计学差异;但实验组的FSH总用量、FSH用药天数、获卵数方面显著低于对照组(P<0.05)。实验组1例发生中度OHSS,对照组则发生3例重度OHSS和2例中度OHSS,重度OHSS发生率差异极显著(P<0.01)。结论:超排卵过程中,出现OHSS早期征象时改行卵母细胞体外成熟培养技术可有效地降低OHSS的发生率。     

辅助生殖技术后妊娠合并卵巢过度刺激综合征的诊治

卵巢过度刺激综合征(ovarian hyperstimulation syndrome,OHSS)是辅助生殖技术最常见的并发症之一,妊娠可使病情加重,严重者甚至危及性命。因此,对妊娠合并卵巢过度刺激综合征需积极预防、严密监测、及时处理,避免其产生的严重后果。     

Administration of methylprednisolone to prevent severe ovarian hyperstimulation syndrome in patients undergoing in vitro fertilization

OBJECTIVE: To determine whether administration of methylprednisolone to high-risk women undergoing IVF/ICSI helps reduce the development of OHSS.DESIGN: Retrospective clinical controlled study.SETTING: IVF unit.PATIENT(S): One thousand ten women who underwent IVF/ICSI from January 9, 1997, to December 31, 1999. Ninety-one patients who were at high risk for OHSS were identified by using standard criteria.INTERVENTION(S): Methylprednisolone, 16 mg/d starting on day 6 of the stimulation and tapered after the first pregnancy test (day 13 after embryo transfer).MAIN OUTCOME MEASURE(S): Occurrence of OHSS.RESULT(S): A significantly lower proportion of methylprednisolone recipients than untreated participants developed OHSS (10.0% vs. 43.9%). Treatment recipients had more oocytes retrieved and more embryos fertilized than did untreated participants. Methylprednisolone treatment was equally effective in preventing OHSS in all causes of infertility and was effective independent of the number of IVF trials and pregnancy rates.CONCLUSION(S): Treatment with methylprednisolone appears to reduce the risk for OHSS. This treatment thus helps to avoid hospitalization, reduces cycle cancellations, and improves the cost-effectiveness of IVF cycles.