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MOGS Chronicles | Volume 1 | Issue 1 | September 2024 13IntroductionOvarian hyperstimulation syndrome is a rare, yet fatal complication seen in in vitro fertilization characterized by cystic enlargement of ovaries with a third space fluid loss due to ovarian neoangiogenesis and increased vascular permeability.[1] This leads to a plethora of symptoms with varying severity. Spontaneous ovarian hyperstimulation syndrome (OHSS) is a rare event reported in 0.2%u20131.2% cases occurring spontaneously in pregnancy without exogenous human chorionic gonadotropin (hCG) use.[2]Case ReportWe report a case of spontaneous OHSS in a 22 year old, third gravida, with previous two full term vaginal deliveries, presenting to us at 8 weeks of amenorrhea with complaints of pain in abdomen, abdominal distention and breathlessness since 3 days. There was no history of any hormone use prior to or during this pregnancy. A battery of investigations were done along with ultrasound was done which was suggestive of a gestational sac corresponding to 5 weeks pregnancy with absence of fetal pole with bilateral bulky ovaries showing fishnet appearance with increased bilateral adnexal vascularity [Figures 1 and 2]. Right ovary measured 8.4 %u00d7 4.8 %u00d7 6.4 cm (80 cc) and left ovary measured 7 %u00d7 3.5 %u00d7 6.5 cm (145 cc). Moderate ascites with bilateral moderate pleural effusion was also noted. Hence, a diagnosis of spontaneous OHSS was made. Patient was admitted in antenatal ward for supportive therapy along with regular monitoring of vitals, weight. Fluid correction was done with intravenous fluids based on charting. Therapeutic paracentesis and thoracocentesis were done twice to provide symptomatic relief. Thromboprophylaxis with use of Enoxaparin injections (40 mg) was given subcutaneously as per her bodyweight. Since patient was not desirous of this pregnancy, she was undertaken for first trimester medical termination of pregnancy by dilatation and evacuation in view of severe OHSS on day 3 after admission. Post procedure, she was started on cabergoline (0.5 mg) for 8 days in view of its role in reducing neoangiogenesis. Patient was discharged after 10 days on attaining symptomatic relief. Patient was followed up 30 days after procedure with an ultrasound which revealed normal findings in bilateral ovaries with no ascites or pleural effusion.DiscussionSince OHSS is typically associated with use of gonadotropins for ovulation induction, its origin in a case of natural pregnancy is largely unknown. Spontaneous Ovarian hyperstimulation syndrome is a rare, yet fatal complication seen in in vitro fertilization characterized by cystic enlargement of ovaries with a third space fluid loss. We report a case of spontaneous ovarian hyperstimulation syndrome (OHSS) in a 22 year old, third gravida, with previous two full term vaginal deliveries, presenting to us at 8 weeks of amenorrhea with complaints of pain in abdomen, abdominal distention and breathlessness since 3 days. There was no history of any hormone use prior to or during this pregnancy.Ultrasound was suggestive of a gestational sac corresponding to 5 weeks pregnancy with absence of fetal pole with bilateral bulky ovaries showing fishnet appearance with moderate ascites and bilateral pleural effusion. Hence, a diagnosis of spontaneous OHSS was made. Patient was admitted for conservative management using intravenous fluids and thromboprophylaxis along with regular monitoring. Therapeutic paracentesis and thoracocentesis were done twice to provide symptomatic relief. Since patient was not desirous of this pregnancy, she was undertaken for first trimester medical termination of pregnancy by dilatation and evacuation in view of severe OHSS on day 3 after admission. Post procedure, she was started on cabergoline (0.5 mg) and was discharged on attaining symptomatic relief. Management of OHSS is dependent on the stage at which it is diagnosed. Early recognition and timely management of such cases ensures prevention of fatal complications yielding good outcome.Keywords: OHSS, Spontaneous Hyperstimulation, Hyperstimulation syndromeA Rare Case of Spontaneous Ovarian Hyperstimulation Syndrome in a Spontaneous Conception with Conservative ManagementAishwarya Agrawal, Prerna Gupta, Madhuri Mehendale, Meenal SarmalkarDepartment of Obstetrician and Gynecologist, LTMMC, Mumbai, Maharastra, IndiaCase ReportAbstractAddress for correspondence: Aishwarya Agrawal, Department of Obstetrician and Gynecologist, LTMMC, Mumbai, Maharastra, India. Mobile: +91-7666517587. E-mail: draishwarya96@gmail.com