Presentation
Nulliparous on management for ovarian hyperstimulation syndrome (OHSS) with ascites. Has rising beta -HCG levels 30, 51, 241, now 2440 IU with amenorrhea of less than one month. To assess for intrauterine pregnancy.
Patient Data
Extensive enlargement and multi-loculated bilateral ovaries with variable sized cysts and follicles (the right ovarian volume equals 161.1 cc with the largest cyst within it's parenchyma measuring 5.32 x 3.48 cm while; the left ovarian volume equals 247 cc with the largest cyst within it's parenchyma measuring 3.91 x 3.53 cm in size). Some of the follicles exhibit low to mid level echo internal fluid suggesting hemorrhagic insults. Significant clear free fluid is noted within the uterine bed and adnexae.
The upper abdominal quadrants are clear. Subtle right sided pleural fluid collection is noted.
A single early intrauterine gestational sac with a positive double decidual reaction is noted burrowed within the fundal endometrial cavity (ranging at 4 weeks gestational maturity by mean gestational sac diameter) with no obvious fetal pole or yolk sac within it's lumen as yet.
Case Discussion
Bilaterally extensively enlarged multiloculated ovaries in a known ovarian hyperstimulation syndrome (OHSS) the patient being on management for the same and under ascitic tapping. Trans-abdominal pelvic viscera could not pick the early intrauterine gestational sac however, an endocavitary uterine evaluation revealed and confirmed the reason for the rising beta-HCG titer serum levels.
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