LAUSR

Ovarian hyperstimulation syndrome (OHSS) is a type of clinical syndrome including enlargement of ovaries, increased capillary permeability, a shift of protein-rich fluid from the intravascular system to the third space and blood concentration (Gomez et al. 2010, Fiedler and Ezcurra 2012, Balint et al. 2020). The main symptoms of the disorder are abdominal pain, distension, nausea, dyspnoea, ascites, pleural effusion, oliguria, enlargement of ovaries with multiple follicles and luteal cysts inside (Chai et al. 2020). For severe cases, OHSS can cause low blood volume shock, acute respiratory distress syndrome, renal failure and even death (Fiedler and Ezcurra 2012, Hansen et al. 2014). OHSS is usually considered as a serious iatrogenic complication of controlled ovarian stimulation (COS), patients with polycystic ovarian syndrome (PCOS) receiving treatment for infertility with COS are at high risk for OHSS (Tso et al. 2020). Early onset OHSS occurs within nine days after oocyte retrieval, triggered by administration of exogenous human chorionic gonadotropin (HCG) for follicular maturation, and usually resolves spontaneously within 7–14 days if no pregnancy occurs (Grossman et al. 2010, Fiedler and Ezcurra 2012, Jinghua et al. 2018). Late onset OHSS appears 10 days after oocyte retrieval (Jinghua et al. 2018) as a result of continuous stimulation by endogenous HCG from trophoblast of the embryo transplanted, however, symptoms of OHSS gradually resolve within 1–2 months in most cases (Haimov-Kochman et al. 2004, Grossman et al. 2010, Humaidan et al. 2016, Jinghua et al. 2018). However, spontaneous form of OHSS in the absence of COS have been reported in the literature, and have nearly always presented between 8 and 15 weeks of pregnancy (Kasum et al. 2013, Sridev and Barathan 2013, Nwafor and Nsikak 2020, Oliveira E. Souza et al. 2021), and also in the non-pregnant (Chai et al. 2020) or postpartum women (He et al. 2008) but has been considered rare in late pregnancy. Categorised as severe in the hypertensive disorders of pregnancy (HDP) (Wilkerson and Ogunbodede 2019), preeclampsia is defined as a newly onset hypertension after 20 weeks of gestation and proteinuria or as evidence of end-organ dysfunction such as thrombocytopenia, renal insufficiency, impaired liver function, cardiac dysfunction, pulmonary edoema, haemolysis, or cerebral or visual symptoms (Leeman 2016, Committee on Practice Bulletins-Obstetrics 2017, Wilkerson and Ogunbodede 2019, Marwan and Maged 2020). Preeclampsia affects up to 1.5% 16.7% of pregnancies worldwide and results in 60,000 maternal deaths (Ma’ayeh et al. 2020). However, preeclampsia complicated with spontaneous OHSS is rare. Herein, we report a case of a pregnant patient who presented with spontaneous OHSS complicated with preeclampsia in the third trimester. She had a favourable outcome upon close surveillance.