Spontaneous ovarian hyperstimulation syndrome in a twin pregnancy: A case report

Background: Spontaneous ovarian hyperstimulation syndrome (OHSS) is an uncommon and potentially life-threatening condition characterized by ovarian enlargement, increased vascular permeability, and extravascular fluid shifts. It is typically associated with iatrogenic ovulation induction; however, it can also occur spontaneously during pregnancy, particularly in cases of multiple gestations or hypothyroidism. The incidence of spontaneous OHSS in non-pregnant women with hypothyroidism ranges from ۰.۲% to ۱.۲%. This case report describes a rare instance of spontaneous OHSS in a twin pregnancy involving a patient with treated hypothyroidism.Case presentation: A ۲۲-year-old woman, gravida ۲, para ۱, presented at ۱۰ weeks of gestation with a spontaneous dichorionic diamniotic twin pregnancy. She reported acute, severe pain in the left lower quadrant and hypogastric region. The patient had a history of hypothyroidism managed with levothyroxine (۱۵۰ µg daily) and had not undergone any prior ovulation induction. Ultrasound examination revealed bilaterally enlarged ovaries (left: ۱۰۶×۹۱×۶۸ mm; right: ۱۱۸×۱۱۲×۶۰ mm) with multiple cysts and minimal pelvic free fluid, consistent with moderate OHSS. Laboratory tests showed normal hemoglobin levels, electrolytes, and renal function. Conservative management included subcutaneous heparin (۵,۰۰۰ units twice daily) for thromboprophylaxis, ceftriaxone, and fluid restriction. The patient's symptoms resolved within ۴۸ hours, and she was discharged with instructions for outpatient follow-up.Discussion: The occurrence of spontaneous OHSS in twin pregnancies is rare but necessitates prompt recognition to avert complications such as thromboembolism or renal failure. Accurate diagnosis relies on ultrasound and clinical evaluation, and conservative management can lead to favorable outcomes. Clinicians should maintain a high index of suspicion for OHSS in pregnant women presenting with ovarian enlargement and abdominal pain, even in the absence of ovulation induction, to facilitate timely intervention.

کلیدواژه ها:

Spontaneous ovarian hyperstimulation syndrome ، twin pregnancy ، Hypothyroidism ، Conservative Management