Edwards-Silva Racine N, Han Christina S, Hoang Yen, Kao Lee-Chuan
Department of Obstetrics and Gynecology, Cedars-Sinai Medical Center, Los Angeles, California, USA.
Obstet Gynecol. 2008 Feb;111(2 Pt 2):498-501. doi: 10.1097/01.AOG.0000279139.12412.90.
Spontaneous ovarian hyperstimulation syndrome is a rare occurrence in pregnancy. This is a case of pregnancy with spontaneous ovarian hyperstimulation syndrome, uncontrolled hypothyroidism, elevated human chorionic gonadotropin (hCG), deep vein thrombosis, and Rh isoimmunization.
An African-American woman in her mid-30s, gravida 3 para 0, with hypothyroidism presented with abdominal pain, hCG 291,206 milli-International Units/mL, thyroid stimulating hormone 41.7 milliunits/L, hematocrit 12.8%, and Anti-D titer 1:256. Pelvic ultrasonography revealed a pregnancy at 10 weeks of gestation with enlarged adnexal masses. Doppler images demonstrated a right, lower extremity, deep vein thrombosis. Conservative maternal treatment involved levothyroxine and heparin with regression of the ovaries by 22 weeks of gestation after adequate thyroid repletion. Fetal surveillance was with serial ultrasound examinations of the estimated fetal weight, amniotic fluid index, and the fetal middle cerebral artery Doppler images. Cesarean delivery of a nonhydropic 1,400-gram newborn occurred at 35 weeks of gestation. Although born prematurely, the newborn required only 2 liters of oxygen through nasal cannula initially, received only 2 blood transfusions, advanced to oral feeds quickly, had good urine output throughout the hospitalization, and had a normal hearing examination upon discharge. The bilirubin levels remained stable with some phototherapy, so exchange transfusion was not necessary.
Spontaneous ovarian hyperstimulation syndrome can occur in pregnant women with severe hypothyroidism or extremely elevated hCG and present with enlarged adnexal masses and acute abdominal pain. Accurate diagnosis and continuation of pregnancy with conservative management is a viable option, once ovarian malignancy is ruled out.
自发性卵巢过度刺激综合征在妊娠中较为罕见。本文报道了一例合并自发性卵巢过度刺激综合征、未控制的甲状腺功能减退、人绒毛膜促性腺激素（hCG）升高、深静脉血栓形成及Rh血型免疫的妊娠病例。
一名35岁左右的非裔美国女性，孕3产0，患有甲状腺功能减退，因腹痛就诊，hCG为291,206毫国际单位/毫升，促甲状腺激素为41.7毫单位/升，血细胞比容为12.8%，抗-D效价为1:256。盆腔超声检查显示妊娠10周，附件区有增大的包块。多普勒超声图像显示右下肢深静脉血栓形成。孕妇的保守治疗包括左甲状腺素和肝素，在甲状腺功能得到充分补充后，妊娠22周时卵巢包块缩小。通过连续超声检查估计胎儿体重、羊水指数及胎儿大脑中动脉多普勒图像进行胎儿监测。妊娠35周时行剖宫产分娩出一名体重1400克、无水肿的新生儿。尽管早产，但新生儿最初仅需通过鼻导管吸氧2升，仅接受2次输血，很快过渡到经口喂养，住院期间尿量良好，出院时听力检查正常。经光疗后胆红素水平保持稳定，无需换血治疗。
自发性卵巢过度刺激综合征可发生于严重甲状腺功能减退或hCG极度升高的孕妇，表现为附件区包块增大及急性腹痛。一旦排除卵巢恶性肿瘤，准确诊断并采用保守治疗继续妊娠是可行的选择。
