Transvaginal drainage of ascites as an alternative to abdominal paracentesis in patients with severe ovarian hyperstimulation syndrome, obesity, and generalized edema.

OBJECTIVE

To describe an alternative technique for transvaginal drainage of ascites in a case of severe ovarian hyperstimulation syndrome (OHSS), generalized edema, and obesity.

DESIGN

Case report.

SETTING

A university-based hospital IVF and Reproductive Medicine Unit.

PATIENT(S): A patient hospitalized with severe OHSS after IVF-ET in whom drainage of large amounts of ascitic fluid was necessary.

INTERVENTION(S): Ultrasonographic transvaginal insertion of a wire guide through a standard IVF needle into the Douglas pouch. Placement of a "peel-away" set on the wire, which was replaced with a "pigtail" indwelling catheter.

MAIN OUTCOME MEASURE(S): Amount of drained ascitic fluid.

RESULT(S): Ascitic fluid was drained efficiently, leading to improvement of the patient's condition.

CONCLUSION(S): Transvaginal ultrasonography-guided insertion of a pigtail catheter through the Douglas pouch is an efficacious procedure when the abdominal approach for decompression of ascites is difficult.