International Clinical and Medical Case Reports Journal (ISSN: 2832-5788) | Volume 5, Issue 3 | Case Report | Open Access
William H. Kutteh*
Jessica Walker1, Natalia Klett2, William Kutteh3*
1Department of Obstetrics and Gynecology, Baptist Memorial Hospital, Memphis, TN 38120
2Atrium Health Women’s Care South Pine OB/GYN, Fort Mill, SC 29708
3Department of Obstetrics and Gynecology, University of Tennessee Health Science Center, Memphis, TN 38103
*Correspondence to: William H. Kutteh
Fulltext PDFSummary: Ovarian hyperstimulation syndrome (OHSS) is a serious complication of ovulation induction associated with significant morbidity and requires prompt recognition and treatment. We present an unusual case of OHSS complicated by a heterotopic quadruplet pregnancy including a cervical pregnancy.
Case Description: 30-year-old female, Gravida 1 Living children 0 Miscarriage 1 with a history of anovulation and secondary infertility. Her prior infertility work-up showed a normal hysterosalpingogram with patent fallopian tubes, a normal semen analysis, anovulation with polycystic ovaries on ultrasound. After the maximum dosage of letrozole failed to induce ovulation, she conceived with combined letrozole and low-dose gonadotropins without complications, but unfortunately the pregnancy ended in a spontaneous miscarriage. Three years later, after again failing ovulation induction with maximum-dose letrozole she consented to treatment with a combination of letrozole and low-dose gonadotropins for three days. Ultrasound showed 2 mature and 2 smaller follicles prior to human chorionic gonadotropin (hCG) trigger and insemination. Ten days later, the patient presented to an outside emergency department with nausea, abdominal pain, decreased urine output, negative urine pregnancy test and was diagnosed with urinary tract infection. At 4 weeks gestation, she had additional symptoms of shortness of breath, tachycardia, abdominal distention, 10-pound weight gain and a positive urine pregnancy test. Imaging revealed bilaterally enlarged ovaries and ascites with a hematocrit of 62% and urine specific gravity 1.032. Severe OHSS was diagnosed and she was started on heparin and aspirin. Multiple paracentesis removed 6 L of ascitic fluid. At 5w1d, two gestational sacs were identified. After vaginal bleeding at 7w6d, ultrasound showed two intrauterine, one non-viable cervical pregnancy and a left sided adnexal mass consistent with ectopic pregnancy. Laparoscopic left salpingectomy and ectopic removal was performed. The cervical pregnancy passed, and a second miscarriage of one of the uterine pregnancies occurred at 14 weeks. Ultimately, she had a healthy, preterm vaginal delivery at 36w3d. This case highlights a rare presentation of OHSS complicated by a multifetal heterotopic pregnancy.
Jessica Walker, Natalia Klett, William Kutteh. Case of Ovarian Hyperstimulation Syndrome complicated by a Heterotopic Quadruplet Pregnancy. Int Clinc Med Case Rep Jour. 2026;5(3):1-6.