卵巣過剰刺激症候群の加療中に腹膜妊娠が判明し、腹腔鏡下手術で治療し得た一例

抄録

  We report a case of an ectopic pregnancy removed via laparoscopic surgery in a patient undergoing therapy for ovarian hyperstimulation syndrome (OHSS). A 36-year-old woman, with a history of egg retrieval after ovulation induction with human menopausal gonadotropin and human chorionic gonadotropin (hCG), was referred to our hospital because of abdominal pain and bloating. Ultrasound examination showed an 8-9 cm bilateral adnexal mass and subphrenic ascites. She was diagnosed with moderate OHSS. Despite conservative therapy, symptoms did not improve and the bilateral adnexal mass did not decrease in size. Serum hCG level was 6339 mIU/ml. Ultrasound examination did not detect a gestational sac in the uterus. Magnetic resonance imaging indicated a cystic mass in the peritoneal cavity. We strongly suspected ectopic pregnancy in the abdominal cavity. Laparoscopic surgery and intrauterine curettage were performed. The histopathological diagnosis was peritoneal pregnancy. Symptoms disappeared and serum hCG levels decreased. We believe that the peritoneal pregnancy caused OHSS. Even if there is a period when of pregnancy failure via assisted reproductive technology, ectopic pregnancy should be considered. Pregnancy should be confirmed and egg retrieval performed before initiating medical treatment in patients with OHSS.