Life-threatening intraabdominal bleeding after oocyte retrieval successfully managed with angiographic embolization

Severe haematoperitoneum caused by ovarian bleeding after transvaginal oocyte retrieval: A retrospective analysis and systematic literature review

“…In addition to the four cases of severe haematoperitoneum caused by ovarian bleeding from the Medical University of Vienna, 11 reports of identified ovarian bleeding were included in this analysis (Aragona et al, 2011;Bandyopadhyay and Kay, 2010;Battaglia et al, 2001;Bennett et al, 1993;Chatrian et al, 2012;Dicker et al, 1993;El-Shawarby et al, 2004;Govaerts et al, 1998;Kart et al, 2011;Liberty et al, 2010;Zhen et al, 2010). Studies and reports on haematoperitoneum after TVOR from other sources (Grynberg et al, 2011;Jayakrishnan et al, 2011;Modder et al, 2006;Wang et al, 2005) or from unknown bleeding sources (Bentov et al, 2006;Bodri et al, 2008;Ludwig et al, 2006;Nyboe Andersen et al, 2009;Sauer, 2001;Siristatidis et al, 2012) were excluded.…”

“…Possible predisposing factors were reported only in a few cases. These included isolated prolongation of the activated partial thromboplastin time (n = 1) (Govaerts et al, 1998); a combination of prolongation of the activated partial thromboplastin time and decreased factor XI and XII concentrations (n = 1) (Battaglia et al, 2001); mild factor VIII deficiency (n = 1) (Kart et al, 2011); and intravenous diclofenac treatment before TVOR (n = 1) (Bandyopadhyay and Kay, 2010). Notably, Liberty et al (2010) evaluated risk factors for ovarian bleeding after TVOR by comparing the characteristics of affected and unaffected patients, and found that lean women with polycystic ovary syndrome were predisposed to haematoperitoneum caused by ovarian bleeding.…”

“…The intraoperative findings were subdivided into 'diffuse bleeding' (n = 8, 25.8%) and 'bleeding from a follicle' 'a puncture site' or 'localized' (n = 22, 71.0%). Apart from one woman who underwent angiographic embolization of the right and left uterine arteries (Kart et al, 2011), all patients were treated with either laparoscopy or laparotomy. In most operations, the bleeding ovary could be preserved.…”

“…Although TVOR is routinely performed worldwide, few systematic data about its complications, in particular, postinterventional haematoperitoneum, have been published, especially if the cause is ovarian bleeding. In addition to case reports, only limited retrospective analyses are available (Aragona et al, 2011;Bandyopadhyay and Kay, 2010;Battaglia et al, 2001;Bennett et al, 1993;Chatrian et al, 2012;Dicker et al, 1993;El-Shawarby et al, 2004;Govaerts et al, 1998;Kart et al, 2011;Liberty et al, 2010;Siristatidis et al, 2012;Zhen et al, 2010). This under-reporting of an important complication may be attributed to the rare nature of this event and the also to the fact that many IVF units might be less interested in reporting complications, as the major scientific focus is on IVF-ICSI outcomes.…”

Case Report: Delayed intra-abdominal bleeding following trans-vaginal ultrasonography guided oocyte retrieval for in vitro fertilization in patients at risk for thrombo-embolic events under anticoagulant therapy

“…While, Battaglia et al 6 reported a 3 hour interval between OPU and surgical intervention in a patient with coagulation factor XI deficiency 6 , intervals of 2 and 10 days, were reported in patients suffering from essential thrombocythemia 7 and factor VIII deficiency 8 , respectively. Notably, none of the aforementioned patients were treated with anticoagulant medications.…”