Severe Hemoperitoneum due to Ovarian Bleeding after Transvaginal Oocyte Retrieval with Surgical Management: A Retrospective Analysis and Comprehensive Review of the Literature

Abstract

Background and Objectives: Severe hemoperitoneum of ovarian bleeding origin is a rare but potentially life-threatening complication of transvaginal oocyte retrieval (TVOR) procedure. The study aimed to present a case series of surgically managed patients from our clinic with hemoperitoneum caused by ovarian bleeding after TVOR, as well as to perform a comprehensive literature review in order to summarize and analyze all published cases with this condition and their management. Materials and Methods: The data of 2939 patients, who underwent TVOR procedures for IVF/ICSI (in vitro fertilization, intracytoplasmic sperm injection) in our clinic between 2010 and 2021 were reviewed. Moreover, a systemic literature search was performed. Main outcome measures from the pooled analysis were incidence and risk factors, type of surgery, intraoperative finding and intervention leading to hemostasis. Results: In our Clinic 4 (0.136%), cases of hemoperitoneum due to ovarian bleeding were surgically managed. Moreover, 39 cases from 18 studies reported in the literature were identified. No risk factors besides lean women with PCOS were identified. In the pooled analysis, the bleeding symptoms appeared in 58.1% of patients within eight hours after TVOR and cumulatively in 81.4% cases during the 24 hours after TVOR. The average time from TVOR to surgery was 27.19 ± 53.25 hours. Hemostasis was mostly established using electrocoagulation, although few cases of ovariectomy were also reported. Embryo transfer at 60% of cases was postponed and embryos cryopreserved. Conclusions: Severe hemoperitoneum due to ovarian bleeding after TVOR is a rare event that should be treated by techniques of minimally invasive surgery whenever possible. Protocols should be developed to enable optimal management strategies for infertility patients. Embryos obtained should be cryopreserved.

Haemoperitoneum due to ovarian rupture after oocyte retrieval procedure

“…In a more detailed literature search for cases of haemoperitoneum caused by ovarian haemorrhage post-TVOR, a retrospective study reported only 3 cases of haemoperitoneum due to ovarian haemorrhage post-TVOR out of 3656 cases recorded (0.08%) 11. A comprehensive literature review had similar findings, stating that the incidence of haemoperitoneum due to ovarian bleeding was 0.09% of patients in the pooled analysis of 31 555 patients who received TVOR 4…”

“…In a comprehensive literature review, 43 cases of haemoperitoneum caused by ovarian haemorrhage due to TVOR were recorded out of 18 studies reviewed. Out of these 43 cases, only 1 case was treated with unilateral ovariectomy with suturing and electrocoagulation being the most common treatment options 4. In the case of ovarian haemorrhage and acute life-threatening bleeding, and when the contralateral ovary appears normal, oophorectomy can be justified given the greater risk and little benefit to leaving the ovary in place.…”

“…In the literature, there are very rare cases that describe severe complications from the procedure including onset of acute haemorrhage from the ovary or haematoma formation resulting from damage to vasculature supplying pelvic organs, ultimately requiring surgical intervention 3–5. The incidence of severe complications including haemoperitoneum following TVOR ranges from 0.08% to 0.22% 4.…”

“…In the literature, there are very rare cases that describe severe complications from the procedure including onset of acute haemorrhage from the ovary or haematoma formation resulting from damage to vasculature supplying pelvic organs, ultimately requiring surgical intervention 3–5. The incidence of severe complications including haemoperitoneum following TVOR ranges from 0.08% to 0.22% 4. In this report, we present the case of a nulliparous woman in her late 30s who presented to the hospital with severe abdominal pain following TVOR and was found to have extensive acute haemoperitoneum attributed to ovarian rupture.…”

Retrospective analysis on clinical characteristics and venous thromboembolism outcomes using bridging prophylaxis with low molecular weight heparin for thrombophilic women performing oocyte retrieval for assisted reproductive procedures: 15 years of experience

“…The rate of thrombosis and bleeding was compared to the rate of patients' ongoing IVF-ET with data available in Literature. [24][25][26]…”