Persistent megalocystic ovary following in vitro fertilization in a postpartum patient with polycystic ovarian syndrome.

OBJECTIVE: Ovarian hyperstimulation syndrome (OHSS) is more severe when pregnancy occurs, as the developing pregnancy produces human chorionic gonadotropin, which stimulates the ovary's persistent growth. If no pregnancy occurs, the syndrome will typically resolve within 1 week. In a maintained pregnancy, slow resolution of symptoms usually occurs over 1-2 months. CASE REPORT: A 31-year-old woman, gravida 2, para 1, aborta 1, with polycystic ovary syndrome underwent in vitro fertilization (IVF) with clomiphene citrate and follicle-stimulating hormone/gonadotropin releasing hormone-antagonist stimulation. During transvaginal oocyte retrieval, enlarged bilateral ovaries were noted. She had an episode of OHSS after IVF/embryo transfer, for which paracentesis was performed three times. Pregnancy was achieved. Throughout antenatal examinations, bilateral ovaries were enlarged. She delivered a healthy baby by cesarean section at term. However, 1 month after delivery, the bilateral ovary had not shrunk, and levels of tumor markers CA125 and CA199 were 50.84 and 41.34 U/mL, respectively. At laparotomy for suspected malignancy, both adnexae formed "kissing ovaries", which were multinodulated with yellow serous fluid. Specimens from wedge resection submitted for frozen section showed a benign ovarian cyst. The final pathology report showed bilateral follicle cysts. CONCLUSION: With the increasing use of gonadotropins in the management of infertility, ovarian enlargement secondary to hyperstimulation is common. Generally, symptoms appear between the 6th and 13th weeks of pregnancy and disappear thereafter. The hyperstimulated ovary often subsides after the first trimester. This case is unusual as the megalocystic ovary persisted after delivery. To the best of our knowledge, we report the first case of enlarged bilateral ovaries persisting 2 months after delivery.

Umbilical cord stricture causing intrauterine fetal death in a 22-week fetus.

OBJECTIVE: Umbilical cord stricture is an uncommon but distinctive condition associated with intrauterine fetal death. Although cases have been reported periodically since the last century, there has been considerable speculation as to whether the condition is real or a postmortem artifact. CASE REPORT: A 27-year-old woman, G2P0SA0AA1, was diagnosed with intrauterine fetal death at 22 weeks' gestation. The dead fetus with Apgar score 0'->0' was delivered. The cord was twisted at the insertion site of the umbilicus. Neither growth restriction nor anatomic abnormalities were noted. CONCLUSION: Although the risk of recurrence has generally been thought to be low in the past, patients with a demise attributed to umbilical cord stricture should be counseled. The mechanism of cord stricture and how it leads to fetal death remain unknown. If the exact etiology of cord stricture can be determined, efforts may be directed at preventing a recurrence. Additional published cases may be helpful.