Table IV.
Serious complications of OPU reported in case reports (published between 1998 and 2018)
| Complication | Case report | Clinical signs/symptoms (day of OPU) | Clinical signs/symptoms (post-OPU) | Clinical signs/symptoms (during pregnancy) | Management | |
|---|---|---|---|---|---|---|
| Bleeding | Intra-abdominal bleeding | (Mashiach et al., 2013) | None |
OPU + 2 days:
- Severe abdominal and shoulder pain - Abdominal bloating Tenesmus |
Exploratory laparoscopy—The vessel was successfully coagulated | |
| None |
OPU + 3 days:
- Lower abdominal pain - Dyspnoea with stable Hb concentration (10.43–10.95 g/dl). OPU + 4 days: - Pale and tachycardiac, with a drop in Hb level (8.84 g/dl) that continued (8.66 g/dl) despite blood transfusion |
Laparoscopy—the tear was successfully coagulated with an accurate haemostasis | ||||
| (Kart et al., 2011) | None |
OPU + 10 days:
- Severe abdominal pain - Vomiting - Vaginal bleeding for 3 days |
Transfusion with 2 units of fresh-frozen plasma and packed red blood cell Percutaneous transcatheter pelvic angiography + immediate bilateral uterine artery embolization |
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| Massive retroperitoneal bleeding | (Azem et al., 2000) |
OPU + 10 h:
- Severe lower abdominal pain - Vomiting - Tenesmus |
OPU + 10 days: | Laparotomy—retroperitoneal haematoma evacuated and drained Recurrence of symptoms after 10 days— treated with IV antibiotics |
||
| Haemoperitoneum | (Chatrian et al., 2012) |
OPU + 3 h:
- Abdominal pain - Blood pressure: normal - Pulse rate: 70 beats per minute. - No fever - Abdomen rebound defence - Haemoglobin level (Hb): 99 g/l - Haematocrit: 29% |
Emergency laparoscopy (7 h post-TVOR) The only way to stop the bleeding was by using an absorbable fibrinogen and thrombin sealant sponge, which was applied around the ovary During laparoscopy three pints of packed red blood were administered |
|||
| Pseudoaneurysm | Pelvic pseudoaneurysm | (Pappin and Plant, 2006) |
12 weeks gestation:
- Painless vaginal bleeding |
Angiography demonstrated the aneurysm to originate from anterior branches of the left internal iliac artery close to the lower uterus and cervix. Drainage was via a leash of vessels both locally and across the midline to the right internal iliac circulation. Selective embolization was performed with coils and intra-arterial thrombin | ||
| Pseudoaneurysm of the internal iliac artery | (Bozdag et al., 2004) |
29 weeks gestation:
- No symptoms during a follow-up visit, a unilocular, anechoic mass with a diameter of 40 mm was noted on the left upper side of the uterus. The Doppler examination was consistent with a (pseudo)aneurysm |
After delivery; the pseudoaneurysm of the left inferior pudendal artery was completely embolized with 1 mL (50%) of N-butyl-2-cyanoacrylate | |||
| Haemorrhage from a pseudoaneurysm of the obturator artery | (Bolster et al., 2014) |
OPU + 4 days:
- life threatening haemorrhagic shock |
Surgical laparotomy followed by CT and selective angiography. The haemorrhage was successfully managed endovascularly with a vessel preserving covered stent | |||
| Infection | Pelvic abscess | (den Boon et al., 1999) |
End of 2nd trimester:
Rupture of bilateral ovarian abscesses |
Emergency laparotomy was necessary because of an acute abdomen Severe maternal and neonatal morbidity, preterm birth and neonatal death |
||
| (Patounakis et al., 2012) |
Gestation of 11 weeks + 2 days:
- left lower quadrant abdominal pain. Serial pelvic US showed growth of the mass from 13.2 to 15 cm over 3 days and a viable twin pregnancy (Streptococcus anginosus) |
Left salpingo-oophorectomy for resection of the mass. Complete spontaneous pregnancy loss by vaginal delivery of both foetuses on post-operative day 1 |
||||
| (Asemota et al., 2013) |
OPU + 6 days:
Actinomycosis pelvic abscess
- Urinary retention - Pelvic pain - Fever |
6 days of intravenous antibiotics CT-guided drainage of the pelvic abscesses |
||||
| Infection | Tubo-ovarian abscess | (Han et al., 2015) |
Gestation of 31 weeks and 2 days
- Lower abdominal pain for 8 h |
Emergent exploratory laparotomy and Caesarean section to terminate gestation. +IV antibiotics | ||
| (Kim et al., 2013) |
7th week of gestation:
- Intermittent right lower abdominal pain. US: 1 foetus appropriate for gestational age and growth of the mass (10.6 × 7.4 cm) 14 weeks: - Right abdominal pain |
Laparoscopy. The abscess was encapsulated within the ovary and there was no pus within the pelvis. IV cefotiam (1 g every 12 h for 10 days) and metronidazole (500 mg every 8 h for 5 days) Spontaneous delivery at 37 weeks and 3 days of gestation without any complications |
||||
| (Romero et al., 2013) |
OPU + 1 month:
- 8 cm pelvic abscess |
Surgical drainage | ||||
|
OPU + 2 months:
- 9 cm pelvic abscess |
IV antibiotics (did not resolve) + surgical drainage | |||||
|
OPU + 3 weeks:
- 9 cm pelvic abscess |
IV antibiotic treatment (favourably response) + surgical drainage and right adnexectomy | |||||
| (Yalcinkaya et al., 2011) | Early pelvic infection | Broad spectrum antibiotics TV-US-guided drainage was performed, posterior colpotomy and T-drain replacement into the cul-de-sac. (OPU + 9 days) Pregnancy follow-up uncomplicated |
||||
| (Van Hoecke, 2013) | Bacteraemia due to actinomyces urogenitalis. Bacteraemia was secondary to a tubo-ovarian abscess | |||||
| (Kelada and Ghani, 2007) |
OPU + 16 days:
- Left iliac fossa pain for 5 days. - Diarrhoea - Vomiting 3 times - Fresh vaginal bleeding. Bilateral ovarian abscesses (staphylococci) |
Laparotomy, a large amount of pus was drained on incising the capsule of each ovary. The peritoneal cavity was washed with normal saline. Two drains were placed through the abdominal wall in the pouch of Douglas IV Gentamicin and Clindamycin were continued post-operatively |
||||
| (Sharpe et al., 2006) |
30 weeks gestation:
- Low-grade fever |
Broad-spectrum antibiotics Abscess was drained percutaneously after Caesarean delivery of twins |
||||
| (Matsunaga et al., 2003) |
16 weeks gestation:
- Fever - Lower abdominal pain 20 weeks gestation: readmitted - Fever - Lower abdominal pain - Small amount of bloody discharge |
Treatment with IV antibiotics Left salpingo-oophorectomy after delivery Delivered at 22 weeks of gestation |
||||
| (Varras et al., 2003) | - Abdominal pain, fever and leukocytosis | |||||
| Infection | Pelvic infection (gram-positive cocci arranged in chains similar to group A b-haemolytic streptococci.) | (El-Toukhy and Hanna, 2006) |
OPU + 1 day:
- Tiredness - Nausea - Lower - Abdominal pain. - Tachycardic, normotensive and afebrile - Mild abdominal distension and tenderness - Cervical motion tenderness |
IV hydration with physiological saline solution and human albumin 4.5% infusion for suspected OHSS. IV antibiotics |
||
| Spondylodiscitis | (Debusscher et al., 2005) |
OPU + 1 day:
- Increasing pelvic and sacroiliac pain OPU + 2 days: - Unbearable pain - Tenderness in lumbosacral area without neurological implications - CRP of 14.2 mg/dl Later - Chills and fever |
IV antibiotics Surgery; the lumbosacral joint was carefully débrided and filled up with a tricortical iliac crest graft. Oral antibiotics continued for 8 months |
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| Infectious spondylitis (Staphylococcus aureus) | (Kim et al., 2015) |
OPU + 14 weeks:
- Lower back pain over the past 3 weeks. Lumbar spine magnetic resonance imaging showed infectious spondylitis |
Intravenous cefazolin was continued for 6 weeks Delivery healthy baby |
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| Pyometra (vancomycin-resistant enterococci) | (Nikkhah-Abyaneh et al., 2010) |
OPU + 4 weeks:
- High fever, chills - No gynaecologic symptoms OPU + 6 weeks: - Unrelenting fever - Abdominal pain |
Antibiotics After recurrence of symptoms: hysterectomy, (showing autolyzed endometrium, sub-serosal and intramural abscess) |
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| Vertebral osteomyelitis | (Almog et al., 2000) |
OPU + 0 h:
- Low back pain |
OPU + 1 week:
- Fever OPU + 2 weeks: - Elevated erythrocyte sedimentation rate |
Treated with antibiotics | ||
| Urinary tract injury | Ureteric/ureteral injury | (Choudhary et al., 2017) |
OPU + 0 h:
- Ureteric injury identified immediately during post-procedure US |
A double-J catheter was inserted under cystoscopic guidance. (in the same sitting) | ||
| (Catanzarite et al., 2015) |
OPU + 4 h:
- Gross haematuria. Cystoscopy, laparoscopy, and retrograde pyelography revealed bleeding from the left ureter, no intra-abdominal bleeding, and a patent left urinary collecting system |
The ureteral bleeding was successfully managed with placement of a ureteral stent | ||||
| (Vilos et al., 2015) |
OPU + 0 h:
- Ureteric injury identified immediately |
Treated with ureteral stents with full resolution. During a subsequent IVF cycle, stenting allowed better visualization, resulting in an uneventful retrieval and subsequent pregnancy |
||||
| (Burnik Papler et al., 2015) |
OPU + 1 day:
- Abdominal pain OPU + 4 days: - Massive haematuria OPU + 6 days: - Reappearing haematuria No signs of renal dysfunction or urinary leakage into retroperitoneal space |
Monopolar coagulation with wire electrode and insertion of a double-J-stent during operative cystoscopy | ||||
| (Grynberg et al., 2011) |
OPU + 1 day:
- Acute pelvic pain Later - Recurrence of the pelvic pain with radiation to the right lumbar region |
Cystoscopy with uncomplicated right ureteral stent placement | ||||
| (Fiori et al., 2006) |
OPU + 2 h:
- Severe abdominal pain - Dysuria - Mild tachycardia - No vaginal bleeding - No vesical globe |
OPU + 1 day:
- Fever (38.4°C) - Nausea - Vomiting - Urinary urgency - Bladder tenesmus Acute-onset uro-retroperitoneum |
Intravenous antibacterial therapy Cystoscopy and right ureteral stenting |
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| Urinary tract injury | Bladder injury with haematuria and urinary retention | (Modder et al., 2006) |
OPU + 8 h:
- Urinary retention - Supra-pubic pain |
Foley catheter, intravenous fluid bolus, bladder irrigation, and computed tomography with post-void films that showed a blood clot in the bladder | ||
| Acute ureteral obstruction | (Miller et al., 2002) |
OPU + 7 h:
- Right lower quadrant and right flank pain with nausea and emesis - Normal temperature and blood pressure with mild tachycardia |
Cystoscopy and right ureteroscopy with ureteral stent placement | |||
| Ureterovaginal fistula | (Spencer et al., 2017) |
OPU + 0 h:
- Severe abdominal pain - Vaginal leakage |
Placement of the left ureteral stent The IVF cycle was converted to a freeze-all cycle |
|||
| (Mongiu et al., 2009) |
OPU + 2 days:
- Fever - Worsening episodes of cramping right lower quadrant abdominal pain Embryo transfer + 2 days: - Vaginal leakage of fluid (slowly increasing) OPU + 21 days: - Continuing fluid leakage (urine) - No fever or pain |
A percutaneous nephrostomy tube was placed using US guidance, and the fistula was allowed to close secondarily | ||||
| (von Eye et al., 2006) |
OPU + 0 h:
- Right lower abdominal pain with irradiation to the supra-pubic area - Vaginal discharge |
A double-J catheter was inserted under general anaesthesia. | ||||
| Other | Acute psychiatric episode | (Hwang et al., 2002) |
OPU + 0 h:
- Acute psychiatric episode (Tachycardia, tachypnoea, transient hypertension and limb rigidity, alterations to stupor and posture) OPU + 9 h: - Unresponsive to stimuli |
OPU + 1 day:
- Aphasia - Wishful thinking of having delivered a baby OPU + 3 days: - Memory loss |
Supportive psychotherapy | |
| Acute portal vein thrombosis | (Mmbaga et al., 2012) |
OPU + XX days:
- Worsening, right upper quadrant pain |
Therapeutic anticoagulation | |||
| Other | Anaphylactic shock | (Iikura et al., 2002) |
End of OPU: anaphylactic shock - Decrease in blood pressure (<50 mm Hg) - Tachycardia (pulse rate 150 beats/min) - Systemic urticarial reactions - Abdominal pain |
Treatment, including epinephrine | ||
|
Middle of an OPU:
- Anaphylactic shock |
Treatment, including epinephrine | |||||
| Pelvic tuberculosis | (Annamraju et al., 2003) | - No change in her bowel or bladder function - Regular periods - No fever, cough, weight loss, or loss of appetite Painless left lower abdominal mass, growing slowly during a 3-month period |
Drainage of the ovarian abscess and biopsy | |||
| Peri-umbilical haematoma (Cullen’s sign) | (Bentov et al., 2006) | - |
OPU + 3 days:
- Urinary tract infection Physical examination revealed a non-tender bluish discoloration around umbilicus |
IV cefuroxime and metronidazole | ||
| - |
OPU + 1 week:
- Abdominal pain Abdominal inspection revealed a peri-umbilical haematoma with dark red-blue color |
Laparoscopy: bilateral ovarian torsion was found and detorsion was performed + aspiration of a few large corpora lutea | ||||
| Severe bradycardia and bradypnoea | (Ayestaran et al., 2000) |
OPU + 85 min:
- Severe bradycardia and bradypnoea |
Emergency application of a pacemaker | |||
| Intra-abdominal needle rupture | (Sõritsa et al., 2017) | Nonz | CT-scan to locate the broken needle and laparoscopy to remove it |
CT, computerized tomography; US, ultrasound.