A 32-year-old woman with PCOS undergoing ovarian stimulation for IVF develops abdominal distension, nausea, and shortness of breath 5 days after oocyte retrieval. Her oestradiol on trigger day was 4200 pg/mL and 18 follicles were retrieved. The most life-threatening complication to anticipate is:

• A Ovarian torsion
• B Haemoperitoneum from follicle puncture
• C Pelvic infection after oocyte retrieval
• D Ovarian hyperstimulation syndrome with thromboembolic complication ✓

Explanation

Ovarian hyperstimulation syndrome (OHSS) in its severe form causes third-space fluid shift, haemoconcentration, and hypercoagulability — making venous thromboembolism (especially internal jugular and upper extremity DVT) the most life-threatening complication. High oestradiol on trigger day and large number of follicles are classic risk factors. Presentation 5 days post-retrieval aligns with the late OHSS pattern triggered by hCG from implantation. Prophylactic anticoagulation and albumin are used in management.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

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Written and medically reviewed by the StethoPrep medical team.