title: Sextuplet heterotopic pregnancy presenting as ovarian hyperstimulation syndrome and hemoperitoneum.
abstract: OBJECTIVE
  To describe a case of bilateral ruptured heterotopic pregnancies presenting as persistent ovarian hyperstimulation syndrome in a quadruplet pregnancy.
  
  
  METHODS
  Case report.
  
  
  METHODS
  University hospital and clinic.
  
  
  METHODS
  An infertile patient who conceived using gonadotropin therapy.
  
  
  METHODS
  Culdocentesis with resultant aspiration of sanguinous fluid prompted laparoscopic exploration and bilateral salpingectomies.
  
  
  METHODS
  Not applicable.
  
  
  RESULTS
  Gross hemoperitoneum and ruptured bilateral heterotopic sextuplet pregnancy.
  
  
  CONCLUSIONS
  Patients who conceive after gonadotropin therapy should be closely monitored during treatment and in early pregnancy to recognize and minimize morbidity and complications. After superovulation, the presence of an intrauterine pregnancy, either single or multiple, does not rule out the possibility of ectopic pregnancy, and this should always be considered as a possibility in the setting of acute anemia.
authors.affiliation: Department of Obstetrics and Gynecology, Stanford University, Stanford, California 94305, USA. sfisher@stanford.edu
authors.forename: Stephanie L
authors.initials: SL
authors.lastname: Fisher
authors.forename: Jamie A M
authors.initials: JA
authors.lastname: Massie
authors.forename: Yair J
authors.initials: YJ
authors.lastname: Blumenfeld
authors.forename: Ruth B
authors.initials: RB
authors.lastname: Lathi
mesh_terms: D000740:Anemia / Q000209:etiology; D003951:Diagnostic Errors; D005260:Female; D005865:Gestational Age; D006465:Hemoperitoneum / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D006801:Humans; D007247:Infertility, Female / Q000628:therapy*; D010535:Laparoscopy; D009099:Multiple Birth Offspring; D016471:Ovarian Hyperstimulation Syndrome / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D010062:Ovulation Induction / Q000009:adverse effects*; D011247:Pregnancy; D018607:Pregnancy Reduction, Multifetal; D011274:Pregnancy, Tubal / Q000175:diagnosis / Q000209:etiology* / Q000601:surgery; D011783:Quadruplets; D058994:Salpingectomy; D016896:Treatment Outcome