title: Severe haematoperitoneum caused by ovarian bleeding after transvaginal oocyte retrieval: a retrospective analysis and systematic literature review.
abstract: A case series of haematoperitoneum caused by ovarian bleeding after transvaginal oocyte retrieval (TVOR) is presented and all published cases summarized. In a retrospective case series, four patients with ovarian bleeding after TVOR were included. In addition, a pooled analysis of all published cases (n = 32) who underwent surgical intervention for severe haematoperitoneum caused by ovarian bleeding after TVOR was carried out. Main outcome measures were incidence, risk factors, course and intraoperative findings. In the pooled analysis, the incidence was 0.08%. The first sign of haematoperitoneum was evident in 33.3% within the first postoperative hour, and, cumulatively, in 93.3% within 24 h. The median time between TVOR and surgical intervention was 10 h. In four patients, the ovary could not be preserved, which was associated with a longer time interval between TVOR and the onset of symptoms (median 18 h versus 2.5 h; P = 0.004) as well as between TVOR and surgical intervention (median 21.5 h versus 8.5 h; 0.004). In conclusion, severe haematoperitoneum occurs in 0.08% after TVOR. Late-onset bleeding is common. A longer time interval between TVOR and surgical intervention might put a patient at risk of ovariectomy.
authors.affiliation: Division of Gynecologic Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
authors.forename: Kazem
authors.initials: K
authors.lastname: Nouri
authors.affiliation: Division of Gynecologic Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
authors.forename: Katharina
authors.initials: K
authors.lastname: Walch
authors.affiliation: Department of Surgery, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
authors.forename: Regina
authors.initials: R
authors.lastname: Promberger
authors.affiliation: Division of Gynecologic Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria.
authors.forename: Christine
authors.initials: C
authors.lastname: Kurz
authors.affiliation: Department of Obstetrics and Gynecology, Ruhr University Bochum, Bochum, Germany.
authors.forename: Clemens B
authors.initials: CB
authors.lastname: Tempfer
authors.affiliation: Division of Gynecologic Endocrinology and Reproductive Medicine, Department of Obstetrics and Gynecology, Medical University of Vienna, Währinger Gürtel 18-20, A-1090 Vienna, Austria. Electronic address: johannes.ott@meduniwien.ac.at.
authors.forename: Johannes
authors.initials: J
authors.lastname: Ott
mesh_terms: D001317:Austria; D005260:Female; D006465:Hemoperitoneum / Q000209:etiology*; D006470:Hemorrhage / Q000150:complications / Q000209:etiology* / Q000473:pathology; D006801:Humans; D054315:Oocyte Retrieval / Q000009:adverse effects*; D010052:Ovariectomy; D010053:Ovary / Q000473:pathology*; D010529:Peritoneal Cavity / Q000473:pathology*; D012189:Retrospective Studies; D013997:Time Factors
keywords: bleeding; hematoperitoneum; in-vitro fertilization; oocyte retrieval; topical hemostatic agents