P-762 Intraabdominal Hemorrhage Following Ultrasound-guided Transvaginal Oocyte Retrieval: Retrospective Analysis of 25 Cases
Authors: Wang Z , Wen Y , Chen L 
Published: June 2022

Abstract

Study question
Intraabdominal hemorrhage is a rare but serious complication following (oocyte pick up, OPU), it is very important for clinicians to know the risk factors.

Summary answer
Intraabdominal hemorrhage is mild in most cases, laparoscopy or laparotomy is the most effective approach to stop bleeding quickly in severe intraabdominal hemorrhage cases.

What is known already
During the OPU procedure, intraabdominal hemorrhage is not visible without the assistance of ultrasound, even minor bleeding, if persists, may lead to life-threatening consequences. Previous publications had limited sample size and the analysis of serial cases was scarce, most studies focused on severe hemorrhage that necessitated surgical interventions and somehow neglected those with mild hemorrhage. The reported incidence of severe intraabdominal hemorrhage varied from 0.06% to 0.27%, while 0.08%-0.1% of patients required surgery.

Study design, size, duration
Retrospective study, 25 cases that underwent post-OPU intraabdominal hemorrhage and required hospitalization in our center since 2003 to January 2021.

Participants/materials, setting, methods
Patients underwent intraabdominal hemorrhage following OPU in a University-affiliated center needed to be hospitalized. We aimed to discuss the clinical characteristics, risk factors, and precautionary measures of intraabdominal hemorrhage following OPU procedures.

Main results and the role of chance
The incidence of intraabdominal hemorrhage following OPU procedures was 0.044%. In all 25 cases, 17 received conservative treatment while emergency surgical exploration was performed to stop bleeding quickly for the remaining patients. Primary symptoms included the following: abdominal distention and/or pain, chest distress, dizziness, syncope, tenesmus, palpitations, etc.48% and 92% of patients had obvious symptoms within the first hour and 12 hours following OPU, respectively. Pelvic hematoma and/or effusion were found under ultrasonic scan in all but three patients. Overall, the reduction in hemoglobin(ΔHb) and hematocrit (ΔHct) were 26.50±13.32 g/L and 7.70%±3.66%, respectively. The mean interval between OPU and surgical procedure was 29.88±18.80 hours. And the main intra-operative findings were laceration and/or active bleeding on the ovary and satisfied hemostasis was achieved through suture or electrocoagulation. The blood aspirated during the procedure was 1 563±548 ml on average. Before they got discharged, these patients stayed at hospital for 5.04 days on average. In addition, our data shows that intraabdominal hemorrhage following OPU does not affect the final pregnancy outcomes, the cumulative live birth rate per woman was 48% (12/25).

Limitations, reasons for caution
This study is limited by its retrospective nature. In addition, patients who underwent mild hemorrhage and received effective therapy in an outpatient clinic rather than hospitalization or elsewhere were not included, which might lead to underestimation of the incidence concerned.

Wider implications of the findings
Intraabdominal hemorrhage is a rare but serious complication following OPU, which might be life-threatening. Nonetheless, hemorrhage is mild in most cases and conservative treatment is the first-line choice. Laparoscopy or laparotomy is the most effective approach to stop bleeding quickly in severe intraabdominal hemorrhage cases.

Trial registration number
not applicable