EFFECTS OF REPEATED ABDOMINAL PARACENTESIS ON UTERINE AND INTRAOVARIAN HEMODYNAMICS AND PREGNANCY OUTCOME IN SEVERE OVARIAN HYPERSTIMULATION SYNDROME

The aims of this study were to investigate the effects of paracentesis on uterine and intraovarian haemodynamics by colour Doppler ultrasoun d and the influences of repeated paracentesis on pregnancy outcome in severe ovarian hyperstimulation syndrome (OHSS), Forty-one abdominal p aracenteses were performed on seven pregnant women with tense ascites and eight thoracocenteses were performed on three pregnant women with pleural effusion. Pulsatility index (PI) and maximum peak systolic vel ocity (MPSV) of uterine and intraovarian arteries were measured before and after each intervention. The mean PI of uterine arteries was decr eased significantly after paracentesis, but not after thoracocentesis. Furthermore, uterine PI was decreased in 13 out of 14 (92.9%) paracen teses with <2500 mi ascites removed, compared with eight out of 13 (61 .5%) with >2500 mi ascites removed. After paracentesis, there were no significant changes in the intraovarian PI and MPSV in either group. T he 24-hour urine output increased significantly in the paracentesis gr oup, but not in the thoracocentesis group. There were no significant c hanges in haematocrit and electrolytes as a result of paracentesis. Ho wever, gradual falls in serum total proteins and albumin concentration s were observed in all patients after repeated paracentesis, necessita ting post-paracentesis albumin infusion. There was no significant diff erence in miscarriage rates between the two groups. We conclude that r epeated abdominal paracentesis increases uterine perfusion and has no adverse effects on pregnancy outcome in severe OHSS, Extraction of 250 0 mi of ascitic fluid did not impair uterine perfusion.