# Multiple Pregnancy (Quintuplets) and Treatment Considerations for Critical Ovarian Hyperstimulation Syndrome

## TL;DR

A woman with quintuplets developed severe ovarian hyperstimulation syndrome requiring emergency treatment to save her life.

## Contribution

This case highlights the extreme severity of OHSS in quintuplet pregnancies and the necessity of urgent maternal-focused interventions.

## Key findings

- OHSS severity increased dramatically with quintuplet pregnancy after controlled ovarian stimulation.
- Therapeutic uterine evacuation was critical for rapid maternal stabilization in life-threatening OHSS.
- Multidisciplinary care is essential in managing OHSS complicated by multiple gestation.

## Abstract

Ovarian hyperstimulation syndrome (OHSS) associated with multiple gestation is often severe, necessitating a multidisciplinary approach. We report a case of OHSS that demonstrated a two-stage progression of severity, induced by controlled ovarian stimulation (COS) and a subsequent quintuplet pregnancy. This report details an exceptionally severe case of critical OHSS in a woman following COS that was profoundly exacerbated by quintuplets. The patient developed a life-threatening clinical course characterized by massive third-space fluid shifts, manifesting as significant ascites, pleural effusion, and subsequent hemodynamic instability. This condition necessitated aggressive multidisciplinary management. Therapeutic uterine evacuation was performed as a lifesaving measure for maternal stabilization, resulting in rapid clinical resolution. This case illustrates the pivotal importance of a coordinated multidisciplinary approach in managing these complex scenarios and underscores that pregnancy termination must be considered a definitive therapeutic intervention when maternal life is acutely compromised, despite the inevitable and significant delay to future fertility treatments.