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

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.