Persistent Ascites in the Puerperium in the Context of a Mosaic Turner Who Conceived through ART

The case is about a young female who delivered twins by c section. At the 4th postoperative day, the
lady presented with - resistant to empirical antibiotic and diuretic treatment - ascites. The woman was
a mosaic Turner’s (XO), who conceived through Assisted Reproduction Techniques (ART) - IVF -
oocyte donation and she had a medical background of chronic use of hormonal medication since
puberty.
Thrombophilia, myelodysplastic syndrome, paroxysmal nocturnal hemoglobinuria have to be
excluded. Obstruction of the outflow (Budd Chiari syndrome) or inflow (portal vein thrombosis) tract of
the liver and thrombosis of the small sinusoids can lead to portal hypertension and ascites. CT
angiography, perfusion studies using contrast and Doppler studies, can help in establishing the
diagnosis. The appropriate, "aggressive" anticoagulation is the main treatment.
Surgical causes have to be primarily excluded in the case of post-operative peritoneal fluid
accumulation. Beyond that, pregnancy is a hyperdynamic hypercoagulative condition during which
possible preexisting pathologies may come to surface and lead to morbidity. High suspicion of clot
formation in the hepatic vasculature is paramount, especially in the case of history of hormonal
treatment.