Vaginal bleeding

During ultrasound-guided trans-vaginal oocyte aspiration, multiple punctures of the vaginal vault, or inappropriate handling and rotation of the ultrasound vaginal probe while inserting the aspiration needle through the vaginal vault, can injure or tear the vaginal mucosa, ovaries, intra-abdominal organs, or blood vessels. Bleeding from the vaginal vault is a common consequence of ovum pick-up, with a reported incidence of 1.4 to 18.4%. In most cases, vaginal bleeding stopped spontaneously at the end of the procedure. In cases in which it does not stopped, the site of bleeding need to identifies, followed by application of pressure with sponge forceps or vaginal packing. If this is unsuccessful, or the tear is wide and deep, suturing is necessary.
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Female pelvic vascular supply

Intraperitoneal or retroperitoneal bleeding

Transvaginal oocyte aspiration can also cause bleeding if intraperitoneal and retroperitoneal pelvic blood vessels are injured or if there is damage to the fine vascular network surrounding the punctured ovarian follicles. The reported incidence of severe intra or retroperitoneal hemorrhage various between 0.1 to 1.3%.
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Retroperitoneal bleeding. Puncture site is noted

Intraperitoneal bleeding tends to be severe with acute hemodynamic deterioration, while reproperitoneal bleeding usually has a later and more indolent presentation.
Intraperitoneal bleeding should be suspected immediately after egg collection in case the patients complains on weakness, dizziness, dyspnea, or presented with tachycardia and anemia is noted. A drop in hemoglobin concentration is an immediate indication for blood transfusion. If hemodynamic deterioration continues, or acute abdominal pain develops; diagnostic laparoscopy or laparotomy with subsequent homeostasis is required.

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An ultrasound scan of intraperitoneal bleeding   
Laparoscopy visualization of intraperitoneal bleeding

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                                                       An ultrasound scans of intraperitoneal bleeding
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