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Dr. Ajith Kumar J MD
Dept. of Emergency Medicne
Travancore Medicity, Kollam
India
editor
Ovarian Hyperstimulation Syndrome can occur following any form supraphysiological ovarian stimulation, including clomifene and gonadotrophin ovulation induction.
As many as 33% of IVF cycles has been reported to be assosciated with mild forms of OHSS.
A gain in weight of 3 kg following administration of hCG is an earliest sign of OHSS. Rapidly rasing estrogen levels or serum levels of estrogen >2500 pg/ml is suggestive of OHSS.
Classification of OHSS
Mild OHSS
Abdominal bloating
Mild abdominal pain
Ovarian size usually <8 cm
Moderate OHSS
Moderate abdominal pain
Nausea, vomiting
Ultrasound evidence of ascites
Ovarian size is usually 8 -12 cm
Severe OHSS
Clinical ascites
Oliguria
Haemoconcentration haematocrit >45%
Hypoproteinaemia
Ovarian size > 12cm
Critical OHSS
Tense ascites or large hydrothorax
Haematocrit
White cell count >25,000/ml
Oliguria/anuria
Thromboembolism
Acute respiratory distress syndrome
Monitoring of patients with OHSS
History and examination
Pain
Breathlessness
Hydration
Weight
Cardiovascular
Heart rate, blood pressure
Abdominal girth, distension, ascites
Intake & output charting
Investigation
Full blood count
Hb, Total count, haematocrit
RFT & electrolytes
LFT
Basline clotting studies
USG Abdomen and pelvis
Chest xray
ECG
Complication
Pleural effusion, pericardial effusion, ascites
Stroke
Thromboembolic episode
Ovarian torsion
Treatment
Preventing ovulation by withholding hCG is an effective method of avoiding hyperstimulation in overestimated ovaries.
Alternatively, aspiration of follicles 36 hrs after administration of the ovulatory dose of hCG may lower the risk of developing clinical hyperstimulation by reducing mass of luteinized granulosa cells.
Fluid resuscitation
Initial fluid resuscitation in a patient with hypotension is done using NS 1-2 L.
Urine output should be monitored; aim to maintain a output > 0.5ml/kg/hr
Further resuscitation is done using volume expanders and CVP guidance.
Volume Expander
Volume expanders like dextran, albumin can be used.
Albumin is the preferred volume expander. 200ml of albumin is given as an infusion over 4 hrs every day.
Hematocrit must be monitored every 4th hrly and volume expanders to be continued until HCT <38%.
Oral Indomethacin
They can be used as it reduces capillary permeability by blocking prostaglandin synthesis.
Diuretics should be avoided. Tapping should be done only if there is respiratory distress.
Updated on 29/11/13
Reference
Ovarian Hyperstimulation Syndrome ; The practice committee of the american society for reproductive medicine,2008.
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emmedonline
Dr. Ajith Kumar J MD
Dept. of Emergency Medicne
Travancore Medicity, Kollam
India
editor