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4: Y4 - Gynaecology [8] > [20] Ovarian Hyperstimulation Syndrome > Flashcards

[20] Ovarian Hyperstimulation Syndrome Flashcards

1
Q

What is the most serious consequence of ovulation due to assisted conception techniques?

A

Ovarian hyperstimulation syndrome

duh

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2
Q

What drugs more commonly cause ovarian hyperstimulation syndrome?

A
  • hCG

- Human menopausal gonadotrophin

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3
Q

When is ovarian hyperstimulation syndrome more common with clomiphene?

A

In PCOS

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4
Q

What happens in ovarian hyperstimulation syndrome?

A

The ovary may form 20 follicles or more and swell due to increased levels of hCG

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5
Q

What is released from the hyperstimulated ovaries?

A

Vasoactive mediators

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6
Q

What happens as a result of the vasoactive mediators released by the hyperstimulated ovaries?

A

Increase in capillary permeability leading to a fluid shift from the intravascular compartment to the third space compartment such as the peritoneal or thoracic cavities

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7
Q

What can cause morbidity/mortality in ovarian hyperstimulation syndrome?

A
  • Effusions
  • Haemoconcentration
  • Liver or kidney dysfunction
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8
Q

What effusions can cause problems in ovarian hyperstimulation syndrome?

A
  • Pericardial
  • Pleural
  • Ascites
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9
Q

What is the risk of haemoconcentration in ovarian hyperstimulation syndrome?

A

Risk of thrombosis and coagulopathy

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10
Q

What proportion of IVF cycles have a mild degree of ovarian hyperstimulation syndrome?

A

1/3

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11
Q

What % of IVF cycles have a moderate degree of ovarian hyperstimulation syndrome?

A

3-6%

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12
Q

What % of IVF cycles have a severe ovarian hyperstimulation syndrome?

A

0.1-2%

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13
Q

What are the risk factors for ovarian hyperstimulation syndrome?

A
  • PCOS
  • Under 30
  • Rapidly rising oestrogen levels and large number of follicles
  • Use of hCG for luteal phase support
  • Low body weight
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14
Q

When may symptoms of ovarian hyperstimulation syndrome first start?

A

Within 24 hours of hCG administration

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15
Q

When do symptoms of ovarian hyperstimulation syndrome tend to become severe?

A

After 7-10 days

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16
Q

What are the symptoms for mild to moderate ovarian hyperstimulation syndrome?

A
  • Mild to moderate abdo pain
  • Abdominal bloating and increased waist size
  • Nausea and vomiting
  • Diarrhoea
  • Tenderness in area of ovaries
  • Sudden weight increase of more than 3kg
17
Q

What are the symptoms of severe ovarian hyperstimulation syndrome?

A
  • Rapid weight gain e.g. 15-20kg in 10 days
  • Severe abdominal pain
  • Severe persistent nausea and vomiting
  • Blood clots in legs
  • Decreased urination
  • Shortness of breath
  • Tight or enlarged abdomen
18
Q

What is classified as mild ovarian hyperstimulation syndrome?

A
  • Abdominal bloating
  • Mild abdo pain
  • Ovarian size <8cm
19
Q

What is classified as moderate ovarian hyperstimulation syndrome?

A
  • Moderate abdo pain
  • Nausea and vomiting
  • USS evidence of ascites
  • Ovarian size 8-12cm
20
Q

What is classified as severe ovarian hyperstimulation syndrome?

A
  • Clinical ascites
  • Oliguria
  • Haemoconcetration haematocrit >45%
  • Hypoproteinaemia
  • Ovarian size usually >12cm
21
Q

What is classified as critical ovarian hyperstimulation syndrome?

A
  • Tense ascites or large hydrothorax
  • Haematocrit >55%
  • WCC > 25x10^/L
  • Thromboembolism
  • ARDS
22
Q

What monitoring is mandatory during drug treatment for IVF?

A

USS of ovaries

23
Q

What is measured in the ovaries during IVF treatment?

A

Rate of follicle growth

24
Q

What is done if rate of follicle growth in IVF treatment is excessive?

A

Treatment is cut back

25
Q

What are the investigations in severe ovarian hyperstimulation syndrome?

A
  • USS ovaries and abdomen
  • FBC
  • U&E’s and creatinine
  • Coagulation screen
  • LFTs
  • CXR
  • Measurement of abdominal girth
26
Q

How is ovarian hyperstimulation syndrome managed?

A

Conservatively until resolves spontaneously

27
Q

What happens if the patient is at risk of developing severe ovarian hyperstimulation syndrome?

A

hCG is withheld

28
Q

What happens to IVF cycle if ovarian hyperstimulation syndrome occurs?

A

Egg collection and insemination can occur but embryo should be frozen and not implanted in that cycle

29
Q

What are the key components to managing mild-to-moderate ovarian hyperstimulation syndrome?

A
  • Analgesia
  • Anti-emetics
  • Increase oral fluids and drink according to thirst
30
Q

What analgesics should be avoided in ovarian hyperstimulation syndrome?

A

NSAIDs

31
Q

How often should women with ovarian hyperstimulation syndrome be monitored if managed in the community?

A

Every 1-2 days

32
Q

Why may hospital admission be needed in moderate cases of ovarian hyperstimulation syndrome?

A

For prevention of thromboemoblism

33
Q

What care setting may be required in severe ovarian hyperstimulation syndrome?

A

Intensive care

34
Q

What monitoring is needed in severe ovarian hyperstimulation syndrome?

A

Fluid balance and electrolytes

35
Q

What electrolyte imbalance is common in severe ovarian hyperstimulation syndrome?

A

Hyponatraemia

36
Q

What immediate intervention can relieve symptoms of severe ovarian hyperstimulation syndrome?

A

Aspiration of ascites or pleural effusion

37
Q

What are the potential complicatiqons of ovarian hyperstimulation syndrome?

A
  • Thromboembolism
  • ARDS
  • AKI
  • Ovarian torsion
  • Death (rare)
38
Q

How can the risk of ovarian hyperstimulation syndrome be reduced?

A
  • Individualised stimulation regimes based on risk
  • Use of GnRH analogues rather than hCG
  • Freeze embryos and implanting in another cycle
  • Use metformin in women with PCOS
39
Q

What is the other significant risk of IVF?

A

Multiple pregnancy

4: Y4 - Gynaecology [8] (52 decks)

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