OHSS

Question 1

Specific OHSS history

Answer 1

• Ovarian stimulation cycle 7-10 days prior
• Medication used for trigger (hCG or GnRH agonist)
• Number of follicles on monitoring scan
• Number of eggs collected
• Were embryos replaced and how many?
• PCOS hx
• Abdominal pain
• Abdominal distension
• Nausea and vomiting
• Diarrhoea
• SOB
• Vulval swelling
• Low urine output
• VTE: swollen/sore calf; PE sx

Question 2

Specific OHSS exam

Answer 2

• General: dehydration, oedema, observations, body weight.
• Abdo: ascites, masses, peritonism, abdo girth
• Respiratory: pleural effusion, pneumonia, pulmonary oedema

Question 3

Investigations for OHSS

Answer 3

• Bloods: FBC, haematocrit, CRP, U&Es, serum osmolality, LFTs, coagulation studies, hCG (to determine outcome of cycle if embryo transferred)
• Imaging: USS pelvis
• Other tests may be indicated: ABG, D-dimer, ECG, CXR, CTPA or VQ scan

Question 4

Differential diagnoses for OHSS

Answer 4

• Ovarian: torsion, cyst accident
• Tubes: Ectopic pregnancy, pelvic infection/abscess.
• Abdo: appendicitis, bowel perforation

Question 5

Management of severe OHSS

Answer 5

• Admit to hospital
• Monitoring: may need HDU. Regular observations. Fluid balance/urine output/IDC. Abdo girth and daily weighs.
• Analgesia: avoid NSAIDs.
• Antiemetics
• VTE prophylaxis: TEDS, clexane
• Haemoconcentraction: drink to thirst; IVFs titrated to UO.
• Ascites: paracentesis
• Drain pleural and pericardial effusions
• MDT: involve ICU, anaesthestists, haematology, respiratory and renal.