OHSS Management GT5 Flashcards
What is the chance of developing severe OHSS requiring hospitilization in controlled ovarian hyperstimulation?
0.3%
What is the chance of developing mild OHSS in controlled ovarian hyperstimulation?
30%
What is the OHSS diagnosis:
Ovarian size 8-12cm
US evidence of ascites
Moderate OHSS
What is the OHSS diagnosis: Clinical ascites +/- hydrothorax Oliguria Haematocrit >45% Na <135 K > 5 Osmolality <282 Albumin <35 Ovarian size >12cm
Severe OHSS
What is the OHSS diagnosis: Tense ascites Haematocrit >0.55 WCC>25 Oliguria VTE ARDS
Critical OHSS
What electrolyte disturbance is often seen in severe OHSS?
Hyponatremia (56% cases)
What is the incidence of combined moderate and severe OHSS?
3-8%
What is recommended LMWH course for women hospitalized with OHSS?
Individualised for risk factors, but generally for the first 12/40
What is the main growth factor implicated in OHSS?
VEGF - increased vascular permeability and prothrombotic
What are the main risk factors for developing OHSS?
PCOS
Young age
Low BMI
How often should women with OHSS being treated as an outpatient be monitored?
Urgently if develop symptoms/signs of worsening OHSS
Every 2-3 days otherwise
When should women with OHSS be admitted?
- Unsatisfactory pain control
- Inadequate fluid intake
- Worsening OHSS
- Unable to attend regular follow up
- Critical OHSS (consider intensive care)
When should diuretics be considered in OHSS?
Generally avoid
May be useful under MDT if oliguria persists despite rehydration and drainage of ascites
When should paracentesis be considered in OHSS?
Severe abdominal distension/pain
SOB and respiratory compromise 2dry to ascites
Oliguria despite fluid replacement
May need IV colloid if large vols removed
How much blood volume is lost in the in acute phase of OHSS?
20%
