Ovarian hyperstimulation syndrome

Question 1

What is Ovarian hyper stimulation syndrome?

Answer 1

Complication of ovarian induction or superovulation
Presence of multiple luteinised cysts within the ovaries result in high levels of oestrogen, progesterone and VEGF

This results in increased membrane permeability and loss of fluid from intravascular compartment

Question 2

What are characteristics of OHSS?

Answer 2

Ovarian enlargement
Fluid shift from intravascular to extravascular space - peritoneum, pleura
Intravascular volume depletion - haemoconcentration and hypercoagulability

Question 3

What are risk factors for OHSS?

Answer 3

Young age
Low BMI
PCOS
hCG or gonadotrophin treatment

Question 4

How does mild/moderate OHSS present?

Answer 4

Mild:
Abdominal discomfort
Abdominal distension

Moderate
+ N/V
Dyspnoea

3-7d after hCG administration

Question 5

What is severe/critical OHSS?

Answer 5

Severe:
Ascites
Oliguria
Haemotcrit > 45%
Hypoproteinaemia

Critical:
VTE
ARDS
Anuria
Tense ascites

Question 6

What is management of mild/moderate OHSS?

Answer 6

Analgesia
Avoid NSAIDs (renal)
Drink to thirt
Avoid strenuous activity and intercourse due to risk of ovarian torsion
Continue with progesterone luteal support and avoid hCG
Review every 2-3d

Question 7

What is management of severe OHSS?

Answer 7

Clinical ascites, oliguria, haematocrit > 45%, hypoproteinaemia

Admit
Analgesia and anti-emetics (avoid NSAIDs)
Daily FBC, U&E, LFT< albumin
tract fluid balance
Daily weight and legs
Thromboprophylaxis with compression stockings and LMWH
Paracentesis for symptom relief (drain ascites)
Urinary catheter

Question 8

What is management of critical OHSS?

Answer 8

ITU
SEnior help
Drain pleural effusion
Fluid balance