Ovarian Hyperstimulation Syndrome Flashcards
What is OHS?
ovaries over respond to the hormone injections used to stimulate the growth of the follicles that contain the eggs.
What is it associated w
injection of hCG, used for inducing final oocyte maturation or triggering their release,
What is the main pathophysiology?
vasoactive products (particularly vascular endothelial growth factor)
What are the characteristics
ovarian enlargement
fluid shift from itrvascular to extravascular space, there is accumulation of fluid in peritoneal/pleural spaces
there is haemoconcentration and hypercoagulability due to reduced intravascular volume
What are RF
- Young
- Low BMI
- Polycystic ovaries
- Previous OHSS
What is presentation ?
Abdo discomfort
N&V
Abdo distension +/- dyspnoea
Usually 3-7 days after hCG administration
What is prevention?
lowest effective regimen of gonadatrophins
cycle cancellation if necessary
What is prevention in PCOS
in vitro maturation involves collecting immature eggs and avoids ovarian stimulation and risk of OHSS
What is the management of mild-mod OHS
Analgesia
Avoid NSAIDs
Don’t drink XS
Avoid strenuous activities, risk of ovarian torsion
Continue w progesterone luteal support, avoid hCG
What is management of severe OHS
Admit to hospital Analgesia + anti-emetics Daily bloods Strict fluid balance Daily assessment of girth (ascites), weight and legs (thrombosis) Thromboprophylaxis (stockings, LMWH) Paracentesis for symptomatic relief Catheter
What is management of critical OHS
ITU
Meticulous attention to fluid balance
What are the features of severe OHS?
Ascites oliguria >45% haematocrit hypoproteinaemia ovary >12cm
what are features of critical OHS?
tense ascites, haematocrit >55% WCC >25 oligo/anuria thromboembolism ARDS
