REI Flashcards
outpatient OHSS - clinical review how often?
every 1-2 days
OHSS occurs after:
a LH surge or exposure to hCG
reported incidence of moderate OHSS after gonadotrpin superovulation
3-6%
reported incidence of severe OHSS
0.1-2%
reported incidence of mild OHSS
20-33% of IVF cycles
pathophysiology of OHSS
increased vascular permeability leading to a fluid shift and subsequent dehydration, loss of end organ perfusion, oliguria
mediators involved in OHSS pathophysiology
VEGF,
ATII,
ILGF-1,
IL-6
mediator correlated to severity of OHSS
VEGF
risk factors for severe OHSS
- age <30
- PCOS or high AFC
- rapidly rising or high serum estradiol
- previous hx OHSS
- large number of small follicles during stimulation
- use of hCG as opposed to progesterone for luteal phase support
- large number of oocytes retrieved (>20)
- early pregnancy
mild OHSS
- abdominal bloating
- mild abdo pain
- ovarian size <8cm
moderate OHSS
-moderate abdo pain
- n/v
- USS evidence of ascites
- ovarian size 8-12cm
severe OHSS
- clinical ascites or pleural effusion
- oliguria
- HCT>45%
- hypoproteinemia
- ovaries >12cm
critical OHSS
- tense ascites or large pleural effusion
- hct >55%
- WBC >25
- oligura/anuria
- VTE
- ARDS
initial presentation of OHSS is most often (symptom?):
abdominal boating secondary to an increase in ovarian size
OHSS symptoms usually become most severe at
7-10 days after hCG
(usually associated with the rise of endogenous hCG)
