Ovarian hyperstimulation syndrome
| Headline | |
|---|---|
| Etiology | Exogenous HCG used to stimulate (super)ovulation |
| Epidemiology | risk factors: previous history of OHSS, young age, lean physique, polycystic ovary syndrome, and multiple pregnancies |
| Clinical presentation | ascites, pulmonary oedema, hypovolaemia, renal failure, shock massively enlarged ovaries |
| Pathogenesis | vasoactive products released by hyperstimulated ovaries → ↑ capillary permeability |
| Diagnostic investigations | hyponatraemia, hyperkalaemia Serum osmolality (hypo-osmolality) Liver function tests (elevated enzymes and reduced albumin) Coagulation profile (elevated fibrinogen and reduced antithrombin) Pelvis USS: enlarged ovaries low serum IgG |
| Management | emp abx ↑ risk pre-eclampsia |
Severity criteria
Severe OHSS
Clinical ascites (± hydrothorax)
Oliguria (< 300 ml/day or < 30 ml/hour) Haematocrit > 0.45
Hyponatraemia (sodium < 135 mmol/l) Hypo-osmolality (osmolality < 282 mOsm/kg) Hyperkalaemia (potassium > 5 mmol/l) Hypoproteinaemia (serum albumin < 35 g/l)
Ovarian size usually > 12 cm
Critical OHSS
Tense ascites/large hydrothorax
Haematocrit > 0.55
White cell count > 25 000/ml
Oliguria/anuria
Thromboembolism
Acute respiratory distress syndrome