Ovarian hyperstimulation syndrome: Difference between revisions
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==Diagnosis== | ==Diagnosis== |
Revision as of 03:30, 28 September 2015
Background
- Fertility treatments causing development of multiple follicles at once
- Fluid shifts out of vasculature
Clinical Features
- Ovarian enlargement
- Movement of fluid out of vasculature
- Ascites
- Pleural effusions
- Pericardial effusion
- Hypotension
- Electrolyte Imbalances
- DIC
- Thromboembolism
- Both venous and arterial
- Hypervolemic hyponatremia
Differential Diagnosis
- Ectopic Pregnancy
- Molar Pregnancy
- Sepsis
- PE
Acute Pelvic Pain
Gynecologic/Obstetric
- Pregnancy-related
- Ectopic Pregnancy
- Spontaneous abortion, threatened or incomplete
- Septic abortion
- Acute Infections
- Vulvovaginitis
- Adnexal Disorders
- Hemorrhage/rupture of ovarian cyst
- Ovarian torsion
- Twisted paraovarian cyst
- Other
- Myoma (degenerating)
- Genitourinary trauma
- Ovarian hyperstimulation syndrome
- Sexual assault
- Recurrent
- Mittelschmerz
- Primary/Secondary Dysmenorrhea
- Pelvic Congestion Syndrome
- Endometriosis
Genitourinary
Gastrointestinal
- Gastroenteritis
- Appendicitis
- Bowel obstruction
- Perirectal abscess
- Diverticulitis
- Inflammatory bowel disease
- Irritable bowel syndrome
- Mesenteric adenitis
Musculoskeletal
- Abdominal wall hematoma
- Psoas hematoma, psoas abscess
- Hernia
Vascular
- Pelvic thrombophlebitis
- Abdominal aortic aneurysm
- Ischemic bowel (Mesenteric Ischemia)
Diagnosis
- Urine pregnancy
- Pelvic ultrasound
- CBC
- Chem 10
- CXR
- Progesterone level
- Estradiol level
- PT/PTT
- Fibrinogen
- Beta-HCG may be positive if beta-HCG injection given as part of fertility treatment
Management
- Fluid Resuscitation
- Therapeutic paracentesis if necessary
- Self limited, resolved in 10-14 days
- Urgent GYN consultation
Disposition
- May require ICU admission for third spacing
- Admit all but most mild cases to monitored setting
See Also
References
- Up to Date
- William's Gynecology
- ↑ Norris DL, Young JD. UTI. EM Clin N Am. 2008; 26:413-30.