Ovarian hyperstimulation syndrome

Background

  • Fertility treatments causing development of multiple follicles at once
  • Fluid shifts out of vasculature

Clinical Features

Differential Diagnosis

Pelvic Pain

Pelvic origin

Abdominal origin

Evaluation

Workup

Evaluation[1].

Classification Clinical features Lab findings
Mild Normal
Moderate Above plus:
  • Ultrasonographic evidence of ascites
  • Elevated hematocrit (>41%)
  • Elevated WBC (>15,000/mL)
  • Hypoproteinemia
Severe Above plus:
  • Hemoconcentration (hematocrit >55%)
  • WBC >25,000/mL
  • Serum creatinine >1.6mg/dL
  • Creatinine clearance <50 mL/min
  • Hyponatremia (Na+ <135 mEq/L)
  • Hyperkalemia (K+ >5 mEq/L)
  • Elevated liver enzymes
Critical Above plus: Worsening findings


Management

Pregnant patients must be followed very closely, as they are likely to worsen

  • Urgent GYN consultation for all

Mild

  • Pain control
  • Encourage oral fluids (1-2 liters/day)
  • Ambulate, but avoid other physical activity. Avoid sexual intercourse

Moderate

  • IV fluids (e.g normal saline)
  • Threaputic paracentesis if ascites (aspirate 0.5-4 L)
  • Thromboembolic prophylaxis (e.g. LMWH)
    • All hospitalized patients
    • Outpatients with 2-3 risk factors:
      • Age >35 years
      • Obesity
      • Immobility
      • Personal or family history of thrombosis
      • Thrombophilias
      • Pregnancy

Severe

Critical

  • As above + resuscitative care

Disposition

  • Mild: outpatient
    • Avoid heavy physical activity
    • Return for
      • Worsening abdominal pain
      • Weight gain (>1 kg/day)
      • Increasing abdominal girth
  • Moderate: outpatient if close follow-up (discuss with GYN)
  • Severe: admit
  • Critical: ICU

Complications

See Also

References

  1. Navot D, Bergh PA, Laufer N. Ovarian hyperstimulation syndrome in novel reproductive technologies: prevention and treatment. Fertil steril 1992; 58:249. From: Fiedler K, Ezcurra D. Predicting and preventing ovarian hyperstimulation syndrome (OHSS): the need for individualized not standardized treatment. Reprod Biol Endocrinol 2012; 10:32. Copyright © 2012 Fiedler and Ezcurra. Reproduced from BioMed Central Ltd

Authors:

Ross Donaldson