Volume 3 Supplement 1

19th International Symposium on Intensive Care and Emergency Medicine

Open Access

Ovarian hyperstimulation syndrome (OHSS) at a maternity hospital

  • V Lappas1,
  • P Myrianthefs1,
  • C Ladakis1,
  • S Pactitis1,
  • A Carousou1,
  • J Stamatiou1 and
  • G Baltopoulos1
Critical Care20003(Suppl 1):P234

https://doi.org/10.1186/cc607

Published: 16 March 2000

Background

Ovarian hyperstimulation syndrome (OHSS) is a clinically important entity due to assisted conception which occurs in about 1-10% of in vitro fertilization (IVF) cycles with serious complications such as deep vein thrombosis, hypovolaemia, haemorrhage, respiratory distress and hepato-renal failure.

Objective

The aim of this study was to describe our experience with OHSS at 'IASO' Maternity Hospital.

Materials and methods

The last year seven patients with age 30 ± 2.4 (X ± SEM) were admitted in our ICU due to severe ovarian hyperstimulation syndrome complications.

Results

Signs and symptoms (Table 1) and labs (Table 2) were due to third space fluid shift (increased capillary permeability) with evidence of hypovolaemia, haemoconcentration and dehydration.

Ultrasound examination of the abdomen showed ascites, pelvic fluid and enlarged ovaries (in our patients > 11 cm in diameter) in all patients and chest X-ray revealed hydrothorax in five patients (71%). Ovarian hyperstimulation syndrome clinical feature is due to exaggerated ovarian response characterized by marked elevation of serum oestradiol levels and the presence of a large number of follicles (>20).

Management and outcome

All patients had bed rest, fluid input-output control, adequate fluid intake, high protein oral intake, human albumin solutions iv and LMWH sc (nadroparin calcium 3000 iu). Two patients had paracentesis of hydrothorax because of dyspnea or discomfort. Hospital and ICU stay was 8 ± 3.3 and 5 ± 1.9 days, respectively. All patients recovered without developing any life threatening complications and were discharged in good condition.

Conclusions and discussion

Ovarian hyperstimulation syndrome is a serious clinical condition [1] which may be complicated by life threatening events in up to 0.5-2% [1,2]. Early recognition and management until normalization of oestradiol serum levels provide good outcome with mortality rate 0.0025% [1].
Table 1.

Signs and symptoms on admission

Generalized edema

100%

Ascites

100%

Weight gain

100%

Chest discomfort

71%

Thirst sensation

71%

Nausea-vomiting

71%

Hydrothorax

71%

Abdominal distension or pain

43%

Anxiety

28%

Table 2.

Labs on admission and discharge

Laboratory

Admission

Discharge

examination

(X ± SEM)

(X ± SEM)

Ht (%)

45 ± 1.97

33 ± 1.67

Na+ (mmol/l)

133 ± 1.02

138 ± 1.29

Urea (mg/dl)

42 ± 4.6

32 ± 1.8

Alb (g/dl)

2.8 ± 0.12

4.25 ± 0.31

WBC × 103/µl

16.4 ± 1.35

10.7 ± 1.54

Oestradiol (pg/dl)

4735 ± 1658

 

Authors’ Affiliations

(1)
Department of Intensive Care Unit of `IASO' Maternity Hospital at Athens, Athens University School of Nursing Intensive Care Unit at `Agioi Anargyroi' Cancer Hospital of Kifissia

References

  1. Brindsen PR, Wada I, Tan SL, Balen A, Jacobs HS: Diagnosis, prevention and management of ovarian hyperstimulation syndrome. Br J Obstet Gynaecol 1995, 102: 767-772.View ArticleGoogle Scholar
  2. Schenker JG, Weinstein D: Ovarian hyperstimulation syndrome: a current survey. Fertil Steril 1978, 30: 255-268.PubMedGoogle Scholar

Copyright

© Current Science Ltd 1999