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Ovarian hyperstimulation syndrome (OHSS) at a maternity hospital

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
Table 2. Labs on admission and discharge

References

  1. 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.

  2. 2.

    Schenker JG, Weinstein D: Ovarian hyperstimulation syndrome: a current survey. Fertil Steril 1978, 30: 255-268.

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Lappas, V., Myrianthefs, P., Ladakis, C. et al. Ovarian hyperstimulation syndrome (OHSS) at a maternity hospital. Crit Care 3, P234 (2000). https://doi.org/10.1186/cc607

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Keywords

  • Oestradiol
  • Ovarian Response
  • Maternity Hospital
  • Nadroparin
  • Oestradiol Serum Level