Ovarian hyperstimulation syndrome: Difference between revisions
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**Cardiac US (r/o [[ | **Cardiac US (r/o [[pericardial effusion]]) | ||
**Progesterone level | **Progesterone level | ||
**Estradiol level | **Estradiol level | ||
Revision as of 13:31, 3 April 2016
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
Workup
- Urine pregnancy
- CBC
- Chem 10
- PT/PTT
- Pelvic ultrasound
- Consider:
- CXR (r/o pleural effusion)
- Cardiac US (r/o pericardial effusion)
- Progesterone level
- Estradiol level
- Fibrinogen (r/o DIC)
Evaluation[2].
| Classification | Clinical features | Lab findings |
| Mild |
|
Normal |
| Moderate | Above plus:
|
|
| Severe | Above plus:
|
|
| 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
- Acetaminophen, Norco, or morphine
- 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
- As above + consider need to drain pleural or pericardial effusion
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
- Ovarian torsion
- Venous thromboembolism
- Hydrothorax
- Pericardial effusion
- Arterial thrombosis
- Pulmonary embolism
- Sepsis
- Acute renal failure
- Acute respiratory distress syndrome (ARDS)
- Disseminated intravascular coagulation (DIC)
See Also
References
- ↑ Norris DL, Young JD. UTI. EM Clin N Am. 2008; 26:413-30.
- ↑ 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