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Laura MRCOG Part 2 > 14) Subfertility - Complications of ART > Flashcards

14) Subfertility - Complications of ART Flashcards

1
Q

Percentage blood volume loss in OHSS

A

20%

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2
Q

Incidence of OHSS

A

Mild - 1/3
Moderate + Severe - 3-8%
Severe - 1-2%
0.3% Hospitalisation Rate

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3
Q

Risk factors for OHSS

A 
Previous OHSS
PCOS
Increased antral follicle count
Increased AMH
Successful conception
Age <30
Low BMI
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4
Q

When does early OHSS occur and what is it due to?

A

Within 7 days of trigger and due to trigger.

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5
Q

When does late OHSS occur and what is it due to?

A

10 or more days after trigger and due to endogenous hCG from early pregnancy

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6
Q

Features of mild OHSS

A

Abdominal pain
Abdominal distension
Ovarian volume <8

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7
Q

Features of moderate OHSS

A

Moderate pain
USS ascites
Ovarian volume 8-12
Nausea +/- vomiting

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8
Q

Features of severe OHSS

A 
Clinical ascites
Ovarian volume >12
Oliguria (<300ml/day or 30ml/h)
Haematocrit >0.45
Na < 135
K > 5
Albumin <35
Osmolality <282
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9
Q

Features of critical OHSS

A 
Tense ascites or large hydrothorax
Oliguria/anuria
ARDS
Thromboembolism
Haematocrit >0.55
WCC>25
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10
Q

Which cases of OHSS should be reported to HFEA and which to MMBRACE?

A

Any severe/critical OHSS should be reported to HFEA. Any deaths to MMBRACE.

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11
Q

Outpatient management of OHSS

A
  • For mild/moderate and some severe
  • Oral fluid (drink to thirst and aim >1L/day)
  • Monitor UO and seek medical RV if <1L/day or positive balance >1L
  • Avoid NSAIDs
  • Thromboprophylaxis if severe
  • Paracentesis of ascitic fluid
  • Review every 2-3d
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12
Q

When does OHSS resolve over?

A

7-10 days

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13
Q

When is inpatient management of OHSS indicated?

A
  • Needed for analgesia
  • Worsening despite outpatient management
  • Unable to tolerate oral fluids
  • Critical OHSS
  • Unable to attend for follow up
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14
Q

How much albumin is used in OHSS?

A

25% HAS 50-100g over 4 hours

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15
Q

Indications for paracentesis

A

Severe abdominal distension and pain
Shortness of breath secondary to ascites
Oliguria despite fluid

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16
Q

How long should thromboprophylaxis be given for?

A

7 days from cure of symptoms if not pregnant or until end of 12th week if pregnant

17
Q

Obstetric risks associated with OHSS

A

PET

Premature labour

18
Q

Single biggest adverse effect of ART

A

Multiple pregnancy

19
Q

Increased rate of multiple pregnancy compared to spontaneous conception

A

20 x increased

20
Q

Multiple birth rate

A

Now around 12% (target is 10%)

21
Q

Risk of monozygotic twins in ART compared to spontaneous

A

Spontaneous 0.4%

ART: 0.7-3%

22
Q

Types of ART that increase risk of monozygotic twins

A

Blastocyst transfer and ICSI

23
Q

Number of women have single embryo transfer

A

30%

24
Q

Cancer risk secondary to ART

A

No increased risk in cervical cancer or endometrial cancer.
No increased risk in breast cancer but may be small increase in women <25y.
No increased risk in ovarian cancer but may be increased borderline tumours.

25
Q

Prevalence of ectopic pregnancy after IVF

A

2-8%

26
Q

Prevalence of heterotopic pregnancy after IVF compared to spontaneous

A

Spontaneous: 1 in 30,000
IVF: 8 in 1000

27
Q

Incidence of minor vaginal bleeding after oocyte retrieval

A

18%

28
Q

Incidence of pelvic infection after oocyte retrieval

A

0.1-0.6%

29
Q

Incidence of severe intra-abdominal bleeding after oocyte retrieval

A

0.05-0.2%

30
Q

Effect of ART on menopause age

A

None

31
Q

Effect of ART on childhood cancers

A

Conflicting data.

Maternal progesterone increases risk of acute lymphocytic leukaemia and tumours of sympathetic nervous system.

32
Q

Effect of ART on preterm birth

A

Increased (2 x risk increase in singletons, 23% increase in multiples)

33
Q

Effect of ART on growth

A

Increased risk of SGA and low birth weight

34
Q

Effect of ART on chromosomal abnormalities

A

Increased risk

35
Q

What are the imprinting conditions associated with IVF?

A

Beckwith-Wiedemann syndrome, Angelman, maternal hypomethylation syndrome

36
Q

Maternal risks of ART

A

Increased risk PIH/PET/GDM/CS/Obstetric haemorrhage

37
Q

Risk of PIH if donor eggs used

A

16-40%

38
Q

Effect of IVF on 1st trimester screening?

A

PAPP-A levels significantly lower.

Laura MRCOG Part 2 (56 decks)

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