Ovarian Hyperstimulation Syndrome Flashcards Preview

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Flashcards in Ovarian Hyperstimulation Syndrome Deck (13)
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1
Q

What is OHS?

A

ovaries over respond to the hormone injections used to stimulate the growth of the follicles that contain the eggs.

2
Q

What is it associated w

A

injection of hCG, used for inducing final oocyte maturation or triggering their release,

3
Q

What is the main pathophysiology?

A

vasoactive products (particularly vascular endothelial growth factor)

4
Q

What are the characteristics

A

ovarian enlargement
fluid shift from itrvascular to extravascular space, there is accumulation of fluid in peritoneal/pleural spaces
there is haemoconcentration and hypercoagulability due to reduced intravascular volume

5
Q

What are RF

A
  • Young
  • Low BMI
  • Polycystic ovaries
  • Previous OHSS
6
Q

What is presentation ?

A

Abdo discomfort
N&V
Abdo distension +/- dyspnoea
Usually 3-7 days after hCG administration

7
Q

What is prevention?

A

lowest effective regimen of gonadatrophins

cycle cancellation if necessary

8
Q

What is prevention in PCOS

A

in vitro maturation involves collecting immature eggs and avoids ovarian stimulation and risk of OHSS

9
Q

What is the management of mild-mod OHS

A

Analgesia
Avoid NSAIDs
Don’t drink XS
Avoid strenuous activities, risk of ovarian torsion
Continue w progesterone luteal support, avoid hCG

10
Q

What is management of severe OHS

A
Admit to hospital 
Analgesia + anti-emetics
Daily bloods
Strict fluid balance
Daily assessment of girth (ascites), weight and legs (thrombosis)
Thromboprophylaxis (stockings, LMWH)
Paracentesis for symptomatic relief
Catheter
11
Q

What is management of critical OHS

A

ITU

Meticulous attention to fluid balance

12
Q

What are the features of severe OHS?

A
Ascites
oliguria
>45% haematocrit 
hypoproteinaemia 
ovary >12cm
13
Q

what are features of critical OHS?

A
tense ascites, haematocrit >55%
WCC >25
oligo/anuria
thromboembolism
ARDS