SEVERE OVARIAN HYPERSTIMULATION SYNDROME (OHSS) – LEADING TO AN INTENSIVE CARE UNIT (ICU) ADMISSION AND NEAR-MISS! SUGGESTED ALGORITHM OF MANAGEMENT WITH CASE REPORT.
Main Article Content
Keywords
OHSS, PCOS, ICU, Pleural Effusion.
Abstract
Ovarian hyperstimulation syndrome (OHSS) is the most serious iatrogenic complication of ovulation induction. It is characterized by multifollicular, theca-lutein ovarian cysts and an acute shift in body fluid distribution resulting in ascites and pleural and pericardial effusions. Polycystic ovarian syndrome or PCOS is one of the major risk factors for the development of OHSS. We report a case of a 35 year old PCOS patient who was undergoing ovulation stimulation in an IVF (in-vitro fertilization) cycle. 72 hours after egg retrieval, the patient presented to the outpatient department with chief complaints of abdominal pain, nausea, and vomiting. She was admitted for observation and two days later she started complaining of shortness of breath and was found to have developed bilateral pleural effusion and massive ascites. Provisional diagnosis of severe OHSS was made and patient was shifted to ICU for monitoring and started on supportive treatment. She was very hypovolemic and hyponatremic. She was managed with fluid management to maintain intravascular compartment, pain relief, thromboprophylaxis and supportive care and OHSS resolved after one week. In conclusion, although severe complications like pleural effusion are rarely seen in OHSS, prompt diagnosis and successful management is likely to avoid the rapid development of serious life threatening complications.
References
2. Rizk, B, Rizk, C B, Nawar, M G, et al. Ultrasonography in the prediction and management of ovarian hyperstimulationsyndome. In Rizk, B, ed. Ultrasonography in Reproductive Medicine and Infertility. Cambridge: Cambridge University Press, 2010, Chapter 36, 299–312.Google Scholar
3. Serour, G I, Aboulghar, M A, Mansour, R, et al. Complications of medically assisted conception in 3,500 cycles. Fertil Steril 1998;70:638–42.Google Scholar
4. Mathur, R S, Akande, A V, Keay, S D, et al. Distinction between early and late ovarian hyperstimulation syndrome. Fertil Steril 2000;73:
5. Vlahos NF, Gregoriou O. Prevention and management of ovarian hyperstimulation syndrome. Ann N Y Acad Sci. 2006 Dec;1092:247-64. doi: 10.1196/annals.1365.021. PMID: 17308149.
6. M.A. Aboulghar, R.T. Mansour, Ovarian hyperstimulation syndrome: classifications and critical analysis of preventive measures, Human Reproduction Update, Volume 9, Issue 3, 1 May 2003, Pages 275–289,
7. Rizk B. Ovarian hyperstimulation syndrome: Epidemiology, pathophysiology, prevention and management. 1 st ed. Cambridge: Cambridge University Press; 2006
8. Mocanu E, Redmond ML, Hennelly B, Collins C, Harrison R. Odds of ovarian hyperstimulation syndrome (OHSS) - time for reassessment. Hum Fertil (Camb). 2007 Sep;10(3):175-81. doi: 10.1080/14647270701194143. PMID: 17786650
9. Delvigne A, Rozenberg S. Review of clinical course and treatment of ovarian hyperstimulation syndrome (OHSS). Hum Reprod Update. 2003;9:77-96. PubMed PMID: 12638783
10. Abramov Y, Elchalal U, Schenker JG. Severe OHSS: An 'epidemic' of severe OHSS: a price we have to pay? Hum Reprod. 1999 Sep;14(9):2181-3. doi: 10.1093/humrep/14.9.2181. PMID: 10469676.
11. Alhilali MJ, Parham A, Attaranzadeh A, Amirian M, Azizzadeh M. Polycystic Ovary Syndrome Develops the Complications of Assisted Reproductive Technologies. Arch Razi Inst. 2022 Aug 31;77(4):1459-1464. doi: 10.22092/ARI.2022.358889.2329. PMID: 36883162; PMCID: PMC9985778.
12. Papanikolaou EG, Pozzobon C, Kolibianakis EM, Camus M, Tournaye H, Fatemi HM, et al. Incidence and prediction of ovarian hyperstimulation syndrome in women undergoing gonadotropin-releasing hormone antagonist in vitro fertilization cycles. Fertil Steril. 2006;85(1):112–20. [PubMed] [Google Scholar]
13. Costello MF, Chew CYM, Lindsay K, Wang A, McNally G. Effect of polycystic ovaries on in vitro fertilization and intra-cytoplasmic sperm injection treatment outcome. Asian Pac J Reprod. 2016;5(3):182–7. [Google Scholar]
14. Sun B, Ma Y, Li L, Hu L, Wang F, Zhang Y, Dai S, Sun Y. Factors Associated with Ovarian Hyperstimulation Syndrome (OHSS) Severity in Women With Polycystic Ovary Syndrome Undergoing IVF/ICSI. Front Endocrinol (Lausanne). 2021 Jan 19;11:615957.
15. Jayaprakasan K, Chan Y, Islam R, Haoula Z, Hopkisson J, Coomarasamy A, et al. Prediction of in vitro fertilization outcome at different antral follicle count thresholds in a prospective cohort of 1,012 women. Fertil Steril. 2012;98:657-63
16. Abramov Y, Fatum M, Abrahamov D, Schenker JG. Hydroxyethylstarch versus human albumin for the treatment of severe ovarian hyperstimulation syndrome: a preliminary report. Fertil Steril 2001;75: 1228–30. Level II-2.
17. Gokmen O, Ugur M, Ekin M, Keles G, Turan C, Oral H: Intravenous albumin versus hydroxyethyl starch for the prevention of ovarian hyperstimulation in an in-vitro fertilization programme: a prospective randomized placebo controlled study. Eur J Obstet Gynecol Reprod Biol 2001, 96:187–192.
18. Tang H, Mourad SM, Wang A, Zhai SD, Hart RJ. Dopamine agonists for preventing ovarian hyperstimulation syndrome. Cochrane Database Syst Rev. 2021 Apr 14;4(4):CD008605.
19. Morris RS, Miller C, Jacobs L, Miller K. Conservative management of ovarian hyperstimulation syndrome. J Reprod Med 1995;40:711–4. Level II-3
Article Sidebar
Article Details
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
All articles published in JPTCP are licensed under Copyright Creative Commons Attribution-NonCommercial 4.0 International License.
Dr Sabahat Rasool, MD, MRCOG, DNB
Associate Professor GMC Srinagar
Dr Qurat Ul Ain, MD
Senior Resident GMC Srinagar
Dr Muzamil Rashid
PG scholar Department of Obstetrics and Gynaecology GMC Srinagar
Prof Shagufta Rather, MD
Professor Department of Obstetrics and Gynaecology GMC Srinagar