Ovarian Hyperstimulation Syndrome
OVERVIEW
- exogenous human chorionic gonadotropin (hCG) used to induce ovulation prior to harvesting
PATHOPHYSIOLOGY
- increased capillary permeability -> hypovolaemia + haemoconcentration -> oedema, ascites, pleural effusions, pericardial effusion, hypovolaemia, shock, renal failure
- massive ovarian enlargement
- tends to settle as the hCG level goes down but can be exacerbated by implantation
INVESTIGATIONS
- Hypo-osmolar, hyponatraemia
- Hyperkalaemia
- Haemoconcentration
- Mild to moderate transaminitis
- Serum IgG low (extrudes into abdominal cavity) -> immunosuppressed
MANAGEMENT
- ECHO to rule out pericardial effusion
- fluid management (N/S and albumin)
- prevention of VTE
- drainage of ascites
- empiric antibiotic therapy (covering: P mirabilis, K pneumoniae, P aeruginosa, E coli, and P vulgaris)
- may deteriorate and require ICU intervention
- if deteriorating may have terminate pregnancy
Further reading
- Hiller J. Ovarian Hyperstimulation Syndrome. FFS
Critical Care
Compendium
Chris is an Intensivist and ECMO specialist at The Alfred ICU, where he is Deputy Director (Education). He is a Clinical Adjunct Associate Professor at Monash University, the Lead for the Clinician Educator Incubator programme, and a CICM First Part Examiner.
He is an internationally recognised Clinician Educator with a passion for helping clinicians learn and for improving the clinical performance of individuals and collectives. He was one of the founders of the FOAM movement (Free Open-Access Medical education) has been recognised for his contributions to education with awards from ANZICS, ANZAHPE, and ACEM.
His one great achievement is being the father of three amazing children.
On Bluesky, he is @precordialthump.bsky.social and on the site that Elon has screwed up, he is @precordialthump.
| INTENSIVE | RAGE | Resuscitology | SMACC