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CDHB

Ovarian Hyperstimulation Syndrome

Definition and Pathophysiology

This is an iatrogenic potentially life-threatening condition that can occur after IVF treatment or ovulation induction resulting from vasoactive products being released from hyperstimulated ovaries. It is worsened and prolonged when pregnancy occurs due to ongoing endogenous HCG stimulation of ovaries.

Refer to CWH Gynaecology Assessment Unit guideline for classification of severity of condition, and consult with on-call Gynaecologist.

Possible Symptoms

• Abdominal bloating /distension and pain
• Nausea and vomiting
• Breathlessness
• Reduced urine output

Assessment

Examine the patient for signs of:

• Hypovolaemia.
• Third space redistribution (ascites, pleural effusions).
• Thromboembolism.

Do not perform bimanual examination.

Investigations

• CBC. Check beta-HCG if pregnancy state unknown.
• Urea, Na, K, creatinine, alb and LFTs.
• Coagulation profile.
• Arterial blood gases if dyspnoeic
• Ultrasound scan of ovaries (dimensions) and abdomen (ascites).

CXR rarely gives additional information to clinical findings in initial workup.

Management

• Rehydration with crystalloid if dehydrated.
• Fluid balance chart, serial girth measurement and daily weight.
• Initially 4 hourly observations.
• Analgesia (paracetamol or codeine - avoid NSAIDs).
• Antiemetics as required.
• Full length TED stockings and prophylactic LMWH daily (at least until discharge).
• Patients should continue their progesterone luteal support (usually pessaries).

Topic Code: 3362