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White DA, Pye C, Ridsdale K, Dimairo M, Mooney C, Wright J, Young TA, Cheong YC, Drakeley A, Mathur R, O'Cathain A, Desoysa L, Sizer A, Lumley E, Chatters R, Metwally M. Outpatient paracentesis for the management of ovarian hyperstimulation syndrome: study protocol for the STOP-OHSS randomised controlled trial. BMJ Open 2024; 14:e076434. [PMID: 38262643 PMCID: PMC10806818 DOI: 10.1136/bmjopen-2023-076434] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 12/06/2023] [Indexed: 01/25/2024] Open
Abstract
INTRODUCTION Ovarian hyperstimulation syndrome (OHSS) is the most significant short-term complication of pharmacological ovarian stimulation. Symptoms range from mild abdominal discomfort to rare complications such as renal failure, thromboembolism and respiratory distress syndrome.Currently, clinical practice typically involves monitoring the patient until the condition becomes severe, at which point they are admitted to hospital, where drainage of ascitic fluid (paracentesis) may take place. Preliminary studies have indicated that earlier outpatient paracentesis may reduce the progression of OHSS and prevent hospitalisation in women. METHODS AND ANALYSIS This UK, multicentre, pragmatic, two-arm, parallel-group, adaptive (group sequential with one interim analysis), open-label, superiority, confirmatory, group sequential, individually randomised controlled trial, with internal pilot will assess the clinical and cost-effectiveness and safety of outpatient paracentesis versus conservative management (usual care) for moderate or severe OHSS. 224 women from 20 National Health Service and private fertility units will be randomised (1:1) and followed up for up to 13.5 months. The primary outcome is the rate of OHSS related hospital admission of at least 24 hours within 28 days postrandomisation. The primary analysis will be an intention to treat with difference in hospitalisation rates as measure of treatment effect. Secondary outcomes include time to resolution of symptoms, patient satisfaction, adverse events and cost-effectiveness. A qualitative substudy will facilitate the feasibility of recruitment. Participant recruitment commenced in June 2022. ETHICS AND DISSEMINATION London-Southeast Research Ethics Committee approved the protocol (reference: 22/LO/0015). Findings will be submitted to peer-reviewed journals and abstracts to relevant national and international conferences, as well as being disseminated to trial participants and patient groups. TRIAL REGISTRATION NUMBER ISRCTN71978064.
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Affiliation(s)
- David Alexander White
- Clinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Clare Pye
- Jessop Wing, Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Katie Ridsdale
- Clinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Munyaradzi Dimairo
- Clinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Cara Mooney
- Clinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Jessica Wright
- Clinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Tracey Anne Young
- Sheffield Centre for Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Ying C Cheong
- Obstetrics and Gynaecology, University of Southampton, Southampton, UK
| | - Andrew Drakeley
- Hewitt Fertility Centre, Liverpool Women's NHS Foundation Trust, Liverpool, UK
| | - Raj Mathur
- Manchester Academic Health Sciences Centre, Manchester University NHS Foundation Trust, Manchester, UK
| | - Alicia O'Cathain
- Sheffield Centre for Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Lauren Desoysa
- Clinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | | | | | - Robin Chatters
- Clinical Trials Research Unit, School of Health and Related Research, The University of Sheffield, Sheffield, UK
| | - Mostafa Metwally
- The University of Sheffield, Sheffield, UK
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
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Ren Y, Li R, Yang S, Yang R, Song D. Pregnancy outcomes in patients with late-onset severe OHSS following different methods of ascetic fluid drainage and a comparison with non-OHSS IVF patients. Arch Gynecol Obstet 2022; 305:1587-1594. [DOI: 10.1007/s00404-021-06326-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Accepted: 11/05/2021] [Indexed: 11/02/2022]
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Ülger Y, Delik A. AN UNUSUAL COMPLICATION OF PIGTAIL CATHETER: COLONIC PENETRATION. Gastroenterol Nurs 2021; 44:463-466. [PMID: 34519674 DOI: 10.1097/sga.0000000000000614] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/30/2021] [Accepted: 04/30/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Yakup Ülger
- Yakup Ülger, MD, is Assoc. Prof. Dr., Department of Gastroenterology, Faculty of Medicine, Çukurova University, Adana, Turkey
- Anıl Delik, PhD, Department of Gastroenterology, Faculty of Medicine, Çukurova University, Adana, Turkey
| | - Anıl Delik
- Yakup Ülger, MD, is Assoc. Prof. Dr., Department of Gastroenterology, Faculty of Medicine, Çukurova University, Adana, Turkey
- Anıl Delik, PhD, Department of Gastroenterology, Faculty of Medicine, Çukurova University, Adana, Turkey
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Ovarian hyperstimulation syndrome: A review for emergency clinicians. Am J Emerg Med 2019; 37:1577-1584. [PMID: 31097257 DOI: 10.1016/j.ajem.2019.05.018] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2019] [Revised: 05/07/2019] [Accepted: 05/07/2019] [Indexed: 12/28/2022] Open
Abstract
INTRODUCTION A great deal of literature has recently evaluated the prevention and management of ovarian hyperstimulation syndrome (OHSS) in the outpatient setting, but there remains a dearth of research evaluating OHSS in the emergency department (ED) and its management. OBJECTIVE This narrative review evaluates the underlying pathophysiology and clinical manifestations of OHSS and discusses approaches to patient care in the ED based on current literature. DISCUSSION OHSS is an iatrogenic complication caused by an excessive response to controlled ovarian stimulation during assisted reproductive cycles (ART). OHSS complicates up to 30% of ART cycles, and many of these patients seek initial care in the ED. Risk factors for the development of OHSS include age < 35, history of polycystic ovarian syndrome or previous OHSS, and pregnancy. Emergency physicians will be faced with several complications including ascites, abdominal compartment syndrome, renal dysfunction, acute respiratory distress syndrome, thromboembolic disease, and hemodynamic instability. Critical patients should be evaluated in the resuscitation bay, and consultation with the primary obstetrics/gynecology team is needed, which improves patient outcomes. This review provides several guiding principles for management of OHSS and associated complications. CONCLUSIONS OHSS occurs in up to 30% of IVF cycles and carries a high morbidity. Effective care of the OHSS patient begins with early diagnosis while evaluating for other diseases and complications. Understanding these complications and an approach to the management of OHSS is essential to optimizing patient care.
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Pathophysiology, treatment and prevention of ovarian hyperstimulation syndrome. Curr Opin Obstet Gynecol 2018; 28:236-41. [PMID: 27273307 DOI: 10.1097/gco.0000000000000284] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Severe ovarian hyperstimulation syndrome (OHSS) is an iatrogenic condition that affects 1% of women that undergo treatment with assisted reproductive technology. The review aims to summarize recent evidence on pathophysiology, treatment, and prevention of OHSS. RECENT FINDINGS The pathophysiology is still not completely understood; however, vascular endothelial growth factor is likely to be an important mediator. Human chorionic gonadotropin was previously thought to be necessary for OHSS to occur; however, recent case reports have proven otherwise. The contribution of an attenuated anti-Mullerian hormone signalling pathway and CD11c + HLA-DR + dendritic cells and associated interleukins has been explored recently as contributors to pathogenesis.Treatment is largely supportive and is based mainly on consensus statements rather than evidence. Therefore, it is important to prevent this condition by identifying women at risk, allowing the clinician to implement preventive strategies, including the use of GnRH antagonist cycles with agonist triggers. SUMMARY More research is required to elucidate the pathophysiology behind the condition. Clinicians should employ strategies to prevent OHSS.
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Gebril A, Hamoda H, Mathur R. Outpatient management of severe ovarian hyperstimulation syndrome: a systematic review and a review of existing guidelines. HUM FERTIL 2017; 21:98-105. [PMID: 28554223 DOI: 10.1080/14647273.2017.1331048] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Ovarian hyperstimulation syndrome (OHSS) is a potentially serious complication of assisted reproductive treatment. Management of women with severe OHSS has traditionally included hospitalisation for close monitoring and supportive treatment. The aim of this review is to assess the evidence for safety and efficacy of outpatient management of severe OHSS. A systematic review of studies describing outpatient management options was performed. Current guidance from advisory bodies was also reviewed. Outpatient management has been found in observational studies to be safe and cost-effective compared to inpatient management. Paracentesis of ascitic fluid seems to be effective treatment for severe OHSS along with supportive management including maintenance of fluid balance and preventative measures against thrombo-embolism. GnRH antagonist was shown in few studies to be effective in treatment of early severe OHSS although further research is required to assess its role in this context. Appropriate outpatient set up and protocols are essential to provide safe outpatient management for women with severe OHSS.
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Affiliation(s)
- Amr Gebril
- a Department of Obstetrics and Gynaecology, Faculty of Medicine , Cairo University , Cairo , Egypt
| | - Haitham Hamoda
- b King's College Hospital NHS Foundation Trust , London , UK
| | - Raj Mathur
- c Department of Reproductive Medicine , Central Manchester University Hospital NHS Foundation Trust , Manchester , UK.,d Maternal and Fetal Health Research Centre, Division of Developmental Biology & Medicine , University of Manchester , Manchester , UK
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Kwik M, Karia S, Boothroyd C. RANZCOG CREI Consensus Statement on treatment of Ovarian Hyperstimulation Syndrome. Aust N Z J Obstet Gynaecol 2015; 55:413-9. [DOI: 10.1111/ajo.12389] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2015] [Accepted: 07/05/2015] [Indexed: 11/28/2022]
Affiliation(s)
- Michele Kwik
- IVF Australia; Greenwich NSW Australia
- Department of Obstetrics & Gynaecology; Royal North Shore Hospital; St. Leonards NSW Australia
- School of Medicine; Sydney University; Sydney NSW Australia
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Tan BK, Mathur R. Management of ovarian hyperstimulation syndrome. Produced on behalf of the BFS Policy and Practice Committee. HUM FERTIL 2013; 16:151-9. [DOI: 10.3109/14647273.2013.788313] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Chen CD, Chen SU, Yang YS. Prevention and management of ovarian hyperstimulation syndrome. Best Pract Res Clin Obstet Gynaecol 2012; 26:817-27. [DOI: 10.1016/j.bpobgyn.2012.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2012] [Revised: 04/15/2012] [Accepted: 04/26/2012] [Indexed: 01/11/2023]
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Abuzeid MI, Mitwally M, Abuzeid YM, Bokhari HA, Ashraf M, Diamond MP. Early initiation of gonadotropin-releasing hormone antagonist in polycystic ovarian syndrome patients undergoing assisted reproduction: randomized controlled trial ISRCTN69937179. J Assist Reprod Genet 2012; 29:1193-202. [PMID: 22960769 DOI: 10.1007/s10815-012-9850-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2012] [Accepted: 08/08/2012] [Indexed: 01/21/2023] Open
Abstract
PURPOSE To compare the implantation rates in two groups of women with Polycystic Ovary Syndrome (PCOS) after embryo transfer based on the initiation time of GnRH antagonist. Secondary outcome measures included clinical pregnancy, delivery and miscarriage rates. METHODS This is a prospective, randomized trial in which 140 PCOS patients underwent ICSI, with 122 having ET performed. GnRH-antagonist was started on day 1 of stimulation in 69 patients (Group 1) or day 5 in 71 patients (Group 2). RESULTS The overall implantation rate in Group 1 (46.2 %) was clinically higher than Group 2 (35.5 %), although not statistically significant (p = 0.075). For blastocysts transfer, the implantation rate in Group 1 was 55.1 %, compared to 40.4 % in Group 2 (p = 0.051). There was a clinically, but not statistically, higher clinical pregnancy rate (68.3 % vs. 56.5 %) and delivery rate (60.0 % vs. 53.2 %) per transfer in Group 1 compared to Group 2, respectively. There was a statistically significant lower biochemical pregnancy rate in Group 1 (2.4 %) compared to Group 2 (18.6 %) [p = 0.015]. There was no difference in miscarriage rates between the two groups. CONCLUSION Our data suggest that early initiation of GnRH antagonist on day 1 of ovarian stimulation in PCOS patients undergoing ICSI-ET may improve implantation rates, especially after blastocyst transfer.
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Affiliation(s)
- Mostafa I Abuzeid
- Center for Reproductive Medicine, Reproductive Endocrinology and Infertility, Department of OB/GYN, Hurley Medical Center, Flint, MI 48503, USA.
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Qublan HS, Al-Taani MI, Megdadi MF, Metri RM, Al-Ahmad N. Multiple transvaginal ascitic fluid aspirations improves the clinical and reproductive outcome in patients undergoing in vitro fertilisation treatment complicated by severe early ovarian hyperstimulation syndrome. J OBSTET GYNAECOL 2012; 32:379-82. [DOI: 10.3109/01443615.2012.663422] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
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Chen CD, Wu MY, Chao KH, Lien YR, Chen SU, Yang YS. Update on management of ovarian hyperstimulation syndrome. Taiwan J Obstet Gynecol 2011; 50:2-10. [PMID: 21482366 DOI: 10.1016/j.tjog.2011.01.014] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Accepted: 09/07/2010] [Indexed: 01/11/2023] Open
Abstract
Ovarian hyperstimulation syndrome (OHSS) is a relatively common complication of ovarian stimulation and can be life threatening. The pathophysiology of OHSS is characterized by increased capillary permeability, leading to leakage of fluid from the vascular compartment, with third-space fluid accumulation and intravascular dehydration. The increased intra-abdominal pressure indicated that OHSS may be considered a compartment syndrome. Vascular endothelial growth factor, also known as vascular permeability factor, has emerged as one of the mediators intrinsic to the development of OHSS. Conventional management is focused on supportive care until the spontaneous resolution of the condition. The standard of care for treatment-monitoring of appropriate clinical parameters, fluid balance management, thrombosis prophylaxis, and ascites treatment-should prevent severe morbidity in most cases. This review will cover inpatient and outpatient management. The potential therapeutic approach targeting the vascular endothelial growth factor system will be discussed.
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Affiliation(s)
- Chin-Der Chen
- Department of Obstetrics and Gynecology, National Taiwan University Hospital, Taipei, Taiwan
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[Ovarian hyperstimulation syndrome: pathophysiology, risk factors, prevention, diagnosis and treatment]. ACTA ACUST UNITED AC 2011; 40:593-611. [PMID: 21835557 DOI: 10.1016/j.jgyn.2011.06.008] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/21/2011] [Revised: 06/07/2011] [Accepted: 06/14/2011] [Indexed: 12/26/2022]
Abstract
The ovarian hyperstimulation syndrome is a major complication of ovulation induction for in vitro fertilization, with severe morbidity and possible mortality. Whereas its pathophysiology remains ill-established, the VEGF may play a key role as well as coagulation disturbances. Risk factors for severe OHSS may be related to patients characteristics or to the management of the ovarian stimulation. Two types of OHSS are usually distinguished: the early OHSS, immediately following the ovulation triggering and a later and more severe one, occurring in case of pregnancy. As no etiologic treatment is available, the therapeutic management of OHSS should focus on its related-complications. Thrombotic complications that can occur in venous or arterial vessels represent the major risk of OHSS, possibly conducting to myocardial infarction and cerebrovascular accidents. Once the OHSS is diagnosed, prevention of thrombotic accidents remains the major issue.
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Chen PH, Hsien-Liu, Lee SL, Chang CY, Chang CC. Ovarian hyperstimulation syndrome associated with von Willebrand's disease. Taiwan J Obstet Gynecol 2011; 50:217-9. [DOI: 10.1016/j.tjog.2009.12.003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/23/2009] [Indexed: 10/18/2022] Open
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Le Gouez A, Naudin B, Grynberg M, Mercier FJ. Le syndrome d’hyperstimulation ovarienne. ACTA ACUST UNITED AC 2011; 30:353-62. [DOI: 10.1016/j.annfar.2010.11.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2010] [Accepted: 11/26/2010] [Indexed: 10/18/2022]
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Pedroviejo Sáez V. [On the article "Severe ovarian hyperstimulation syndrome after exogenous administration of human chorionic gonadotropin]. REVISTA ESPANOLA DE ANESTESIOLOGIA Y REANIMACION 2010; 57:392-393. [PMID: 20645497 DOI: 10.1016/s0034-9356(10)70259-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
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Smith LP, Hacker MR, Alper MM. Patients with severe ovarian hyperstimulation syndrome can be managed safely with aggressive outpatient transvaginal paracentesis. Fertil Steril 2008; 92:1953-9. [PMID: 18976762 DOI: 10.1016/j.fertnstert.2008.09.011] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2008] [Revised: 09/03/2008] [Accepted: 09/03/2008] [Indexed: 10/21/2022]
Abstract
OBJECTIVE To describe our experience with aggressive outpatient transvaginal paracentesis to manage ovarian hyperstimulation syndrome (OHSS). DESIGN Retrospective case series. SETTING Private, academically affiliated IVF center. PATIENT(S) Women undergoing assisted reproductive technologies (ART) and having a diagnosis of OHSS. INTERVENTION(S) Management of OHSS with hospitalization or outpatient transvaginal paracentesis between 1999 and 2007. MAIN OUTCOME MEASURE(S) Grade and stage of OHSS, need for hospitalization, and adverse events. RESULT(S) From 1999 to 2007, we identified 183 patients with OHSS. We began performing outpatient transvaginal paracentesis to treat OHSS in 2002. We have performed 146 outpatient transvaginal paracenteses in 96 patients with no procedure-related complications. With the implementation of early, aggressive, outpatient paracentesis, the number of patients requiring hospitalization for OHSS decreased. From 2006 to 2007, 29 patients were diagnosed with severe OHSS and 25 (86%) were managed as outpatients with transvaginal paracentesis with no complications. CONCLUSION(S) This report represents one of the largest series of patients with OHSS managed with outpatient transvaginal paracentesis. Although there continues to be a small percentage of patients with OHSS who require hospitalization, the vast majority of patients with severe OHSS at our center in the past 2 years had their condition successfully managed as outpatients with use of aggressive transvaginal paracentesis.
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Abstract
The management of recurrent, symptomatic malignant ascites can be problematic for physicians and patients. The most common, low-risk method is large-volume paracentesis. Patient disease progression often leads to rapid reaccumulation of ascites, which requires frequent return visits to the hospital for symptom management. Other techniques have been developed to achieve palliation of symptoms, including tunneled external drainage catheters, peritoneal ports, and peritoneovenous
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Affiliation(s)
- Stefanie M Rosenberg
- Department of Radiology, Lutheran General Hospital, 1775 Dempster Avenue, Park Ridge, IL 60068, USA.
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Abstract
OBJECTIVE Ovarian hyperstimulation syndrome (OHSS) is a rare iatrogenic complication of ovarian stimulation usually occurring during the luteal phase or during the early part of pregnancy. OHSS is a potential complication of ovarian induction by almost every agent used for ovarian stimulation. Today, due to aggressive treatment protocols including the development of in vitro fertilization and cryopreservation with the goal of obtaining sufficient numbers of oocytes and embryos, an increased risk of developing OHSS is present. OHSS is now becoming increasingly more recognized due to the higher number of women undergoing assisted reproductive techniques. DESIGN Review of the literature regarding ovarian hyperstimulation syndrome. METHODS A review of the epidemiology, pathophysiology, risk factors, classification, clinical features, and treatment and prevention of OHSS. CONCLUSION OHSS can be thought of as the loss of control over the hyperstimulation of the ovaries. Although the prevalence of the severe form of OHSS is small, it is important to remember that OHSS is usually an iatrogenic complication of a nonvital treatment that has the potential for a fatal outcome. Therefore, critical care physicians play an integral part in the care of these patients and therefore should be familiar with and recognize the various clinical manifestations and potential outcomes of this entity.
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Affiliation(s)
- Marie M Budev
- Department of Allergy, Pulmonary, The Cleveland Clinic Foundation
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Davitian C, Uzan M, Hugues JN, Sifer C, Cédrin-Durnerin I, Wolf JP, Poncelet C. Hyperstimulation ovarienne : place de la chirurgie. ACTA ACUST UNITED AC 2005; 33:718-24. [PMID: 16126437 DOI: 10.1016/j.gyobfe.2005.06.013] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2005] [Accepted: 06/18/2005] [Indexed: 11/25/2022]
Abstract
Ovarian hyperstimulation syndrome is a iatrogenic complication that could happen during ovulation induction. Metabolic modifications can lead to a third sector and organic failure. Medical treatment, undertaken in first line, may be insufficient. In these cases, invasive treatment, using surgical techniques, in association with reanimation principles becomes necessary. From the simple drainage to final measures for the patient's rescue, this review describes the different solutions and their respective place. Several means exist, but serious evaluation is lacking. Their use should be indicated specifically. Medico-surgical associations seemed to offer interesting results.
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Affiliation(s)
- C Davitian
- Service de gynécologie-obstétrique, CHU Jean-Verdier, AP-HP, avenue du 14-Juillet, 93143 Bondy cedex, France
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Abstract
Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication that is associated with modern techniques for in vitro fertilization. Extensive efforts have been made to understand the pathophysiology and to improve the management of this entity. The severe and life-threatening forms of the ovarian hyperstimulation syndrome are still challenging for critical care physicians. This article reviews the pathogenesis, epidemiology, classification, clinical manifestations, and complications of these forms of OHSS. The different therapeutic options currently available are reviewed, and a stepwise approach for the management of these patients is provided.
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Affiliation(s)
- Jaime F Avecillas
- Department of Pulmonary and Critical Care Medicine, Cleveland Clinic Foundation, 9500 Euclid Avenue, Cleveland, OH 44195, USA
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