Untitled

Abstract

Outpatient treatment consisting of culdocentesis, intravenous rehydration, and albumin minimized the need for hospitalization in hyperstimulated patients.

The pathophysiology of ovarian hyperstimulation syndrome: an unrecognized compartment syndrome

“…The timing, method, and aggressiveness of paracentesis is institution and physician dependent. Some investigators (59–61) have advocated early intervention by aggressive paracentesis because they have noted dramatic clinical improvement and shortened hospital stay in OHSS patients (59). Others (10, 62) have proposed paracentesis is indicated only when conservative management has failed because of rare complications, including damage to hypervascularized and enlarged ovaries, bowel, and post paracentesis vulvar edema (63, 64).…”

“…Transvaginal ultrasound guided paracentesis is the first choice for most patients. Ascitic fluid seen on imaging in patients with moderate to severe OHSS symptoms should be removed, with typical volumes equaling 2–3 liters (59, 61); however, anecdotally, we note that significant improvement can be seen with removal of smaller volumes, perhaps because of reduction in hydrostatic pressure at a “tipping point” where the patients become symptomatic. Patients should be well hydrated before paracentesis and fluid status should be evaluated after the procedure.…”

“…Outpatient management with vaginal paracentesis at early stages of OHSS, with simultaneous presence of ascites has been proposed (61), and has recently been shown to be cost effective (66). Multiple culdocenteses (and IV albumin) were used alternatively to hospitalization to manage patients who met criteria for moderate to severe OHSS (61), with reaccumulation of fluid.…”

“…Multiple culdocenteses (and IV albumin) were used alternatively to hospitalization to manage patients who met criteria for moderate to severe OHSS (61), with reaccumulation of fluid. The average fluid removed was 1910±59 mL, with an average 3.4 outpatient treatments.…”

“…The average fluid removed was 1910±59 mL, with an average 3.4 outpatient treatments. In aggressively treating OHSS with paracentesis before the development of symptoms including weight gain, hemoconcentration, electrolyte imbalance, or renal abnormality, only 9.4% of patients ultimately required hospitalization (61) for repetitive culdocenteses.…”