Patients with severe ovarian hyperstimulation syndrome can be managed safely with aggressive outpatient transvaginal paracentesis

Smith, Laura; Hacker, Michele R.; Alper, Michael M.

doi:10.1016/j.fertnstert.2008.09.011

Cited by 39 publications

(17 citation statements)

References 39 publications

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“…Owing to the concern of protein loss, gradual aspiration has been recommended [159]. Yet, large amounts of drainage, even without albumin replacement, has been performed without any adverse events [160,161]. Such an approach is certainly associated with less-frequent drainage.…”

Section: Management Of Ohssmentioning

confidence: 99%

Pathophysiology of ovarian hyperstimulation syndrome and strategies for its prevention and treatment

Ata

Tulandi²

2009

Expert Review of Obstetrics & Gynecology

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Ovarian hyperstimulation syndrome (OHSS) is characterized by ovarian enlargement, ascites and pleural effusion. Most cases of OHSS develop after ovarian stimulation with gonadotropins. The basis of the process is increased vascular permeability, and this is related to VEGF. VEGF is produced in granulosa cells in response to gonadotropin stimulation and its secretion is augmented following human chorionic gonadotropin administration. One of the major risk factors is polycystic ovaries. Preventive strategies include mild stimulation protocols, coasting, in vitro maturation, infusion of macromolecule solutions and coadministration of dopamine agonists. OHSS is a self-limiting condition and most cases can be managed with paracentesis and fluid replacement. In this article, we review pathogenesis, risk factors, strategies for prevention and management of OHSS. Keywords: albumin • cabergoline • coasting • dextran • dopamine • hydroxyethylstarch • macromolecule • ovarian hyperstimulation syndrome • pathogenesis • prevention • treatment • VEGF Pathophysiology of ovarian hyperstimulation syndrome and strategies for its prevention and treatment Expert Rev.

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Section: Management Of Ohssmentioning

confidence: 99%

Pathophysiology of ovarian hyperstimulation syndrome and strategies for its prevention and treatment

Ata

Tulandi²

2009

Expert Review of Obstetrics & Gynecology

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“…Abuzeid et al [9] reported that outpatient management using an abdominal pigtail catheter was feasible and successful in 33 women with severe OHSS. In accordance, Smith et al [10] reported a retrospective series of 146 outpatient transvaginal paracenteses in 96 severe OHSS patients without severe procedure-related complications. Continuous and serial abdominal and transvaginal paracenteses have been reported to be safe up to a maximum of 65 liters [11,12,13].…”

Section: Introductionmentioning

confidence: 66%

“…In contrast to the large body of literature investigating the pathophysiology and prevention of OHSS, only a few studies have been published so far about the natural course of this disorder, the clinical outcome of affected women, and useful predictors of paracentesis. A PubMed search using the search terms, OHSS, outcome, recovery, treatment, and paracentesis (search date April 20, 2015), yielded 68 studies with 27 reporting on clinical outcomes among women with OHSS [10,11,12,13,14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29,30,31,32,33,34,35,36]. Enskog et al [8] found that severe OHSS developed in 18 out of 428 (4%) women after controlled ovarian stimulation/IVF and was associated with a higher prevalence of allergy and a higher live birth rate compared to women after controlled ovarian stimulation/IVF without OHSS.…”

Section: Introductionmentioning

confidence: 99%

Predictors of Paracentesis in Women with Severe Ovarian Hyperstimulation Syndrome: A Retrospective Cohort Study

Nouri

Ott²,

Lenart³

et al. 2016

Gynecol Obstet Invest

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Background: To identify predictors of paracentesis in women with severe ovarian hyperstimulation syndrome (OHSS). Methods: In a retrospective cohort study, we assessed patient characteristics and outcome measures of women with severe OHSS Golan grade II/III from 1996 to 2010 using univariate and multivariate analyses with the number of paracenteses as the main outcome. Results: Three hundred ninety four women with OHSS Golan grade II (n = 40) and grade III (n = 354) were included in the study. Paracentesis was performed in 108/394 (27%) of these women. One paracentesis was performed in 63 (16%), 2 paracenteses in 26 (6%), and ≥3 paracenteses 19 (5%) women, respectively. No thrombotic or cerebrovascular morbidity occurred. The mortality of the cohort was 0/394 (0%). In a univariate analysis, late onset OHSS (p = 0.02), pregnancy (p < 0.001), human chorionic gonadotropin use (p = 0.02), ovarian diameter (p = 0.006), and elevated serum levels of alanine aminotransferase (p < 0.001), hematocrit (p < 0.001), leucocytes (p < 0.001), thrombocytes (p < 0.001), and uric acid (p < 0.001) were associated with paracentesis. In a multivariate logistic regression analysis, only alanine aminotransferase (OR 1.006; 95% CI 1.001-1.01) and hematocrit (OR 1.16; 95% CI 1.05-1.27) were independently associated with paracentesis. Conclusion: Alanine aminotransferase and hematocrit at initial presentation are independent predictors of paracentesis.

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“…In non-randomized case series, aggressive and early paracentesis has been reported to be successful in the outpatient management of OHSS [ 49 ]. Based on modeling the cost effectiveness of outpatient paracentesis versus in-patient management of OHSS, early aggressive outpatient paracentesis was reported to result in lower costs [ 50 ].…”

Section: Paracentesismentioning

confidence: 99%

Ovarian Hyperstimulation Syndrome (OHSS)

Barbieri

2013

Endocrine Emergencies

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Précis1. Clinical Setting: abdominal bloating and distention, intravascular volume depletion, ascites, hemoconcentration, and oliguria following a fertility intervention involving the administration of exogenous FSH. of a GnRH agonist to stimulate endogenous LH secretion to trigger ovarian follicle luteinization in order to reduce ovarian production of VEGF. Cessation of FSH stimulation (coasting), in order to reduce the ovarian production of VEGF. Freezing all embryos and cancelling embryo transfer to avoid a late case of OHSS caused by pregnancy. Administration of a dopamine agonist such as cabergoline to reduce ovarian production of VEGF.

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Patients with severe ovarian hyperstimulation syndrome can be managed safely with aggressive outpatient transvaginal paracentesis

Cited by 39 publications

References 39 publications

Pathophysiology of ovarian hyperstimulation syndrome and strategies for its prevention and treatment

Pathophysiology of ovarian hyperstimulation syndrome and strategies for its prevention and treatment

Predictors of Paracentesis in Women with Severe Ovarian Hyperstimulation Syndrome: A Retrospective Cohort Study

Ovarian Hyperstimulation Syndrome (OHSS)

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