Update on management of ovarian hyperstimulation syndrome

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.

Intra-abdominal pressure, intra-abdominal hypertension, and pregnancy: a review

“…The mechanism is not entirely understood but is thought to be mediated by vasoactive cytokines in response to exogenous administration of human chorionic gonadotropin [58]. Significant third spacing as a result of capillary vascularity due to ovarian neoangiogenesis can occur [56], and in its most severe form, massive and rapid accumulation of abdominal ascites results in an overt ACS [58]. Management for this condition ranges from conservative observation to intensive care admission with IAP monitoring and paracentesis to relieve ACS [57,58].…”

“…Significant third spacing as a result of capillary vascularity due to ovarian neoangiogenesis can occur [56], and in its most severe form, massive and rapid accumulation of abdominal ascites results in an overt ACS [58]. Management for this condition ranges from conservative observation to intensive care admission with IAP monitoring and paracentesis to relieve ACS [57,58]. As assisted reproduction increases in prevalence, it becomes imperative to recognize this relatively common complication and to consider the potential role of IAH in its pathophysiology.…”

Intra-abdominal hypertension and abdominal compartment syndrome in burns, obesity, pregnancy, and general medicine

“…The mechanism is not entirely understood but is a response to exogenous administration of human chorionic gonadotropin (HCG) [73]. It is hypothesized that the use of HCG in ovulation induction triggers a systemic inflammatory response resulting in increased capillary permeability and ovarian neoangiogenesis.…”

“…Significant third space fluid accumulation with pleural, pericardial, and abdominal effusions may occur as a result of capillary leak (ovarian neoangiogenesis) and along with visceral edema, increased IAP may result [61,62]. In its most severe form, massive and rapid accumulation of abdominal ascites results in overt ACS [73]. Management includes intensive care unit admission with IAP monitoring and paracentesis to relieve IAH or ACS, especially if respiratory failure occurs [62,73].…”

“…In its most severe form, massive and rapid accumulation of abdominal ascites results in overt ACS [73]. Management includes intensive care unit admission with IAP monitoring and paracentesis to relieve IAH or ACS, especially if respiratory failure occurs [62,73]. Figure 3 and Table 1 show the evolution of IAP in a patient with OHSS after staged paracentesis.…”