Severe ovarian hyperstimulation syndrome leading to ICU admission (original) (raw)

Pleural effusion following ovarian hyperstimulation

2012

Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication that occurs in the luteal phase of an induced hormonal cycle. In most cases, the symptoms are self-limited and spontaneous regression occurs. However, severe cases are typically accompanied by acute respiratory distress. The objective of the present study was to describe the clinical presentation, treatment, and outcome of pleural effusion associated with OHSS in three patients undergoing in vitro fertilization. The patients ranged in age from 27 to 33 years. The onset of symptomatic pleural effusion (bilateral in all cases) occurred, on average, 43 days (range, 27-60 days) after initiation of hormone therapy for ovulation induction. All three patients required hospitalization for massive fluid resuscitation, and two required noninvasive mechanical ventilation. Although all three patients initially underwent thoracentesis, early recurrence of symptoms and pleural effusion prompted the use of drainage with a pigta...

Ovarian hyperstimulation syndrome and pulmonary edema – a rare complication

International Journal of Reproduction, Contraception, Obstetrics and Gynecology, 2017

Background: Ovarian Hyperstimulation Syndrome (OHSS) is a life-threatening complication of controlled ovarian stimulation almost exclusively associated with gonadotropins but occasionally with clomiphene citrate. Prevention of this syndrome lies in the recognition of risk factors and individualizing the treatment regimens. Causes of respiratory distress in patients with OHSS are pleural effusion, pulmonary embolism, and acute respiratory distress syndrome (ARDS). Pulmonary edema is rare but a grave complication of OHSS.Case report: We report, a case of severe OHSS with tense ascites and anasarca after controlled ovarian hyperstimulation (COH) for IVF. She was managed conservatively followed by paracentesis after which she developed pulmonary edema during the course of the treatment.Conclusion: OHSS is an iatrogenic complication which can be prevented by individualizing stimulation protocols and should be managed urgently with a multidisciplinary approach.

Acute respiratory failure following ovarian hyperstimulation syndrome

Italian Journal of Medicine, 2013

Ovarian hyperstimulation syndrome is a serious and potentially life-threatening physiological complication that may be encountered in patients who undergo controlled ovarian hyperstimulation cycles. The syndrome is typically associated with regimes of exogenous gonadotropins, but it can be seen, albeit rarely, when clomiphene is administered during the induction phase. Although this syndrome is widely described in scientific literature and is well known by obstetricians, the knowledge of this pathological and potentially life-threatening condition is generally less than satisfactory among physicians. The dramatic increase in therapeutic strategies to treat infertility has pushed this condition into the realm of acute care therapy. The potential complications of this syndrome, including pulmonary involvement, should be considered and identified so as to allow a more appropriate diagnosis and management. We describe a case of a woman with an extremely severe (Stage 6) ovarian hypersti...

Compressive pleural effusion after ovarian hyperstimulation syndrome--a case report and review

Fertility and …, 2008

Objective: To report a case of early onset ovarian hyperstimulation with massive pleural effusion and respiratory failure before IVF. Design: Case report. Setting: University teaching intensive care unit. Patient(s): A 26-year-old healthy woman with an unexplained infertility transferred to the intensive care unit on day 4 after hCG injection for early severe presentation of ovarian hyperstimulation syndrome with massive compressive pleural effusion before she underwent embryo transfer. Intervention(s): Mechanical ventilation, thoracocentesis. Main Outcome Measure(s): Resolution of symptoms/stopping of embryos transfer. Result(s): Drainage of 5,300 mL of sterile exudative pleural fluid for a period of 48 hours, which permitted resolution of symptoms and allowed mechanical weaning. The IVF procedure was stopped. Conclusion(s): This case described is unusual in that the patient presented with early massive pleural effusion on day 4 after hCG injection and before embryo transfer. This is much earlier than in any case report elsewhere. (Fertil Steril Ò 2008;89:1826.e1-3.

A Case of Severe Ovarian Hyperstimulation Syndrome

Indian Journal of Clinical Biochemistry, 2013

Ovulation induction has been an important mode of treatment of infertility. Ovarian stimulation may result in a supraphysiologic response leading to an iatrogenic complication known as the ovarian hyperstimulation syndrome (OHSS). This syndrome is potentially a lethal condition, the pathophysiologic hallmark of which is the accumulation of massive extravascular exudate combined with profound intravascular volume depletion and hemoconcentration. We report a case of severe OHSS with very large ovaries in a 35 year old case of embryo transfer. The patient presented to the emergency department with abdominal pain, massive ascites, respiratory distress and amenorrhea. The patient was managed symptomatically with no complications. Although ovarian hyperstimulation is a rare entity, it is important that the physician recognizes this condition. Prompt diagnosis and successful management is likely to avoid serious and rapid development of complications.

A Early Development of Severe Ovarian Hyperstimulation Syndrome following Ovulation Induction

JMS SKIMS

Ovarian Hyperstimulation is a rare but potentially fatal complication of ovarian stimulation during treatment of infertility. Worldwide the incidence of this syndrome is increasing due to liberal use of invitro fertilization for management of infertility. The syndrome is characterized by cystic ovarian enlargement and abnormal capillary permeability due to secretion of vasogenic substances by ovaries. The syndrome is classified into early and late variants with early variants usually mild to moderate in severity. We present a case of severe ovarian hyperstimulation syndrome (OHSS) developing early in a 25-year female while undergoing In-vitro fertilization (IVF). Six days after ovulation induction, the woman developed ascites, bilateral pleural effusion and acute renal failure with ultrasound abdomen revealing bilateral cystic enlargement of ovaries. JMS 2011;14(1):30-32

Ovarian hyperstimulation syndrome (OHSS)-our clinical experience

2015

Introduction: Ovarian hyperstimulation syndrome (OHSS) is a serious complication of the luteal phase/early pregnancy, usually iatrogenic, after ovulation induction or ovarian hyperstimulation in the context of intrauterine insemination and in vitro fertilization (IVF). It is usually a self limiting disorder but may be more severe and persist longer than usual, if pregnancy is successful. Renal and hepatic dysfunction, thrombosis, hydrothorax, cerebral infarct and adult respiratory distress syndrome (ARDS) are the leading causes of morbidity and mortality seen in severe cases. Materials and methods: This is a retrospective study of two years which included women with clinical signs and symptoms suggestive of OHSS. Diagnosis was confirmed by the investigations. Conservative medical management was the main stay of treatment with daily monitoring of the clinical and biochemical parameters. Surgical management like paracentesis, pleuracentesis, diagnostic laparoscopy and therapeutic term...

Ascites due to ovarian hyperstimulation syndrome: A case report and review of literature

Indian Journal of Critical Care Medicine, 2007

Objectives: To report a case of ovarian hyperstimulation syndrome (OHSS), to discuss the differential diagnosis and to give a review of current evidences in diagnosis and management of ovarian hyperstimulation syndrome. Design: A detailed description of a case of OHSS followed by a thorough review of case reports, randomized controlled trials and review articles to assess the current modalities of diagnosis and management of ovarian hyperstimulation syndrome. Results: A 29-year-old female was admitted with dyspnoea and features suggestive of polyserositis. Patient was evaluated for causes of polyserositis. She gave history of ovulation induction and invitro fertilization one week prior to the onset of dyspnoea. With the positive history of invitro fertilization and negative markers for other causes of capillary leak syndrome the patient was diagnosed to have OHSS. She was treated and improved within a week. Conclusion: Diagnosis and management of ovarian hyperstimulation syndrome requires high index of suspicion, prompt investigation and early initiation of effective therapy. With correct diagnosis and early treatment, most patients recover.