it is simple to learn about complications of oI

1. Management of Ovarian
hyper-stimualtion syndrome
Dr. wael Naeem M.
Assistant Lecturer
Benha university hospitals .
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3. Outline
• Background
• Pathophysiology
• Clinical presentations
• Complications
• Prevention
• Treatment
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4. Back ground
• What is OHSS ??
• Incidence
• Mortality rate 1: 300.000
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10. COMPLICATIONS
• Morbidity
• 1.Thrombosis
• 2.Renal& liver dysfunction
• 3.ARDS
• 4.Psychological burden & their willingness to undergo
further fertility tt (Verberg et al., 2008).
• 5.Pregnancy-related complications
Miscarraige
PTL
PIH
(Abramovet al., 1998; Courbiereet al., 2011).
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11. • Causes of mortality in OHSS
• 1.ARDS .
• 2.Cerebral infarction.
• 3.Hepatorenalfailure.
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13. •So how to prevent OHSS
???
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16. • 1-Reducing dose of Gondatrophins
• 2-using GNRH antagonist
• 3- reducing dose of HCG triggering
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17. • 4- Avoiding use of HCG for triggering …
• 5- Alternatives for triggering .
• 6- avoiding use of HCG for luteal phase
support
• 7- IVM
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18. • 8- insulin sensitizing agents ( metformin )
• 9- cycle cancellation
• 10- Cryopreservation of All embryos
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19. • 11- Antagonist Salvage .
• 12- Albumin Vs HES .
• 13- Dopamine agonists .
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20. Treatment of OHSS
• In patient
VS
out patient
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21. Outpatient management of OHSS
• Indication:
• 1.Mild or moderate OHSS
• 2.Selected cases with severe OHSS
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22. Treatment:
1- Reassurance:
II-. Instruct the patient .
1. Fluid intake
2. fluid chart
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23. •3. Avoid:
• a. Strenuous exercise
• b. Sexual intercourse {fear of injury or torsion
of hyperstimulatedovaries}.
• c. Complete bed rest {Increase DVT}
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24. • 4. Urgent clinical review:
• a. increasing severity of pain
• b. increasing abdominal distension
• c. shortness of breath
• d. reduced u output
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25. • III. Analgesia:
• Paracetamol or codeine
• NSAID should not be used
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26. • IV. Continue progesterone luteal support
but hCG luteal support is inappropriate.
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27. V. Severe OHSS
• 1. Thromboprophylaxis with LMWH.
The duration individualized, taking into account
risk factors whether or not conception occurs.
• 2. Paracentesis of ascitic fluid
carried out on an outpatient basis by the
abdominal or transvaginalroute under
ultrasound guidance.
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28. VII. Review and monitoring:
• Urgently
if symptoms or signs of worsening
• In the absence of these
every 2–3 days .
• Baseline laboratory investigations
repeated if severity is thought to be worsening.
Hct
useful guide to the degree of intravascular volume
depletion.
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29. S & S of worsening OHSS
• 1.increasing abdominal distension and pain
• 2.shortness of breath
• 3.tachycardia or hypotension
• 4.reduced urine output (≤ 1000 ml/24 h)
• 5.positive fluid balance (≥1000 ml/24 h)
• 6.weight gain and increased abdominal girth
• 7.increasing haematocrit(≥ 0.45).
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30. Inpatient management
Indication
• 1.unable to achieve satisfactory pain control
• 2.unable to maintain adequate fluid intake due
to nausea
• 3.show signs of worsening OHSS despite
outpatient intervention
• 4.unable to attend for regular outpatient follow-
up
• 5.have critical OHSS.
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31. Paracentesis
• when to DO ???
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32. • 1-severe abdominal distension and abdominal
pain secondary to ascites
• 2.shortness of breath and respiratory
compromise secondary to ascites and
increased intra-abdominal pressure
• 3.oliguria despite adequate volume
replacement secondary to increased
abdominal pressure causing reduced renal
perfusion.
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33. • Never to USE
Diuretics
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34. Surgery be cautious
• Indication
• 1.adnexal torsion: Laparoscopic ‘untwisting
• 2.ovarian rupture
• 3.ectopic pregnancy
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