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Ohss
This document discusses the management of ovarian hyperstimulation syndrome (OHSS). It covers the background, pathophysiology, clinical presentations, complications, prevention, and treatment of OHSS. Prevention strategies include reducing gonadotropin doses, using GnRH antagonists, reducing or avoiding HCG, cycle cancellation, and cryopreservation of embryos. Treatment involves reassurance, fluid management, analgesia, thromboembolism prophylaxis, and paracentesis for ascites. Hospitalization is required for uncontrolled pain, inability to maintain fluids, or worsening signs like shortness of breath.
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Ohss
- 1. Management of Ovarian hyper-stimualtionsyndrome Dr. wael Naeem M. Assistant Lecturer Benha university hospitals . 1wael Naeem
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- 3. Outline • Background • Pathophysiology •Clinical presentations • Complications • Prevention • Treatment 3wael Naeem
- 4. Back ground • Whatis OHSS ?? • Incidence • Mortality rate 1: 300.000 4wael Naeem
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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). 10wael Naeem
- 11. • Causes ofmortality in OHSS • 1.ARDS . • 2.Cerebral infarction. • 3.Hepatorenalfailure. 11wael Naeem
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- 13. •So how toprevent OHSS ??? wael Naeem 13
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- 16. • 1-Reducing doseof Gondatrophins • 2-using GNRH antagonist • 3- reducing dose of HCG triggering wael Naeem 16
- 17. • 4- Avoidinguse of HCG for triggering … • 5- Alternatives for triggering . • 6- avoiding use of HCG for luteal phase support • 7- IVM wael Naeem 17
- 18. • 8- insulinsensitizing agents ( metformin ) • 9- cycle cancellation • 10- Cryopreservation of All embryos wael Naeem 18
- 19. • 11- AntagonistSalvage . • 12- Albumin Vs HES . • 13- Dopamine agonists . wael Naeem 19
- 20. Treatment of OHSS •In patient VS out patient wael Naeem 20
- 21. Outpatient management ofOHSS • Indication: • 1.Mild or moderate OHSS • 2.Selected cases with severe OHSS wael Naeem 21
- 22. Treatment: 1- Reassurance: II-. Instructthe patient . 1. Fluid intake 2. fluid chart wael Naeem 22
- 23. •3. Avoid: • a.Strenuous exercise • b. Sexual intercourse {fear of injury or torsion of hyperstimulatedovaries}. • c. Complete bed rest {Increase DVT} wael Naeem 23
- 24. • 4. Urgentclinical review: • a. increasing severity of pain • b. increasing abdominal distension • c. shortness of breath • d. reduced u output wael Naeem 24
- 25. • III. Analgesia: •Paracetamol or codeine • NSAID should not be used wael Naeem 25
- 26. • IV. Continueprogesterone luteal support but hCG luteal support is inappropriate. wael Naeem 26
- 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. wael Naeem 27
- 28. VII. Review andmonitoring: • 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. wael Naeem 28
- 29. S & Sof 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). wael Naeem 29
- 30. Inpatient management Indication • 1.unableto 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. wael Naeem 30
- 31. Paracentesis • when toDO ??? wael Naeem 31
- 32. • 1-severe abdominaldistension 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. wael Naeem 32
- 33. • Never toUSE Diuretics wael Naeem 33
- 34. Surgery be cautious •Indication • 1.adnexal torsion: Laparoscopic ‘untwisting • 2.ovarian rupture • 3.ectopic pregnancy wael Naeem 34