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12 Cards in this Set
- Front
- Back
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a) Define OHSS.
b) Does it typically happen before or after embyro transfer/establishment of pregnancy? |
a)
Bilateral enlarged multicystic ovaries with intravascular volume depletion from 3rd spacing of fluids; usually secondary to gonadotropin induction of ovulation for IVF or superovulation IUI cycles. b) After |
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What molecule is thought to contribute to the pathogenesis (fluid 3rd spacing, hemoconcentration)
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VEGF
causes capillary leak |
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What patient features can suggest impending OHSS and for which you might recommend aborting embryo transfer?
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Weight gain
serum estradiol level Size and number of ovarian follicles |
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List risk factors for OHSS.
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ART (Superovulation)
Young age PCOS Low bodyweight previous OHSS high-doses of gonadotropins |
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Describe physical findings/signs in a patient with severe OHSS
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Tachycardia
Hypotension Respiratory compromise Tense ascites Oliguria |
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List possible sequelae of severe OHSS.
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Hypovolemic shock
Renal Failure ARDS/Respiratory failure VTE/Pulmonary embolism Ovarian rupture |
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Describe management of a patient admitted with OHSS.
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IV resuscitation
Crystalloids, colloids (albumin) Monitor Electrolytes, replace PRN Pain control (ovarian capsule distention) Oxygen Therapeutic paracentesis PRN Prophylactic anticoagulation Thoracentesis if necessary |
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Where are women with OHSS more likely to develop DVT/clots?
What is the percentage of arterial versus venous clots? |
torso/upper limbs; e.g. IJ, subclavian, axillary, mesenteric vessels, stroke has been reported.
25%/75% |
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What precautions should be given to women with OHSS?
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No Intercourse
Minimal physical activity |
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Is lasix indicated for peripheral edema?
for ascites? for pleural effusions? |
No.
No. No. |
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What can be considered if lung function is compromised by restriction/compression from pleural effusions?
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Chest tubes/thoracentesis.
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a) A women with known OHSS and ascites suddenly becomes hypotensive, increasingly tachycardic, and reports increased abdominal pain and distension in the last 30min. What has happened?
b) What is the management? |
a) Ovarian rupture
b) Laparotomy |
