Ovarian hyperstimulation syndrome: A review for emergency clinicians

Douglas Timmons, Tim Montrief, Alex Koyfman, Brit Long
The American journal of emergency medicine · 2019 · vol. 37(8) , pp. 1577–1584 · doi:10.1016/j.ajem.2019.05.018 · PMID:31097257 · W2944212297
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This review outlines the pathophysiology, clinical presentation, diagnosis, and management of ovarian hyperstimulation syndrome (OHSS) for emergency clinicians.

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Abstract

INTRODUCTION: A great deal of literature has recently evaluated the prevention and management of ovarian hyperstimulation syndrome (OHSS) in the outpatient setting, but there remains a dearth of research evaluating OHSS in the emergency department (ED) and its management. OBJECTIVE: This narrative review evaluates the underlying pathophysiology and clinical manifestations of OHSS and discusses approaches to patient care in the ED based on current literature. DISCUSSION: OHSS is an iatrogenic complication caused by an excessive response to controlled ovarian stimulation during assisted reproductive cycles (ART). OHSS complicates up to 30% of ART cycles, and many of these patients seek initial care in the ED. Risk factors for the development of OHSS include age < 35, history of polycystic ovarian syndrome or previous OHSS, and pregnancy. Emergency physicians will be faced with several complications including ascites, abdominal compartment syndrome, renal dysfunction, acute respiratory distress syndrome, thromboembolic disease, and hemodynamic instability. Critical patients should be evaluated in the resuscitation bay, and consultation with the primary obstetrics/gynecology team is needed, which improves patient outcomes. This review provides several guiding principles for management of OHSS and associated complications. CONCLUSIONS: OHSS occurs in up to 30% of IVF cycles and carries a high morbidity. Effective care of the OHSS patient begins with early diagnosis while evaluating for other diseases and complications. Understanding these complications and an approach to the management of OHSS is essential to optimizing patient care.

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MeSH descriptors

Emergency Service, Hospital Ovarian Hyperstimulation Syndrome Ovarian Hyperstimulation Syndrome Reproductive Techniques, Assisted Ascites Ascites Dyspnea Dyspnea Female Humans Ovarian Hyperstimulation Syndrome Ovarian Hyperstimulation Syndrome Practice Guidelines as Topic Pregnancy Reproductive Techniques, Assisted Risk Factors

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