OVARIAN HYPERSTIMULATION SYNDROME question n answers graded A+ 2023/2024

OVARIAN HYPERSTIMULATION SYNDROME Background - correct answer OHSS is a systemic disease resulting from vasoactive products released by hyper stimulated ovaries. The pathophysiology of OHSS is characterized by increased capillary permeability, leading to leakage of fluid from the vascular compartment, with third space fluid accumulation and intravascular dehydration. Severe manifestations include a tendency to develop thrombosis, renal and liver dysfunction and acute respiratory distress syndrome (ARDS), causing serious morbidity. Although the true incidence of mortality from OHSS is unknown -Women should be informed that mild forms of OHSS are common, affecting up to 33% of in vitro fertilization (IVF) cycles and that 3-8% of IVF cycles are complicated by moderate or severe OHSS. -A diagnosis of OHSS is usually straightforward, given a history of ovarian stimulation, either by gonadotrophins or antiestrogens, followed by the typical symptoms of abdominal distension, abdominal pain, nausea and vomiting -In the UK, any death related to OHSS must be reported to the Confidential Enquiries into Maternal Deaths, irrespective of whether the woman was pregnant. The HFEA Standards for Assisted Conception Centres states that all adverse incidents occurring at the treatment centre must be reported by telephone to the HFEA within 12 working hours of the identification of the incident and submission of an Incident Report Form within 24 working hours. Classification of severity of OHSS - correct answer **Mild OHSS : Abdominal bloating, Mild abdominal pain, Ovarian size usually 8 cm* **Moderate OHSS Moderate abdominal pain: Nausea ± vomiting, Ultrasound evidence of ascites, Ovarian size usually 8-12 cm*