Ovarian hyperstimulation syndrome

The ovaries are very important organs for women. If there is a problem in this part, it will have serious consequences. Ovarian hyperstimulation syndrome is a typical one. Ovarian hyperstimulation syndrome is one of the main complications of in vitro fertilization and requires timely treatment after it occurs. Let's take a look at the details of ovarian hyperstimulation syndrome.

Ovarian hyperstimulation syndrome is one of the main complications of in vitro fertilization. It is an overreaction of the human body to ovulation-inducing drugs. It is a complication with a series of clinical symptoms characterized by the development of multiple follicles in both ovaries, enlarged ovaries, abnormal capillary permeability, and extravasation of abnormal body fluids and proteins into the third space of the human body. The main clinical manifestations of OHSS are ovarian cystic enlargement, increased capillary permeability, and fluid accumulation in the interstitial space, causing peritoneal effusion, pleural effusion, and local or systemic edema. In recent years, the incidence of OHSS has been on the rise, attracting more and more attention from clinical medical workers.

Causes

OHSS can occur after the follicles are stimulated in various ways. The main risk factors associated with OHSS are:

1. The ovaries are highly sensitive to ovulation-inducing drugs (hypersensitive ovaries): common in patients with polycystic ovary and young (age <35 years old) thin people.

2. Use HCG to promote ovulation or maintain the corpus luteum of pregnancy.

3. Endogenous HCG secretion in early pregnancy.

4. Patients with a history of OHSS.

Clinical manifestations

The main clinical manifestations of OHSS are ovarian cystic enlargement, increased capillary permeability, and fluid accumulation in the interstitial space, causing peritoneal effusion, pleural effusion, and local or systemic edema. OHSS can generally be divided into three degrees: mild, moderate (incidence rate is 3% to 6%), and severe (incidence rate is 0.1% to 2%).

Some patients may suffer from acute abdominal symptoms such as ovarian torsion, lutein cyst rupture and bleeding due to their enlarged ovaries. It is divided into three levels: mild, moderate and severe. Mild: Symptoms and signs usually appear 3 to 7 days after HCG injection, manifested as bloating, poor appetite, lower abdominal discomfort, heaviness or mild lower abdominal pain. Ultrasound examination showed that the ovaries were enlarged and the diameter was ≤5cm. Moderate: There is obvious lower abdominal distension and pain, and there may be nausea, vomiting, thirst, and occasionally diarrhea, and weight gain ≥3kg. Ultrasound examination showed enlarged ovaries with a diameter of 5 to 10 cm, and 4.5 kg of peritoneal fluid. A large amount of pleural and abdominal effusion may lead to decreased blood volume, blood concentration, hypercoagulable state, and hypovolemic shock. In severe cases, it may cause abnormal cardiopulmonary function, electrolyte imbalance, liver and kidney function damage, thrombosis, and adult respiratory distress syndrome.

treat

OHSS is a self-limiting disease that usually occurs 3 to 7 days after HCG injection. If you are not pregnant, the course of the disease is about 14 days; if you are pregnant, it will continue for a period of time and the condition may worsen.

1. Mild

Generally no special treatment is required. Patients are encouraged to drink more water. Most patients can recover within 1 week.

2. Moderate

Instruct patients to conduct self-examination, including bed rest, adequate fluid intake, and monitoring of abdominal circumference, urine volume, and weight. Some patients may be hospitalized for observation.

3. Severe

The patient should be hospitalized for treatment, the goal of which is to maintain adequate blood volume, correct hemoconcentration, maintain normal urine output, improve symptoms to the greatest extent, and avoid serious complications such as shock, thromboembolism, water and electrolyte imbalance, abnormal liver and kidney function, etc.

(1) Closely monitor changes in vital signs.

(2) Symptomatic treatment: ① Rest, eat a high-protein diet, drink small amounts of water frequently in the early stages, and replenish normal saline and glucose in time to increase urine output. ② The first choice for volume expansion is intravenous drip of human albumin, which helps to maintain plasma colloid osmotic pressure and effective blood volume, and reduce free estrogen and some harmful factors. ③ To reduce fluid leakage into the chest and abdominal cavity, take prednisone tablets orally. ④ To prevent thrombosis, encourage patients to turn over, move their limbs, massage their legs, and take enteric-coated aspirin tablets. Severe cases require anticoagulant therapy. ⑤ When there is an indication for the treatment of ascites, peritoneal drainage can be performed. ⑥ Treatment of pleural effusion: It occurs less frequently. If present, pleural effusion is usually on the right side. Sometimes pleural effusion and peritoneal effusion occur simultaneously.

(3) When OHSS presents with ovarian rupture and severe internal bleeding, surgical treatment should be performed. When twisting occurs, you can raise your hips and change your body position, which can usually relieve the problem on its own. Surgical treatment if necessary.