中、重度卵巢过度刺激综合征31例临床分析

目的探讨卵巢过度刺激综合征(OHSS)的临床表现及相应的治疗对策。方法回顾分析本院发生的31例中、重度OHSS临床资料。结果OHSS绝大多数发生在促排卵治疗后,临床表现主要为腹胀、恶心、腹水、胸水、水肿、尿少、血液浓缩、低蛋白血症、氮质血症,经严密监护、输白蛋白或血浆扩容及放腹水等对症治疗后治愈。结论OHSS在严密监护下,经相应的对症治疗可治愈。     

Ovarian hyperstimulation syndrome: A review for emergency clinicians

IntroductionA 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.ObjectiveThis narrative review evaluates the underlying pathophysiology and clinical manifestations of OHSS and discusses approaches to patient care in the ED based on current literature.DiscussionOHSS 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.ConclusionsOHSS 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.     

B超介导下经阴道穿刺引流术在卵巢过度刺激综合征患者中的应用和护理

目的探讨对体外受精一胚胎移植术（IVF—ET）后卵巢过度刺激综合征（OHSS）出现张力性腹水需B超介导经阴道穿刺引流术患者的护理措施。方法回顾分析体外受精～胚胎移植周期中23例0HSS需行B超介导经阴道穿刺引流术患者的术前准备、术中配合和术后护理。结果23例患者手术均顺利进行，病情得以控制，未发生严重的心肺功能障碍和严重肝肾功能受损等并发症。结论B超介导经阴道穿刺引流术是治疗卵巢过度刺激综合征患者出现张力性腹水的有效方法。手术的成功取决于医生的技术，护士熟识手术步骤能更好地配合医生进行手术。术后饮食指导是患者治疗成功的重要环节。     

Ovarian hyperstimulation syndrome

Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication that is associated with modern techniques for in vitro fertilization. Extensive efforts have been made to understand the pathophysiology and to improve the management of this entity. The severe and life-threatening forms of the ovarian hyperstimulation syndrome are still challenging for critical care physicians. This article reviews the pathogenesis, epidemiology, classification, clinical manifestations, and complications of these forms of OHSS. The different therapeutic options currently available are reviewed, and a stepwise approach for the management of these patients is provided.     

不同促排卵方法治疗不孕症成功47例分析

目的　分析不同促排卵方法对不孕症治疗的效果及其并发症的防治。方法　采用不同促排卵方法治疗成功的 4 7例不孕症患者 ,分成 3组 :克罗米酚 (CC)组、CC 人绝经期促性腺激素 (HMG)组、HMG组 ,比较其妊娠率、多胎率、流产率及卵巢过度刺激综合征 (OHSS)发生率。结果　各组的妊娠率、多胎率及流产率均无显著差异 (P >0 .0 5 )。HMG组、CC HMG组、CC组的OHSS发生率分别为 4 2 .0 % ,7.7% ,0 % ,HMG组显著高于CC组和CC HMG组 (P <0 .0 5 )。结论　应用HMG治疗不孕症的OHSS发生率较高 ,故严密监测极为重要。     

卵巢过度刺激综合征的临床治疗与分析

目的 探讨卵巢过度刺激综合征(OHSS)的特征以及防治疗方法 .方法 对我院46例OHSS患者的临床资料采取回顾性分析的方法 .结果 经过治疗,所有患者症状均有所缓解,复查各项生化指标正常.结论 OHSS应高度重视和警惕,早期识别、相应的预防措施及对症支持治疗能减少OHSS发生,保护患者的生命安全.     

中重度卵巢过度刺激综合征90例临床分析

目的探讨辅助生殖技术中的卵巢过度刺激综合征(OHSS)的高危因素及临床监测与治疗。方法对四川省人民医院90例中、重度卵巢过度刺激综合征临床资料进行回顾性分析。结果 (1)OHSS发生的高危因素:年轻患者、多囊卵巢综合征、过多卵泡数目以及妊娠。(2)妊娠的OHSS患者与未妊娠患者的病程分别为(18.56±12.19)d及(8.28±3.21)d,临床治疗时间及病程明显延长;未妊娠与妊娠患者所使用清白蛋白量为(130.43±24.22)g及(257.39±64.35)g,妊娠患者症状重、清蛋白治疗用量大。(3)扩容及输注清蛋白是治疗OHSS的有效措施,严重患者穿刺引流胸腔积液和腹水可缓解症状。结论 OHSS是辅助生育技术控制性超排卵治疗引起的医源性并发症,应予以正确的防治。     

Ovarian hyperstimulation syndrome (OHSS): diagnosis and management

Objective: To present our experience and the current knowledge about pathophysiology, diagnosis, and management of the ovarian hyperstimulation syndrome (OHSS). Design: Retrospective study concerning clinical and laboratory findings of severe OHSS. Setting: General ICU at a maternity-surgical hospital. Patients: Ten patients suffering from severe OHSS. Interventions: Supportive and preventive therapeutic measures applied are described. Measurements and results: Admission and discharge data as well as worst values during disease course were recorded. Clinical and laboratory findings showed third space fluid shift leading to weight gain, generalized tissue edema, ascites, hydrothorax, abdominal distension and pain, chest discomfort, hypovolemia, dehydration, ovaries enlargement, electrolyte disturbances, hypoalbuminemia, high hematocrit, urea, and WBC. Conclusions: OHSS is an iatrogenic complication of assisted conception of unknown pathogenesis, with potentially life-threatening sequelae due to hemoconcentration such as circulatory shock, ARDS, hepato-renal failure, thromboembolic phenomena, and multi-organ dysfunction syndrome. Gynecologists and intensivists must be aware of the diagnosis and management of the syndrome because of the widely used reproductive techniques for assisted conception. Received: 8 July 1999 Final revision received: 3 January 2000 Accepted: 15 February 2000     

卵巢过度刺激综合征77例临床分析

目的：探讨多囊卵巢综合征（OHSS）治疗的临床特征和治疗方法。方法：回顾性分析77例OHSS住院患者的临床资料。结果：77例OHSS患者均发生在超促排卵周期的第9～22 d,其中50例患者发生在体外受精胚胎移植（IVF-ET）术后。经过监护、扩容、补液、注射黄体酮及腹腔、胸腔穿刺引流后,患者在6～43d内病情缓解并出院,77例患者妊娠47例,其中一例终止妊娠。结论：OHSS的治疗主要是对症支持治疗,严密监护OHSS的病情发展,扩容是治疗的关键,治疗严重的难以控制的OHSS,终止妊娠是最有效的手段。     

低剂量FSH治疗多囊卵巢综合征的临床效果分析

目的 探讨低剂量FSH治疗多囊卵巢综合征的临床效果。方法 多囊卵巢综合征28例 ,其中常规FSH治疗组12例 ,低剂量FSH治疗组16例。比较两组患者的年龄、不孕年限、E2水平、卵泡数、卵巢过度刺激综合征发生率及妊娠率。结果 常规FSH组和低剂量FSH组的年龄、不孕年限、妊娠率无差异(p>0.05)。低剂量FSH组的E2水平明显低于常规FSH组(p<0.01) ,常规FSH组的卵泡数明显多于低剂量FSH组(p<0.01) ,低剂量FSH组的卵巢过度刺激综合征发生率明显低于常规FSH组(p<0.01)。结论 低剂量FSH方案在降低卵巢过激危险同时可获得较高的妊娠率 ,有可能成为治疗多囊卵巢综合征较理想的治疗方案     

Continuous ascitic recirculation in severe ovarian hyperstimulation syndrome

Massive ascites, hydrothorax, acute renal failure and thromboembolism are clinical manifestations of severe ovarian hyperstimulation syndrome (OHSS) which may complicate the induction of ovulation with exogenous gonadotrophins. We report a case of severe OHSS with ascites formation in excess of five litres per day. Massive ascites and bilateral pleural effusions resulted in respiratory failure. Continuous ascitic recirculation (AR) was commenced after repeated paracentesis and IV fluid therapy failed to improve the patient's condition. The procedure was undertaken for a total of 15 days and rapidly resulted in marked improvement of impaired respiratory function. Febrile episodes occurred on 3 occasions, but we did not observe coagulation disturbances or adverse haemodynamic effects. Continuous AR is a safe and effective treatment of complicated severe OHSS.     

Ovarian overstimulation syndrome: problem of intensive care

Ovarian hyperstimulation syndrome (OHSS) is an iatrogenic complication, the basis for which is a hyperergic uncontrolled ovarian response to gonadotropins in the ovulation stimulation cycles and assisted procreation programs. The clinical picture of OHSS is characterized by a broad spectrum of clinical and laboratory manifestations: increased vascular permeability resulting in the excess release of liquid into the third space and its storage with the development of hypovolemia, hemoconcentration, oliguria, hypoproteinemia, electrolyte imbalance, polyserositis; in severe cases, acute renal failure, thromboembolic events, and adult respiratory distress syndrome develop. The goal of treatment is to prevent the development of multiply organ dysfunctions. Its leading methods are infusion therapy with colloid-crystalloid solutions and anticoagulant therapy. Whether diuretics and other drugs are administered is under consideration. Indications for laparocentesis and peritoneal transudate evacuation are discussed. Complications requiring surgery are identified.     

Emergency ultrasound diagnosis of ovarian hyperstimulation syndrome: case report

Background

Ovarian hyperstimulation syndrome (OHSS) is an exaggerated response to ovulation induction therapy. It is a known complication of ovarian stimulation in patients undergoing treatment for infertility. As assisted reproductive technology and the use of ovulation induction agents expands, it is likely that there will be more cases of OHSS presenting to the Emergency Department (ED).

Objectives

OHSS has a broad spectrum of clinical manifestations, from mild abdominal pain to severe cases where there is increased vascular permeability leading to significant fluid accumulation in body cavities and interstitial space. Severe cases may present to the ED with ascites, pericardial effusions, pleural effusions, and lower extremity edema. Through a case report, we review OHSS with an emphasis on early diagnosis by Emergency Physician (EP)-performed bedside ultrasonography.

Case Report

We present a case of a patient undergoing treatment for infertility who presented to the ED with shortness of breath and abdominal pain. The diagnosis of severe OHSS was made, largely based on EP-performed bedside ultrasonography showing peritoneal free fluid and bilateral pleural effusions, as well as multiple ovarian follicles.

Conclusions

This report reviews the pathophysiology of OHSS, its clinical features, and pertinent diagnostic and management issues. This report emphasizes the importance of early EP-performed bedside ultrasonography.     

Spontaneous ovarian hyperstimulation syndrome and hyperreactio luteinalis are entities in continuum.

Hyperreactio luteinalis (HL) and spontaneous ovarian hyperstimulation syndrome (OHSS) are both rare conditions during pregnancy. The clinical presentation of HL and OHSS are comparable and both should be differentiated from ovarian carcinoma. We present a case of a 32-year-old woman who was initially seen with markedly enlarged multicystic ovaries and ascites in the 13th week of a spontaneously conceived pregnancy. Ultrasonographic follow-up and magnetic resonance imaging of the ovaries were employed in order to avoid exploratory laparotomy and rule out ovarian carcinoma. The patient received supportive therapy and delivered a healthy child at term. The increasing use of ultrasonography may lead to more frequent findings of multicystic ovaries in spontaneously conceived pregnancies. Making the distinction between HL and spontaneous OHSS in these cases may be difficult though clinically irrelevant as the approach to treatment is similar in both.     

A “kiss” before conception: triggering ovulation with kisspeptin-54 may improve IVF

A 30-year-old primigravid (G1P000) female with infertility secondary to her partner’s oligospermia and her chronic anovulation presented 13 days after an oocyte retrieval for in vitro fertilization (IVF) with a positive home pregnancy test, abdominal distention, a 5-pound weight gain, nausea, shortness of breath, and reduced urinary frequency. Her IVF cycle included the usual cocktail for gonadotropin stimulation and was uncomplicated, except for excessively stimulated ovaries that led to a peak estradiol level of 6,000 pg/ml and the retrieval of 30 oocytes. Her past history was relevant only for anovulation due to polycystic ovarian syndrome (PCOS), though her preprocedure body mass index was normal at 21 kg/m². Pelvic ultrasound revealed abundant ascites and enlarged ovaries, at 8 cm average diameter. Serum human chorionic gonadotropin (hCG) concentration was 200 mIU/ml; she was hemoconcentrated (hemoglobin 16 g/dl), with normal liver function and coagulation testing. An ultrasound guided, transvaginal paracentesis removed 4 liters of straw-colored fluid, resulting in significant short-term symptom relief.The patient described above has moderate to severe ovarian hyperstimulation syndrome (OHSS), the most serious maternal complication of gonadotropin therapy. OHSS poses a significant risk of maternal morbidity and mortality as well as pregnancy loss. The patient’s risk factors for having OHSS include youth, excessive ovarian stimulation, PCOS, and a likely twin gestation. Signs and symptoms of severe OHSS include abdominal distention, compromised renal function (including renal failure) due to decreased renal perfusion secondary to pressure from tense ascites and decreased intravascular volume, respiratory compromise due to pleural effusion and pulmonary edema, thromboembolism (including stroke) due to hemoconcentration and high estrogen levels, ovarian rupture, electrolyte abnormalities, and liver dysfunction. Although most cases are mild and self limited, severe cases can result in acute respiratory distress syndrome (ARDS) or stroke and can require intensive care unit (ICU) admission to prevent death.     

An unusual cause of tachycardia, hypotension, and intraabdominal free fluid: ovarian hyperstimulation syndrome

We report a case of ovarian hyperstimulation syndrome (OHSS) in a 37-year-old female who had recently underwent assisted reproductive technology involving oocyte retrieval. Her emergency department (ED) presentation, clinical course, and a discussion of ovarian hyperstimulation syndrome are also presented. Ovarian hyperstimulation syndrome is a critical diagnosis in emergency medicine, and emergency physicians must consider it in the differential for any female nontrauma patient presenting with hypotension, tachycardia, and abdominal pain.     

Ovarian Hyperstimulation Syndrome as a Growing Diagnostic Problem in Emergency Department Settings: A Case Report

Background

Ovarian hyperstimulation syndrome (OHSS) is a common complication of an in-vitro fertilization (IVF) procedure, which is usually clinically insignificant. However, without monitoring, it can progress into a life-threatening condition. With the increasing popularity of IVF technology, patients with OHSS may begin visiting emergency departments (EDs) more frequently.

超声对卵巢过度刺激综合征的诊断价值

目的探讨超声对卵巢过度刺激综合征的诊断价值.方法收集我院自1999年来诊治的7例卵巢过度刺激综合征病例进行回顾分析.结果 7例患者的卵巢增大,3例伴腹水,1例腹水伴胸水.结论超声是诊断卵巢过度刺激综合征的首选方法.     

Hemoperitoneum from ruptured cyst in a hyperstimulated ovary: a sonographic mimic of ovarian hyperstimulation syndrome

We report a case of a ruptured cyst in a hyperstimulated ovary that was initially misinterpreted as ovarian hyperstimulation syndrome (OHSS). A 22-year-old woman who was on oral clomiphene citrate for primary infertility presented with pain in the lower abdomen, hypotension, and tachycardia. Sonographic examination revealed multiple cysts in both ovaries and free fluid in the abdomen, and the initial diagnosis was OHSS. However, sonographically guided aspiration of free fluid revealed a hemoperitoneum, and the patient underwent emergent surgery. At laparotomy, an actively bleeding ruptured cyst in a hyperstimulated ovary was found to be the cause of the hemoperitoneum. Radiologists must be familiar with the imaging features of this condition to avoid misdiagnosing it as OHSS, because this could potentially delay urgently required surgery.     

超声早期诊断卵巢过度刺激综合征的价值

目的探讨超声对卵巢过度刺激综合征(ovarian hyperstimulation syndrome,OHSS)的早期诊断价值.方法经腹超声,对使用促排卵药物后发生过度刺激反应的卵巢动态观察和监测.结果卵巢体积增大、成熟卵泡(直径>2.0 cm)数目增多并等大、陶氏腔积液、腹水、胸水等是超声诊断OHSS发生的早期声像表现.结论超声对OHSS具有较高的早期诊断价值.