卵巢过度刺激综合征的B型超声诊断

本文报告用HMG—HCG治疗12例无排卵不育症患者,其中3例发生了卵巢过度刺激综合征。该症的特点:以双卵巢增大,卵泡增大,伴腹水为主要症状,其发生率略高于国外,超声检查为该症提供了早期诊断的指标。     

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.     

羟乙基淀粉在卵巢过度刺激综合征中的应用8例分析

目的 观察羟乙基淀粉(贺斯)治疗卵巢过度刺激综合征(OHSS)的疗效.方法 8例卵巢过度刺激综合征患者单纯给予羟乙基淀粉并适时穿刺放腹水.结果 8例中、重度卵巢刺激综合征患者全部转归.结论 羟乙基淀粉有很好的扩容效果,可广泛的用于OHSS治疗,与白蛋白相比费用低廉,来源方便,更适宜临床应用.     

超声在预防卵巢过度刺激综合征中的应用17例分析

目的探讨超声在预防卵巢过度刺激综合征(OHSS)中的应用。方法经阴道超声及经腹部超声,对使用药物促排卵发生过度刺激的卵巢进行监测。结果轻度OHSS 9例,中度OHSS 5例,重度OHSS 3例。结论超声对预防OHSS发生具有较高的早期诊断价值。     

重度卵巢过度刺激综合征行腹腔穿刺放腹水的护理

总结19例重度卵巢过度刺激综合征患者行B超引导腹腔穿刺放腹水的护理。认为护理重点是做好患者的心理护理,完善腹腔穿刺前准备,放腹水时加强生命体征监测、密切配合医生操作、重视腹水引流护理,放腹水后加强饮食指导,以提高重度卵巢过度刺激综合征的治疗效果,获得理想的妊娠结局。     

二维超声对卵巢纤维瘤的诊断价值

目的：探讨二维超声对卵巢纤维瘤的诊断价值。方法：45例拟诊为卵巢纤维瘤的患者，术前1周行二维及彩色多普勒超声检查，观察其声科特征，术后经病理组织学验证。结果：45例中有38例为卵巢纤维瘤患者，超声诊断符合率为84．4％，其中单侧34例，双侧4例，共查出42枚肿瘤，声像图特征：均质低回声为主（35枚，占83．3％），少数肿瘤伴变性（7枚），呈不均匀混合回声，38例患者中有1例伴胸腹水，即Meigs综合征：有12例伴腹水。结论：以二维超声为基础，结合彩色多普勒血流显像，可以提高卵巢纤维瘤的诊断率。     

卵巢过度刺激综合征的护理

卵巢过度刺激综合征 (OHSS)是辅助生育的主要并发症 ,在使用诱导排卵的激素时 ,所产生的一种并发症。我院 2 0 0 0年 9月～ 2 0 0 3年 2月收治重度卵巢过度刺激综合征 5例 ,经严密监测、精心护理 ,痊愈出院 ,现报告如下。1　临床资料本组 5例 ,年龄 2 6～ 37岁 ,其中 1例为原发不孕 ,4例继发不孕。 5例患者于胚胎植入术后 2～ 12天 ,均不同程度出现腹胀、腹痛 ,恶心呕吐、伴心慌及呼吸困难 ,5例患者均有大量腹水及双下肢水肿 ,2例伴外阴水肿 ,1例伴胸水。均有不同程度贫血、低蛋白血症及轻度酸碱平衡失调。B超检查患者卵巢大小均超过 10cm…     

医源性卵巢过度刺激综合征的临床观察与护理

对10例卵巢过度刺激综合征患者进行了仔细观察，认为卵巢过度刺激综合征与患者的个体反应以及卵泡发育的数目、大小有关。提出对卵巢过度刺激综合征患者应予心理护理，对出现的消化道症状，如恶心、呕吐、腹胀、腹痛等，应在排除卵泡破裂，出血和早孕反应后予以对症处理。对重度卵巢过度刺激综合征患者应密切观察生命体征和一般情况，注意腹围、体重变化，观察24h出入量，绝对卧床休息，注意保持电解质的平衡，保持血容量、合理安排输液顺序，胸水引起呼吸困难时，可作胸腔引流，腹水久未消退可考虑腹腔穿刺点滴放腹水，以减轻症状。     

重度卵巢过度刺激综合征2例临床护理

目的:探讨重度卵巢过度刺激综合征(OHSS)的临床护理方法.方法:对2例重度卵巢过度刺激综合征患者根据其临床症状实施全方位的护理.结果:经有效的治疗和护理,2例均康复出院,避免了OHSS危象发生.结论:对重度卵巢过度刺激综合征患者给予精心护理,可以减轻OHSS症状,避免OHSS危象发生,促进疾病的转归.     

中重度卵巢过度刺激综合征患者的护理

总结45例中、重度卵巢过度刺激综合征患者的护理经验。认为充分认识卵巢过度刺激综合征的高危因素,严密监测患者病情变化;采取积极的心理护理,转变患者及其家属的心态;指导患者进食高蛋白饮食,促进腹水的吸收;完善各项基础护理措施,确保患者生命体征稳定;配合医生做好穿刺放液的护理是有效控制中、重度卵巢过度刺激综合征进展的关键。经有效治疗和精心护理,本组患者均安全度过反应期,好转或康复出院。     

诱发排卵时卵巢过度刺激综合征44例临床分析

目的：回顾性分析44例卵巢过度刺激综合征(OHSS)，提出预防和治疗的措施。方法：293个超排卵周期中，44个周期发生OHSS。分析OHSS的年龄、体重指数、促排方案、临床表现、以及治疗结果。结果：轻度和部分中度患者，未作任何处理自动缓解；9例给予人体血清白蛋白；6例给予人体血清白蛋白，并放腹水，3～55天内缓解；28例中、重度患者，住院监测后缓解。结论：B超预览双侧卵巢状态，以发现多囊卵巢(PCO)征象病人；白蛋白是扩容的首选，可预防性和治疗性用药；适当抽腹水、胸水以改善循环功能。     

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。     

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.     

留置中心静脉导管腹水引流治疗中重度卵巢过度刺激综合征合并张力性腹水的临床应用

目的回顾性分析留置中心静脉导管（CVC）腹水引流治疗中重度卵巢过度刺激综合症（OHSS）合并张力性腹水的临床疗效。方法将本中心2009年1月-2011年6月、2004年6月-2008年12月收治的中重度OHSS合并张力性腹水患者分别作为置管组（n=10）、对照组（n=15）。置管组采用CVC腹腔留置引流腹水,对照组采用传统多次腹腔穿刺引流腹水,评价临床疗效。结果置管组均一次性置管成功,引流腹水后患者腹胀明显缓解,腹围、体重、红细胞压积、尿比重均明显下降,24h尿量明显增多;与对照组比较,治疗5d患者腹围明显减小、腹水引流量及总引流次数增多、病程有所缩短,且置管组无特殊并发症。结论采用CVC腹腔留置引流治疗中重度OHSS合并张力性腹水患者效果良好,且方便、安全、经济,患者依从性好。值得推广。     

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.     

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。     

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.     

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.     

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.