Severe Ovarian Hyper Stimulation Syndrome: Case Report and Literature Review
Abstract
Introduction: Severe ovarian hyper stimulation syndrome is the most serious complication of ovarian stimulation during the induction of ovulation. Characteristic findings are the presence of increased ovarian volume and ascites in relation to fluid extravasation due to increased capillary permeability whose severity can lead to respiratory failure, renal failure, and hemodynamic collapse and thromboembolic events. Objective: To describe a clinical case of OHSS, along with a review of the literature on the pathology, aimed at the diagnosis and optimal treatment of patients with these clinical characteristics. Case presentation: A 29-year-old patient with a history of polycystic ovarian syndrome who presented severe Severe ovarian hyper stimulation syndrome as a secondary complication to gonadotrophic stimulation. The clinical profile showed enlarged ovaries in the sonographic test; anasarca due to ascites and bilateral pleural effusions and respiratory failures that belong to a respiratory distress type in this adult patient. Paracentesis was performed and noninvasive mechanical ventilation was used, achieving lung expansion with it. Discussion: The analysis of this case was started seven days after the administration of gonadotropin, favored by the patient’s previous conditions, with no lethal complications. Conclusions: Paracentesis may be an effective therapeutic option in the treatment of ascites with compromised lung function. Noninvasive mechanical ventilation is a strategy to avoid intubation in these patients, which avoids the periods of exhaustive sedation and the consequent risk of bronchoaspiration. [Urbina-Contreras ZE, Urbina-Echeverry SE, Lamos-Duarte AF, Picón-Jaimes YA. Severe Ovarian Hyper Stimulation Syndrome: Case Report and Literature Review. MedUNAB 2017; 20(2): 244-251].
References
2. Mai Q, Hu X, Yang G, Luo Y, Huang K, Yuan Y, et al. Effect of letrozole on moderate and severe early-onset ovarian hyperstimulation syndrome in high-risk women: a prospective randomized trial. Am J Obstet Gynecol. 2017; 216(1):42.e1-42.e10. Disponible en: https://doi.org/10.1016/j.ajog.2016.08.018
3. Poyo A. Plan de cuidados de Enfermería en el Síndrome de Hiperestimulación Ovárica. Rev enferm CyL. 2016; 8(2):10–7.
4. Corbett S, Shmorgun D, Claman P, Cheung A, Sierra S, Carranza B, et al. The Prevention of Ovarian Hyperstimulation Syndrome. J Obstet Gynaecol Canada. 2014; 36(11):1024–33. Disponible en: https://doi.org/10.1016/S1701-2163(15)30417-5
5. Cervantes E, Vallejo V, Luna R, Sandler B. Síndrome de hiperestimulación ovárica. Actualización, ventajas de su diagnóstico y tratamiento oportuno. Rev Mex Med la Reprod. 2014; 6(3):158–68.
6. Fatemi H, Popovic B, Humaidan P, Kol S, Banker M, Devroey P, et al. Severe ovarian hyperstimulation syndrome after gonadotropin-releasing hormone (GnRH) agonist trigger and “freeze-all” approach in GnRH antagonist protocol. Fertil Steril. 2014; 101(4):1008–11. Disponible en: https://doi.org/10.1016/j.fertnstert.2014.01.019
7. Nieto J, Zuluaga M, Aristizábal A, Serna L, Ocampo C, Zuluaga G. Falla renal aguda asociada a síndrome de hiperestimulación ovárica. Acta Med Colomb. 2016; 41(1):58–61.
8. Pfeifer S, Butts S, Dumesic D, Fossum G, Gracia C, La Barbera A, et al. Prevention and treatment of moderate and severe ovarian hyperstimulation syndrome: a guideline. Fertil Steril. 2016; 106(7):1634–47. Disponible en: https://doi.org/10.1016/j.fertnstert.2016.08.048.
9. American Society for Reproductive Medicine, Birmingham. Ovarian hyperstimulation syndrome. Fertil Steril. 2008; 90(5):S188–93. Disponible en: https://doi.org/10.1016/j.fertnstert.2008.08.034.
10. Pooniya S, Behera C, Mridha A, Bhardwaj D, Millo T. Fatal ovarian hyperstimulation syndrome in an anonymous egg donor. Med Leg J. 2016; 84(4):219–23. Disponible en: https://doi.org/10.1177/0025817216665074.
11. Shields R, Vollenhoven B, Ahuja K, Talmor A. Ovarian hyperstimulation syndrome: A case control study investigating risk factors. Aust New Zeal J Obstet Gynaecol. 2016; 56(6):624–7. Disponible en: https://doi.org/10.1111/ajo.12515.
12. Miller I, Chuderland D, Grossman H, Ron-El R, Ben-Ami I, Shalgi R. The Dual Role of PEDF in the Pathogenesis of OHSS: Negating Both Angiogenic and Inflammatory Pathways. J Clin Endocrinol Metab. 2016; 101(12):4699–709. Disponible en: https://doi.org/10.1210/jc.2016-1744.
13. El Tokhy O, Kopeika J, El-Toukhy T. An update on the prevention of ovarian hyperstimulation syndrome. Women’s Health. 2016; 12(5):496–503. Disponible en: https://doi.org/10.1177/1745505716664743.
14. Guo J, Zhang D-D, Zhao Y, Zhang D, Zhang X-M, Zhou C-Q, et al. Pharmacologic Interventions in Preventing Ovarian Hyperstimulation Syndrome: A Systematic Review and Network Meta-Analysis. Sci Rep. 2016; 6:1-11. Disponible en: https://doi.org/10.1038/srep19093.
15. Kwik M, Maxwell E. Pathophysiology, treatment and prevention of ovarian hyperstimulation syndrome. Curr Opin Obstet Gynecol. 2016; 28(4):236–41. Disponible en: https://doi.org/10.1097/GCO.0000000000000284.
16. Youssef M, Mourad S. Volume expanders for the prevention of ovarian hyperstimulation syndrome. Cochrane Database Syst Rev. 2016;(8). Disponible en: https://doi.org/10.1002/14651858.CD001302.pub3.
17. Kollmann M, Martins W, Lima M, Craciunas L, Nastri C, Richardson A, et al. Strategies to improve the outcomes of assisted reproduction in women with polycystic ovarian syndrome: a systematic review and meta-analysis. Ultrasound Obstet Gynecol. 2016; 48(6):709-18. Disponible en: https://doi.org/10.1002/uog.15898.
18. Rose B. A new treatment to avoid severe ovarian hyperstimulation utilizing insights from in vitro maturation therapy. J Assist Reprod Genet. 2014; 31(2):195–8. Disponible en: https://doi.org/10.1007/s10815-013-0143-6.
19. Kasum M, Orešković S, Franulić D, Čehić E, Lila A, Vujić G, et Al. Current medical strategies in the prevention of ovarian hyperstimulation syndrome. Acta Clin Croat. 2017; 56(1):133-42. Disponible en: https://doi.org/10.20471/acc.2017.56.01.19.
Downloads
| Article metrics | |
|---|---|
| Abstract views | |
| Galley vies | |
| PDF Views | |
| HTML views | |
| Other views | |
