From the Research
Management of Ovarian Hyperstimulation Syndrome (OHSS) after egg retrieval should prioritize outpatient paracentesis for moderate to severe cases, as it reduces the risk of hospitalization and complications, as shown in the most recent study 1. The approach to managing OHSS involves supportive care and symptom management based on the severity of the condition. For mild OHSS, outpatient management is sufficient, including:
- Oral hydration (2-3 liters daily)
- Pain control with acetaminophen or NSAIDs
- Monitoring for worsening symptoms Moderate OHSS may require closer monitoring with:
- Daily weight checks
- Abdominal circumference measurements
- Possibly antiemetics like ondansetron 4-8mg every 8 hours for nausea Severe OHSS necessitates hospitalization for:
- IV fluid management (typically crystalloids)
- Thromboprophylaxis with enoxaparin 40mg daily
- Possibly paracentesis for significant ascites causing respiratory compromise Albumin infusion (25g IV) may be considered for severe cases with hypoalbuminemia, as supported by earlier studies 2. Throughout treatment, it is essential to monitor electrolytes, renal function, and hematocrit regularly. Patients should be advised to avoid intense physical activity and sexual intercourse until symptoms resolve. OHSS typically resolves within 7-10 days in non-pregnant women but may persist longer if pregnancy occurs due to continued hCG production. The underlying pathophysiology involves increased vascular permeability from excessive ovarian stimulation, leading to third-spacing of fluid, which explains the focus on fluid management and monitoring for complications like thromboembolism, as discussed in recent reviews 3. Key considerations in managing OHSS include early diagnosis, evaluation for other diseases and complications, and understanding the potential complications such as ascites, abdominal compartment syndrome, renal dysfunction, acute respiratory distress syndrome, thromboembolic disease, and hemodynamic instability, as highlighted in emergency medicine literature 4, 3. The use of cabergoline has been explored as a preventive measure for OHSS, showing promise in reducing the risk of OHSS, especially moderate OHSS, without affecting pregnancy outcomes, as demonstrated in earlier research 5. However, the most recent and highest quality study 1 supports the use of outpatient paracentesis as an effective strategy in managing OHSS, emphasizing the importance of staying updated with the latest evidence in clinical practice.