From the Guidelines
Fluid management in Ovarian Hyperstimulation Syndrome (OHSS) requires careful monitoring and a balanced approach, with the primary goal of maintaining adequate urine output while avoiding fluid overload, as evidenced by studies such as 1 and 1. Intravenous fluid therapy should be administered judiciously, with crystalloids (typically normal saline) as the initial fluid of choice at rates adjusted to maintain adequate urine output (>0.5 mL/kg/hr) while avoiding fluid overload. Some key points to consider in fluid management for OHSS include:
- Albumin (25%, 50-100g) may be administered for severe cases with significant hypoalbuminemia or when hemoconcentration persists despite crystalloid therapy.
- Oral fluid intake should be guided by thirst rather than forced, with a recommended 1-1.5 liters daily.
- Fluid balance monitoring is essential, including daily weight, abdominal circumference, input/output measurements, and laboratory parameters (hematocrit, electrolytes, liver and renal function).
- Paracentesis is indicated for severe ascites causing respiratory compromise or severe discomfort, removing 1-2 liters initially with additional drainage as needed.
- Diuretics should generally be avoided as they may worsen hemoconcentration and increase thrombosis risk, although forced diuresis may be useful in certain cases, as noted in 1 and 1. This approach balances the need to correct intravascular volume depletion while preventing third-spacing of fluids, which occurs due to increased vascular permeability from high levels of vasoactive substances like VEGF released by hyperstimulated ovaries. It's worth noting that the provided evidence, such as 1, 1, 1, and 1, primarily focuses on the management of acute hypercapnic respiratory failure in adults, rather than OHSS specifically, but the principles of fluid management can still be applied, with consideration of the unique pathophysiology of OHSS. However, the most relevant and recent study to guide fluid management in OHSS is not explicitly provided, so the approach is based on general principles of fluid management in critically ill patients and the pathophysiology of OHSS. In clinical practice, the management of OHSS would prioritize minimizing morbidity, mortality, and improving quality of life, and would likely involve a multidisciplinary approach, including obstetricians, intensivists, and other specialists, as needed.
From the Research
Fluid Management Strategies for OHSS
The fluid management strategies for Ovarian Hyperstimulation Syndrome (OHSS) include:
- Maintenance of fluid balance 2, 3, 4
- Preventative measures against thrombo-embolism 2, 3
- Paracentesis of ascitic fluid, which seems to be an effective treatment for severe OHSS 2, 4, 5
- Administration of intravenous (i.v.) fluids, such as crystalloids and colloids, to expand intravascular volume 4
- Use of dopamine to improve diuresis 4
- Prophylactic heparin to prevent venous thrombosis 4
Aspiration of Ascitic Fluid
Aspiration of ascitic fluid has been shown to result in marked improvement of symptoms, improved diuresis, and shortened hospital stay 4, 5.
- Ultrasonically guided transvaginal aspiration of ascitic fluid can be used to manage severe OHSS 5
- The average volume of aspirated fluid can be around 3900 mL 5
Hospitalization and Outpatient Management
Hospitalization is usually necessary for severe or critical cases of OHSS, while mild and moderate cases can be managed on an outpatient basis 3, 6, 4.