EpistemisOvarian hyperstimulation syndrome
Specialty: Gynecology and breast.
Why it occurs
- Exaggerated response of the ovaries to iatrogenic hormonal stimulation during assisted reproduction techniques (by administration of recombinant gonadotropins or hCG to induce follicular maturation) with severe increase in vascular permeability mediated by VEGF (vascular endothelial growth factor)
Initial workup
Urgent transvaginal or abdominal ultrasound to evaluate the size of the ovaries (frequently enlarged >10-12 cm in diameter, with multiple luteal cysts) and quantify the volume of free ascites. Urgent blood analysis that includes complete blood count (monitor hemoconcentration with hematocrit >45-50%), coagulation tests, kidney function (serum urea, creatinine), transaminases and ionogram.
red flags
Massive and painful abdominal distension in the days after follicular puncture, rapid weight gain of more than 1 kg in 24 hours, progressive dyspnea at rest (due to pleural effusion or massive ascites), severe oliguria or anuria, signs of pulmonary or deep venous thromboembolism (chest pain, cough, swelling of one leg).
Standard management
- Cabergoline 0.5 mg orally daily for 8 days — started on the day of hCG administration or after puncture to block VEGF-2 receptors
- Mandatory antithrombotic prophylaxis with Enoxaparin 40 mg (or 0.4 mL) subcutaneously every 24 hours to prevent thromboembolic phenomena secondary to hemoconcentration
- Controlled intravenous fluid therapy with 20% human albumin infusion if there is severe hypoalbuminemia with hypotension (note: the routine use of loop diuretics such as furosemide is contraindicated as it aggravates intravascular hypovolemia, except after restoration of adequate volume).
Educational guidance for study. It is NOT a prescription recommendation. The actual choice depends on the cause, the patient, and current guidelines.
- Area
- Gynecology and breast
- Listed causes
- 1
- Treatment options
- 3