SEVERE OHSS-AN IATROGENIC COMPLICATION stitugo

Institute
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A case report
Dr Suryakanta Jayasingh,2nd yr pg,SCB MCH
ASSO.PROF.Dr puspanjali khuntia

Introduction

OHSS is a rare iatrogenic Insert relevant .Aims and Objectives

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complication of ovarian As the prevalence of therapy
stimulation by artificial employing ART is increasing ,
reproductive techniques and gynaecologists must become
familiar with OHSS and its clinical
other infertility treatment. It
presentation which cause
may rarely complicate normal multiorgan dysfunction leading to
pregnancy. It may be of mild, death.
moderate and severe
variety.The incidences being
8-23%,1-7% and .25-5%
respectively.
 SEVERE OHSS-AN IATROGENIC COMPLICATION Institute
A case report Hospital
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or
nd
Dr Suryakanta Jayasingh,2 yr pg,SCB MCH
ASSO.PROF.Dr puspanjali khuntia
Affiliation Logo
Observation and (Case Details )
Mrs shankari mandal 22yrs nulliparous female with 3 yrs of primary infertility was undergoing treatment for
infertility developed vomitting 4-5 episodes per day bilious in nature for last 5 days associated with pain over rt.
hypochondrium and distension of abdomen since 4days. She was having loose motions 4-5 episodes per day since
last 4 days. Then she had breathing difficulty and became dyspnoeic for which she was referred to our hospital. Her
LMP was on 15/8/15and her previous cycles were 1-2d/30-33regular with scanty flow, married since 3yrs was
treated with tab myo inositol fr 3 mths and was planned for ovulation induction and was given inj HMG150 IU
onD3,D5,D7,D9,D11.On D12 follicular study was done. IUI was done and then given inj HCG10000IU. On
examination she was having B/L pitting edema, tachycardia, B/L vesicular breath sounds with B/L crepts, absent B.S.
over both basal region. Her abdomen was tense ,tender, fluid thrill was present and liver was palpable. on P/V ut
was not palpable, Cx long, B/L fx free. Her investigatios Hb 12gm%, PCV 36, TLC-11200/cmm, N 66%, L32%, sr ur-54,
sr cr-2.1, sr Na+125, sr K+4.1, sr.Bilirubin (t)-1.2, (d)0.4 AST-142, ALP158, ALP 238.CXR B/L minimal pleural effusion,
PT(c)11.7,(t) 14.8, aPTT(c)27.6 (t)28.8, INR 1.24, Sr protein 4.7, albumin2.1 and USG shows B/L enlarged ovaries
with multiple cysts RT-7.85*4.43*8.25 cmvol 150 cc, total 10-12 follicles largest being 42*40cc. LT-
7.28*4.36*5.35cm,vol 88cc,total 9-10 follicles, largest being 32*28mm with gross ascites. Pt was managed
conservatively with propped up position, O2 inhalation, nebulisation with duolin & flowhale, inj deriphylline, inj
human albumin, inj lasix, tab cabergoline, ascitic fluid tapping was done, and pt was stabilised.
 SEVERE OHSS-AN IATROGENIC COMPLICATION Institute
A case report Hospital or
Lo
Dr Suryakanta Jayasingh,2nd yr pg,SCB MCH Affiliation Logo
ASSO.PROF.Dr puspanjali khuntia

Discussion
OHSS usually develops several days after oocyte retrieval or assisted Conclusions
ovulation following gonadotropin therapy.the syndrome is charecterised by •These patients need to get
ovarian enlargement due to multiple ovarian cyst and acute fluid shift into admitted to an hospital set up with
extravascular space. compliations of OHSS includes ascitis, intensive care facility where the
hemoconcerntration,hypovolemia,renal failure, pleural effusion, electrolyte clinical picture is well understood
and management could be done
imbalance and pulmonary edema.the prognosis in mild to moderate cases of
•The aim is to prevent ohss with
OHSS is excellent however morbidity is clinically significant in severe softstimulation protocols,agonist
OHSS.estimated fatality rates is 1/40000-50000 cycles.The priciples of trigger with antagonist
management are to maintain a fluid and electrolyte balance ensuring adequete downregulation,cycle
urine output but preventing risk of pulmonary edema.thoracocentesis and cancellation,freeze all strategies
paracentesis under usg guidance if symtoms are severe.surgical intervention is and the use of dopamine agonists.
rarely required.
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