History and Physical Examination
History
Women with ovarian hyperstimulation syndrome (OHSS) will have recently had gonadotropin stimulation to induce ovulation or will have been treated with an assisted reproductive technology such as in vitro fertilization.
Early OHSS is usually mild to moderate and manifests 3-7 days after the administration of hCG. Late OHSS is usually severe and occurs 12-17 days after hCG treatment. [16] The early type is due to exogenously administered hormone, and the late type often occurs during an implanting or an implanted pregnancy, because pregnancy hCG exacerbates the disease. [11]
Signs of OHSS
Signs of OHSS include those listed below (percentages refer to all classes of OHSS) [6, 17] :
-
Ascites
-
Hypercoagulability - 6.2%
-
Thrombosis
-
Hemoconcentration
-
Leukocytosis - White blood cell (WBC) count over 20,000/mm3
-
Electrolyte abnormalities - Eg, hyponatremia, hyperkalemia
-
Elevated transaminase values - 26%
-
Pulmonary embolism - 2%
-
Acute renal failure - 1%
Symptoms of OHSS
Symptoms of OHSS include those listed below (percentages refer to cases of severe OHSS) [6, 17] :
-
Shortness of breath - 92%
-
Abdominal discomfort - 99%
-
GI disturbances - Nausea, vomiting, diarrhea; 54%
-
Oliguria - 30%
-
Peripheral edema - 13%
-
Lethargy
-
Rapid weight gain
Although OHSS usually manifests with a constellation of symptoms, atypical presentations can occur. Rare presentations such as thromboembolism (venous and arterial) have been observed. Atypical locations of venous thromboembolism include the internal jugular vein, the subclavian vein, the inferior vena cava, the ileofemoral veins, and the intracerebral veins. [18]
Other abnormal forms of presentation include isolated hydrothorax and isolated thromboembolism. Additional situations leading to elevated hCG concentrations, such as molar pregnancy and the presence of gonadotroph adenomas, may in rare cases lead to mild forms of OHSS. [19]
Physical examination
Physical findings of OHSS include right or left lower quadrant pain below the umbilicus, as well as edema.
Of note, abdominal palpation must be performed gently to avoid the possibility of rupturing a large cyst. Pelvic examination should be deferred in favor of ultrasonography of the pelvis.
-
Ultrasonographic presentation of ovarian hyperstimulation syndrome.
