M R Fluker1, J E Copeland, A A Yuzpe. 1. Genesis Fertility Centre, Vancouver, British Columbia, Canada. fluker@genesis_fertility.com
Abstract
OBJECTIVE: To evaluate a protocol of active outpatient management, including outpatient paracentesis and albumin administration, in women at risk for severe ovarian hyperstimulation syndrome (OHSS). DESIGN: Prospective cohort. SETTING: Freestanding IVF program. PATIENT(S): Thirteen women progressing from moderate to severe OHSS. INTERVENTION(S): Bed rest and home monitoring with intermittent outpatient paracentesis and albumin administration. MAIN OUTCOME MEASURE(S): Procedural outcomes and time to resolution of OHSS symptoms. RESULT(S): The initial paracentesis occurred 14.1 +/- 3.3 days after oocyte retrieval, removing 1,735 +/- 506 mL of ascitic fluid. Eleven women required a second paracentesis and five women required a third paracentesis over the next 8 days. Six women received albumin on seven occasions because of hypoalbuminemia. The onset of diuresis occurred 2.8 +/- 1.9 days and recovery occurred 7. 4 +/- 3.0 days after the first paracentesis. There were no hospitalizations for OHSS symptoms and no complications. All 13 women had viable intrauterine pregnancies. CONCLUSION: Active outpatient intervention in the early stages of OHSS, including paracentesis and albumin administration, can avoid hospitalization while minimizing the progression and complications of OHSS.
OBJECTIVE: To evaluate a protocol of active outpatient management, including outpatient paracentesis and albumin administration, in women at risk for severe ovarian hyperstimulation syndrome (OHSS). DESIGN: Prospective cohort. SETTING: Freestanding IVF program. PATIENT(S): Thirteen women progressing from moderate to severe OHSS. INTERVENTION(S): Bed rest and home monitoring with intermittent outpatient paracentesis and albumin administration. MAIN OUTCOME MEASURE(S): Procedural outcomes and time to resolution of OHSS symptoms. RESULT(S): The initial paracentesis occurred 14.1 +/- 3.3 days after oocyte retrieval, removing 1,735 +/- 506 mL of ascitic fluid. Eleven women required a second paracentesis and five women required a third paracentesis over the next 8 days. Six women received albumin on seven occasions because of hypoalbuminemia. The onset of diuresis occurred 2.8 +/- 1.9 days and recovery occurred 7. 4 +/- 3.0 days after the first paracentesis. There were no hospitalizations for OHSS symptoms and no complications. All 13 women had viable intrauterine pregnancies. CONCLUSION: Active outpatient intervention in the early stages of OHSS, including paracentesis and albumin administration, can avoid hospitalization while minimizing the progression and complications of OHSS.
Authors: John M Csokmay; Belinda J Yauger; Melinda B Henne; Alicia Y Armstrong; John T Queenan; James H Segars Journal: Fertil Steril Date: 2008-11-05 Impact factor: 7.329