Ovarian Hyperstimulation Syndrome

Excessive

Step 1: View clinicals

A 25 year old nulliparous woman presents with nausea, lower abdominal pain, and progressive abdominal distension for 1 week. She is otherwise asymptomatic. Her gynecological history is significant for primary infertility for 2 years. She was started on ovulation induction therapy with clomiphene citrate on the 3rd day of her last regular menstrual period, which was 3 weeks ago. She is not on any other medications, and her medical, surgical, and family histories are unremarkable. There is no history of promiscuity.


Step 2: Order all relevant investigations

Urine hCG Test

The Urine hCG test is positive.

Ultrasound Abdomen

Both ovaries show multiple small cysts ranging from 2 to 6 mm in size. The right ovary is grossly enlarged, measuring 12.8 × 8 cm, while the left ovary is normal in size. The uterus is normal in size and appears empty. There is a large amount of free fluid in the peritoneal cavity. The other intra-abdominal organs are sonographically normal.

Comprehensive Metabolic Panel

Random Plasma Glucose: within normal parameters Serum Electrolytes: within normal parameters Renal Profile and Liver Profile: no abnormalities

Full Blood Count

WBC: 9,600/mm3 (4,000-11,000) N:59% L:35% Hb: 12.1 g/dL (11.5-13.5) PCV (Hct): 37% (35-47) Platelets: 190,000 (150,000-400,000)


Step 3: Select appropriate management

IV Fluids
Strict Bed Rest
Paracentesis
Laparoscopy


Score: ★★☆