Severe OHSS after a fresh embryo transfer — emergency management station

Team-based emergency station: severe, late OHSS with haemoconcentration and oliguria. Tests recognition that the normal blood pressure hides intravascular depletion, the VEGF pathophysiology, the balanced fluid strategy, paracentesis and thromboprophylaxis, and the decision to escalate to high-dependency care. Includes assessor key and marking domains.

Prompt

A 30-year-old woman with PCOS is brought to the emergency department on day 6 after a fresh embryo transfer in a GnRH antagonist cycle triggered with hCG. She is breathless, her abdomen is grossly distended, she has gained 4 kg in three days, and she has passed only 150 mL of urine in 12 hours. The emergency team has called the on-call gynaecology registrar (you). Her pulse is 114 bpm, BP 98/60 mmHg, saturation 93% on air, and a venous blood gas shows haematocrit 0.51.

Station brief

Format. Emergency management station, approximately 12 minutes. You are the on-call gynaecology registrar. A junior doctor, an emergency nurse and an anaesthetist are with you; your consultant and the reproductive medicine team have been called and are en route. The assessor will run the clock and feed you new observations. ^[1]

Candidate instruction. Lead the management of severe ovarian hyperstimulation syndrome. Verbalise your assessment, your fluid and thromboprophylaxis orders, your decision on paracentesis, and your communication with the team and the patient. ^[1]^[3]

References6Show

[1]Golan A, Weissman A Symposium: Update on prediction and management of OHSS. A modern classification of OHSS Reprod Biomed Online, 2009.PMID 19573287
[2]McClure N, Healy DL, Rogers PA, Sullivan J, Beaton L, Haning RV Jr, Connolly DT, Robertson DM Vascular endothelial growth factor as capillary permeability agent in ovarian hyperstimulation syndrome Lancet, 1994.PMID 7913160
[3]Rizk B, Aboulghar M Modern management of ovarian hyperstimulation syndrome Hum Reprod, 1991.PMID 1806565
[4]Corbett S, Shmorgun D, Claman P; Reproductive Endocrinology Infertility Committee The prevention of ovarian hyperstimulation syndrome J Obstet Gynaecol Can, 2014.PMID 25574681
[5]Mathur RS, Akande AV, Keay SD, Hunt LP, Jenkins JM Distinction between early and late ovarian hyperstimulation syndrome Fertil Steril, 2000.PMID 10785214
[6]Tang H, Mourad SM, Wang A, Zhai SD, Hart RJ Dopamine agonists for preventing ovarian hyperstimulation syndrome Cochrane Database Syst Rev, 2021.PMID 33851429

Severe OHSS after a fresh embryo transfer — emergency management station

Station brief

References6Show

[1]Golan A, Weissman A Symposium: Update on prediction and management of OHSS. A modern classification of OHSS Reprod Biomed Online, 2009.PMID 19573287
[2]McClure N, Healy DL, Rogers PA, Sullivan J, Beaton L, Haning RV Jr, Connolly DT, Robertson DM Vascular endothelial growth factor as capillary permeability agent in ovarian hyperstimulation syndrome Lancet, 1994.PMID 7913160
[3]Rizk B, Aboulghar M Modern management of ovarian hyperstimulation syndrome Hum Reprod, 1991.PMID 1806565
[4]Corbett S, Shmorgun D, Claman P; Reproductive Endocrinology Infertility Committee The prevention of ovarian hyperstimulation syndrome J Obstet Gynaecol Can, 2014.PMID 25574681
[5]Mathur RS, Akande AV, Keay SD, Hunt LP, Jenkins JM Distinction between early and late ovarian hyperstimulation syndrome Fertil Steril, 2000.PMID 10785214
[6]Tang H, Mourad SM, Wang A, Zhai SD, Hart RJ Dopamine agonists for preventing ovarian hyperstimulation syndrome Cochrane Database Syst Rev, 2021.PMID 33851429