Abstract
Massive ascites, hydrothorax, acute renal failure and thromboembolism are clinical manifestations of severe ovarian hyperstimulation syndrome (OHSS) which may complicate the induction of ovulation with exogenous gonadotrophins. We report a case of severe OHSS with ascites formation in excess of five litres per day. Massive ascites and bilateral pleural effusions resulted in respiratory failure. Continuous ascitic recirculation (AR) was commenced after repeated paracentesis and IV fluid therapy failed to improve the patient's condition. The procedure was undertaken for a total of 15 days and rapidly resulted in marked improvement of impaired respiratory function. Febrile episodes occurred on 3 occasions, but we did not observe coagulation disturbances or adverse haemodynamic effects. Continuous AR is a safe and effective treatment of complicated severe OHSS.
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References
Asch RH, Li HP, Balmaceda JP, Weckstein LN, Stone SC (1991) Severe ovarian hyperstimulation syndrome in assisted reproductive technology: definition of high risk groups. Hum Reprod 6:1395–1399
MacDougall MJ, Tan SL, Jacobs HS (1992) In-vitro fertilization and the ovarian hyperstimulation syndrome. Hum Reprod 7:597–600
Rizk B, Aboulghar M (1991) Modern management of ovarian hyperstimulation syndrome. Hum Reprod 6: 1082–1087
Alboughar MA, Mansour TR, Serour GI, Riad R, Ramzi AM (1992) Autotransfusion of the ascitic fluid in the treatment of severe ovarian hyperstimulation syndrome. Fertil Steril 58: 1056–1059
Massey S, Smith GB, Taylor BL, Granger CA (1993) Continuous ascitic filtration and reinfusion in a patient with refractory ascites. Clin Intensive Care 4:98
Wilkinson SP, Davidson AR, Henderson J (1975) Ascitic reinfusion using the Rhodiascit apparatus — clinical experience and coagulation abnormalities. Postgrad Med J 51:583–587
Bruno S, Borzio M, Romangnoni M, Battezatti PM, Rossi S, Chiese A, Podda M (1992) Comparison of spontaneous ascitic filtration and reinfusion with total paracentesis with intravenous albumin infusion in cirrhotic patients with tense ascites. Br Med J 304: 1655–1658
Wilde JT, Cooper R, Kennedy HJ, Triger DR, Preston FE (1990) Coagulation disturbances following ascitic recirculation. Hepatology 10:217–222
Salem HH, Koutts J, Handley C, van der Weyden MB, Dudley FJ, Firkin BG (1981) The aggregation of human platelets by ascitic fluid: a possible mechanism for disseminated intravascular coagulation complicating LeVeen shunts. Am J Haematol 11:153–157
Katoh S, Tatsukawa H, Kondoh M, Inoue M, Ida K, Miyagawa F (1991) Prevention of febrile reactions occurring on reinfusion of cell-free and concentrated autogenous ascites. Jpn J Med 30:311–317
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Beck, D.H., Massey, S., Taylor, B.L. et al. Continuous ascitic recirculation in severe ovarian hyperstimulation syndrome. Intensive Care Med 21, 590–593 (1995). https://doi.org/10.1007/BF01700165
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DOI: https://doi.org/10.1007/BF01700165