Management of ovarian hyperstimulation syndrome with abdominal compartment syndrome, based on intravesical pressure measurement

Abstract

There are few reports on abdominal compartment syndrome that are caused by ovarian hyperstimulation syndrome (OHSS). Here, a case of a 29 year old woman is reported in which intravesical pressure measurement was useful in the management of severe OHSS that had been complicated by abdominal compartment syndrome. The patient's urinary output and general condition did not improve after the initial treatment. The woman's intra‐abdominal pressure was evaluated indirectly, based on her intravesical pressure, and was found to be significantly elevated. The patient's urinary volume increased after a 14 mm Hg decrease in the intravesical pressure was achieved by the drainage of ascitic fluid. Intravesical pressure measurement was useful in the management of the general condition of this patient with OHSS.

Tatalaksana Sindroma Hiperstimulasi Ovarium (SHO)

“…11 Gejala OHSS yang berat berkaitan dengan kadar VEGF yang lebih tinggi. 10,12 Kadar VEGF yang lebih tinggi dijumpai pada cairan folikuler (tidak dalam darah) wanita yang menjalani maturasi oosit dengan hCG dibanding dengan maturasi yang dipicu oleh agonis gonadotropin-releasing hormone (GnRH). 2 Mekanisme lain yang berperan pada OHSS adalah sistem renin-angiotensin (RAS) intra-ovarium.…”

“…10 Sistem renin angiotensin ovarium berperan dalam mengatur permeabilitas vaskuler, angiogenesis, proliferasi endotel, dan pelepasan prostaglandin. 12 Sindroma hiperstimulasi ovarium spontan biasanya terjadi pada siklus ovulasi spontan, khususnya pada kehamilan multipel disertai dengan hipotiroidisme dan sindroma polikistik ovarium. Sindroma hiperstimulasi ovarium spontan sangat jarang terjadi pada wanita yang tidak hamil.…”

“…Peningkatan tekanan intra abdomen akan menurunkan functional residual capacity (FRC) paru. 12 Penyebab lain dari dispnea relatif jarang pada OHSS seperti efusi pleura, edema paru, atelektasis, emboli paru, acute respiratory distress syndrome (ARDS) dan efusi perikardium. 3 Status hiperkoagulasi Hiperkoagulasi disebabkan oleh hemokonsentrasi dan hipovolemia akibat pergeseran cairan ke rongga ketiga.…”

Perspective Advices in the Management of Ovarian Hyperstimulation Syndrome

“…The classic triad, including respiratory disorders, decrease in venous return, and restriction of internal perfusion is present both in severe OHSS and IAH patients. Several studies related specific indices of the intra-abdominal pressure (IAP) with varying degrees of OHSS [3][4][5][6][7]. According to these data, the condition of IAH Grade I in moderate OHSS and IAH Grade II-III in severe OHSS are present [8].…”

Intensive treatment of ovarian hyperstimulation syndrome. Clinical guidelines (treatment protocol)

“…Асцит при СГЯ всегда сопровождается внутрибрюшной гипертензией (ВБГ) [14][15][16][17]. Компрессия мезентериальных вен приводит к абдоминальной венозной гипертензии; снижается мезентериальный кровоток; вследствие низкого перфузионного давления развивается ишемия кишечника; растет региональное pCO 2 , внутрижелудочный ацидоз; возрастает интерстициальный отек и проницаемость, в результате чего повышается транслокация бактерий; прогрессивно растет концентрация провоспалительных цитокинов (ИЛ-1β, ИЛ-6, ФНО-α); нередко возникают язвенные кровотечения и некротический энтероколит; развиваются паралитический или механический илеус, перитонеальная адгезия.…”