Severity Markers in Women with Ovarian Hyperstimulation Syndrome
Objective: To assess the usefulness of severity markers in women with OHSS and of various anthropometric indicators in determining the severity of ovarian hyperstimulation syndrome (OHSS) and indications for paracentesis. Study design: An observational study was designed including 76 women with varying degrees of severity of OHSS. Clinical history, physical examination, laboratory tests, and ultrasound measurement of the ovarian volume (OV) and ascites index (AsI) were carried out in all patients. Intra-abdominal pressure (IAP) was measured using an intravesical Foley Manometer catheter. The anteroposterior diameter of the abdomen (APD) and transverse diameter of the abdomen (TS) were measured with a pelvimeter. The APD/TS ratio was calculated. Results: Ascites index and ovarian volume increased progressively being highest in the most severe stage of OHSS. The median IAP in mild OHSS was found to be lower than that in the moderate and severe OHSS (4.0 mm, 12 mm, and 16.0 mm, respectively). Critical cases of OHSS presented the highest IAP (25.0 mm). IAP did not reach the level of intra-abdominal hypertension in mild OHSS, whereas moderate and severe OHSS was associated with intra-abdominal hypertension grade I and grade II–III respectively. Values of IAP in critical OHSS were found similar to those observed in abdominal compartment syndrome patients. The IAP showed a strong positive correlation with ovarian volume and ascites index. The reduction of IAP after paracentesis was greater among critical OHSS patients. The APD/TS ratio increased progressively and tended to be the highest in the most symptomatic stage of OHSS (Kruskal-Wallis test, p<0.001). The median APD/TS was significantly lower in patients with moderate OHSS (0.55 [IQR, 0.44 – 0.64]) compared with severe OHSS (0.87 [IQR, 0.80 – 0.93]; p<0.001) or critical OHSS (1.04 [IQR, 1.04 – 1.13]; p<0.001). Similarly, the median APD/TS of the moderate OHSS group (0.65 [IQR, 0.61 – 0.70]) was significantly lower than that of the severe (p<0.001) and critical OHSS group (p=0.001). There was a strong positive correlation between APD/TS and IAP (Spearman’s r = 0.886, p<0.01). The APD/TS ratio showed a significant positive correlation with AsI (Spearman’s r = 0.695, p<0.01) and OV (Spearman’s r = 0.622, p<0.01). No significant differences were observed in age, height, weight, body mass index, hip circumference or waist circumference between moderate, severe and critical OHSS groups.