TREATMENT OF SEVERE OVARIAN HYPERSTIMULATION SYNDROME BY A CONSERVATIVE MEDICAL APPROACH

Objective. To assess the value of a conservative medical therapeutic a pproach in the management of severe ovarian hyperstimulation syndrome (OHSS). Design. Prospective longitudinal study. Setting. Assisted Repr oduction Unit of the Hospital Clinic i Provincial de Barcelona, a tert iary care setting. Patients. Twenty-five women with ascites because of OHSS. Interventions. Patients were treated by strict bed rest, low-so dium diet (60 mEq/day), plasma volume expansion with albumin (50 g/day of salt-poor albumin) and diuretics (20 mg of furosemide given intrav enously every 8-12 hours). Main outcome measures. Measurement al admis sion and 48 hours after commencement of treatment of the following: bo dy weight, mean arterial pressure, heart rate, hematocrit, hemoglobin concentration, leukocyte and platelet counts, urine volume, sodium exc retion, serum sodium, serum creatinine, plasma renin activity, and pla sma aldosterone, norepinephrine, antidiuretic hormone, and atrial natr iuretic peptide concentrations. Results. After 2 days of therapy there was married improvement in clinical symptoms, standard laboratory par ameters, diuresis and urinary sodium excretion in all patients. There was also a significant decrease in the plasma levels of volume-depende nt endogenous vasoactive substances in the five patients in whom these measurements were repeated during treatment. The length of treatment with albumin plus furosemide ranged between 2 and 6 days with an avera ge of 3.3 and it correlated directly with the severity of the syndrome . The hospital stay ranged from 4 to 10 days (mean 6.5 days). All pati ents recovered without any complication. Conclusions. Severe ovarian h yperstimulation syndrome can be managed using the proposed conservativ e medical approach.