How do you treat OHSS?

TR of OHSS- Please admit the case in ICU and involve Internist for proper monitoring and to avoid death. This is a hypercoagulable state along with release of VEGF and lots of hemodilution and there is loss of fluid into extra cellular space with formation of ascites/ Trannsudate from ovaries hypoprotineamia with low urine output.

(1)    Intake output chart 20 % albumin infusion (Haemlog) - hydrate well / ringer solution it is a hyper coagulable state ,  Pulse, BP, Temperature, Pulse oximtery- Oxygen saturation, Avoid Catheter so that no UTI occurs, Daily Body wt record and also record dally abdominal girth, listen to lungs for creps, avoid lasix and mannitol(Better restrict IV fluid)

(2)     Electrolyte balance, daily CBC, BT CT, Platelate

(3)    PCV=Haematocrit,-must be kept below 55%,  

(4)    Central line for recording of Arterial pressure

(5)    Central Venous Pressure

(6)    Pan- D IV, Zofer tablet to prevent vomiting

(7)    Avil 25 mg TDS 

(8)    Renal. Hepatic Function tests

(9)     Serum creatinine must be < 1.5 mg.

(10)           Peritoneal Tap in severe cases

(11)           Use Inotrops if BP and Urine output is low- noradereline micro drip ( Pre adjusted- Drip 30 minute basis depending upon rise of fall BP), Carbon dioxide retention in the system has to be taken care of by the ICU nurse.

(12)           Antagonist and cabergolin and LMWH (Must)

(13)           Daly USG particularly look for hepatorenal pouch of Morrison for any fluid.

Specific TR: - Rehydration, -by NS or Hartmann solution, TR of hypotension, Crystalloids. If crystalloids do not improve the condition thenà Dextrin, Fresh Frozen Palm, or Low salt Albumin, No diuretics except persistent oliguria inspite of full hydration of Pt. Anticoagulation: if coagulation profile sosuggests.