A 32-year-old woman underwent IVF with oocyte retrieval 5 days ago. She now presents with abdominal distension, nausea, shortness of breath, and oliguria. Ultrasound shows bilateral enlarged ovaries (each 8 cm) with massive ascites. Haematocrit is 48%, creatinine 1.3 mg/dL. This is classified as:

• A Mild OHSS managed with oral fluids and analgesics as outpatient
• B Critical OHSS requiring urgent oophorectomy
• C Moderate OHSS treated with progesterone support only
• D Severe OHSS requiring hospitalisation, thromboprophylaxis, and albumin/cabergoline ✓

Explanation

Severe OHSS is characterised by ovarian enlargement >12 cm (or significant), massive ascites/pleural effusion, haemoconcentration (haematocrit >45%), oliguria, and electrolyte disturbances. This patient meets criteria with ovaries 8 cm (moderate-severe borderline), massive ascites, Hct 48%, and oliguria. Management includes hospitalisation, fluid monitoring, IV albumin (maintains oncotic pressure), LMWH thromboprophylaxis (haemoconcentration causes thromboembolism risk), and cabergoline (dopamine agonist that reduces vascular permeability). Oophorectomy is never indicated for OHSS.

Reference: Shaw's Textbook of Gynaecology, 17th ed.

High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP

Written and medically reviewed by the StethoPrep medical team.