A 28-year-old woman with PCOS undergoes IVF. After oocyte retrieval, she develops abdominal distension, nausea, and shortness of breath. Ultrasound shows bilateral ovarian enlargement to 12 cm with free peritoneal fluid. Serum albumin is 2.8 g/dL and haematocrit is 46%. She is classified as having severe OHSS. The MOST important initial management priority is:

• A Emergency bilateral oophorectomy
• B IV dopamine infusion to promote diuresis
• C Immediate laparoscopy to drain cysts
• D Immediate albumin 20% infusion and thromboprophylaxis ✓

Explanation

Severe OHSS management priorities are: IV fluid resuscitation to correct haemoconcentration (haematocrit > 45% is a danger sign), albumin infusion to combat third-space fluid shift and hypoalbuminaemia, and LMWH thromboprophylaxis (OHSS markedly increases VTE risk from both haemoconcentration and immobility). Paracentesis may be needed for tense ascites compromising respiratory function. Oophorectomy and laparoscopy are not indicated; dopamine is not a primary OHSS treatment.

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

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Written and medically reviewed by the StethoPrep medical team.