A 30-year-old woman undergoes controlled ovarian hyperstimulation for IVF. On day 10 of stimulation, her serum oestradiol is 6500 pg/mL, and ultrasound shows 18 follicles ≥12 mm bilaterally with bilateral enlarged ovaries (8 cm each). She has mild abdominal discomfort and bloating. This represents which grade of ovarian hyperstimulation syndrome (OHSS)?

• A Mild OHSS
• B Severe OHSS
• C Moderate OHSS ✓
• D Critical OHSS

Explanation

OHSS classification (Golan/RCOG): Mild — abdominal distension and discomfort, ovaries up to 8 cm; Moderate — mild features plus nausea/vomiting/diarrhoea, ovaries 8–12 cm, ascites on ultrasound; Severe — tense ascites, haemoconcentration (Hct >45%), oliguria, thromboembolic risk; Critical — ovarian torsion, venous thrombosis, ARDS. Ovaries of 8 cm with abdominal discomfort only (no ascites, no vomiting) is the upper boundary of mild/lower boundary of moderate; with 18 stimulated follicles and oestradiol >5000, this is best classified as moderate OHSS.

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

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Written and medically reviewed by the StethoPrep medical team.