Rizk B, Aboulghar M
Academic Department of Obstetrics and Gynaecology, University of Cambridge, UK.
Hum Reprod. 1991 Sep;6(8):1082-7. doi: 10.1093/oxfordjournals.humrep.a137488.
The number of women receiving ovulation induction has markedly increased with the advent of medically assisted reproduction. Consequently, ovarian hyperstimulation syndrome (OHSS) has become a frequent clinical problem. It is a potentially life-threatening situation. In its severe forms it is complicated by haemoconcentration, hypovolaemia, hypotension, acute renal insufficiency and thromboembolism. The pathophysiology of OHSS is poorly understood. The occurrence of OHSS correlates well with the level of oestradiol, the number of follicles, and administration of human chorionic gonadotrophin (HCG). The risk is increased in polycystic ovarian disease. The aim of this paper is to review critically the published literature on prediction, prevention and modern management of OHSS. Complete prevention of OHSS is not possible although several methods are used to predict and reduce its occurrence. Endocrine profile and ultrasonic follicular monitoring are the mainstays of prediction. The presence of a large number of small and intermediate size follicles at sonography is a risk factor. Withholding HCG, continuation of gonadotrophin-releasing hormone analogues and cryopreservation of embryos are optional courses of action for prevention. Mild OHSS is usually self-limiting and requires no active therapy. Moderate and severe cases are treated by correction of fluid and electrolyte imbalance, and by prevention of thromboembolism. The use of surgery is limited to cases of torsion or rupture of ovarian cysts, or the presence of concomitant ectopic pregnancy. Aspiration of the ascitic fluid, preferably by the transvaginal route, is recommended in cases with severe ascites.
随着医学辅助生殖技术的出现，接受促排卵治疗的女性数量显著增加。因此，卵巢过度刺激综合征（OHSS）已成为一个常见的临床问题。这是一种潜在的危及生命的情况。严重形式的OHSS会并发血液浓缩、血容量不足、低血压、急性肾功能不全和血栓栓塞。OHSS的病理生理学尚不清楚。OHSS的发生与雌二醇水平、卵泡数量以及人绒毛膜促性腺激素（HCG）的使用密切相关。多囊卵巢疾病患者的风险会增加。本文的目的是对已发表的关于OHSS预测、预防和现代管理的文献进行批判性综述。尽管有几种方法用于预测和减少OHSS的发生，但完全预防是不可能的。内分泌指标和超声卵泡监测是预测的主要手段。超声检查发现大量小卵泡和中等大小卵泡是一个危险因素。停用HCG、继续使用促性腺激素释放激素类似物以及胚胎冷冻保存是预防的可选措施。轻度OHSS通常是自限性的，无需积极治疗。中度和重度病例通过纠正水电解质失衡和预防血栓栓塞进行治疗。手术仅用于卵巢囊肿扭转或破裂或合并异位妊娠的情况。对于严重腹水的病例，建议首选经阴道途径抽吸腹水。
