Pulmonary manifestations of severe ovarian hyperstimulation syndrome: a multicenter study

• Published in: Fertility and sterility Vol. 71; no. 4; pp. 645 - 651
• Main Authors: Abramov, Yoram, Elchalal, Uriel, Schenker, Joseph G
• Format: Journal Article
• Language: English
• Published: New York, NY Elsevier Inc 01.04.1999; Elsevier Science
• Subjects: Adult; Arterial blood gases; Biological and medical sciences; Carbon Dioxide - blood; chest x-rays; dyspnea; Female; Female genital diseases; Gynecology. Andrology. Obstetrics; Humans; Hydrogen-Ion Concentration; Hypoxia - etiology; Lung Diseases - diagnostic imaging; Lung Diseases - etiology; Medical sciences; Non tumoral diseases; Ovarian Hyperstimulation Syndrome - complications; Oxygen - blood; Pneumonia, Pneumococcal - etiology; Pulmonary Embolism - etiology; pulmonary manifestations; Radiography; Respiratory Distress Syndrome, Adult - etiology; Retrospective Studies; severe ovarian hyperstimulation syndrome; severe ovarian hyperstimulation syndrome; chest x-rays; dyspnea; pulmonary manifestations; Arterial blood gases; Human; Blood gas; Respiratory disease; Multicenter study; Cardiovascular disease; Ovarian hyperstimulation syndrome; Artery; Female genital diseases; Vascular disease; Infection; Dyspnea; Blood vessel; Complication; Respiratory distress; Circulatory system; Woman; Thromboembolism
• ISSN: 0015-0282; 1556-5653
• DOI: 10.1016/S0015-0282(98)00528-7

Objective: To assess the pulmonary manifestations of severe ovarian hyperstimulation syndrome (OHSS). Design: A retrospective nationwide 10-year multicenter study. Setting: Sixteen of 19 tertiary medical centers in Israel. Patient(s): All patients hospitalized at these centers for severe OHSS between January 1987 and December 1996. Main Outcome Measure(s): Clinical presentation, arterial blood gases on room air, and chest roentgenogram results. Result(s): Of 209 patients, 4% had lobar pneumonia, 2% had adult respiratory distress syndrome (ARDS), and 2% had pulmonary thromboembolism. Most patients had dyspnea, tachypnea, moderate hypoxemia, increased alveolar–arterial oxygen difference, hypocarbia, respiratory alkalosis, and metabolic compensation. The most common findings on chest roentgenogram were bilateral elevation of the diaphragm, pleural effusion, and pulmonary atelectasis. Patients with pulmonary thromboembolism, ARDS, and pneumonia presented with severe hypoxemia and alveolar–arterial oxygen difference and distinct radiographic findings. Conclusion(s): Severe OHSS is characterized by an extraparenchymal restrictive type of pulmonary dysfunction, attributed to intraabdominal or pleural fluid accumulation, which limits descent of the diaphragm and expansion of the thoracic cage. This may induce uncoordinated lung ventilation and atelectasis with subsequent ventilation-perfusion mismatch and hypoxemia. The clinical picture may deteriorate further because of pulmonary infection, pulmonary thromboembolism, or ARDS, all of which have distinct clinical, radiographic, and blood gas characteristics.