The pathophysiology of ovarian hyperstimulation syndrome: an unrecognized compartment syndrome.
OBJECTIVE
To compare and contrast the pathophysiology of ovarian hyperstimualtion syndrome (OHSS) with known syndromes of increased intraabdominal pressure (IAP), and to explore the relationship of increased IAP with symptom severity in OHSS.


METHODS
Literature review.


METHODS
Correlation of OHSS symptoms with IAP; effects of paracentesis on IAP in patients with OHSS.


METHODS
Academic Research Institution.


METHODS
None.


RESULTS
OHSS involves a rapid accumulation of volume (from 1.5-17 liters) in the peritoneal cavity that can lead to organ dysfunction, including respiratory impairment and oliguria. In published reports of 20 moderate-to-severe OHSS patients in whom IAP was measured, IAP was found to be elevated to a pathologic range. The increased IAP indicates that OHSS may be considered a compartment syndrome and meets criteria for abdominal compartment syndrome in advanced cases. For this reason, management of OHSS should include reduction of pressure by paracentesis to avoid morbidity and syndrome progression. In addition, measurement of IAP may help to classify the stage of OHSS.


CONCLUSIONS
IAP was found to be elevated in the few cases of OHSS in which it was measured, substantiating the conclusion that OHSS may be considered a compartment syndrome. An understanding of the pathophysiology of increased intrabdominal pressure is useful in the management of OHSS.
Grossman
Lisa C
LC
Georgetown University School of Medicine, Washington, DC; Reproductive Biology and Medicine Branch, Eunice Kennedy Shriver, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
Michalakis
Konstantinos G
KG
Reproductive Biology and Medicine Branch, Eunice Kennedy Shriver, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
Browne
Hyacinth
H
Reproductive Biology and Medicine Branch, Eunice Kennedy Shriver, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland.
Payson
Mark D
MD
Walter Reed Army Medical Center, Washington, DC.
Segars
James H
JH
Reproductive Biology and Medicine Branch, Eunice Kennedy Shriver, National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, Maryland. Electronic address: segarsj@mail.nih.gov.
D000005:Abdomen / Q000098:blood supply / Q000503:physiopathology; D000465:Algorithms; D003161:Compartment Syndromes / Q000145:classification / Q000175:diagnosis* / Q000209:etiology / Q000503:physiopathology; D003937:Diagnosis, Differential; D005260:Female; D006439:Hemodynamics / Q000502:physiology; D006801:Humans; D006973:Hypertension / Q000150:complications; D016471:Ovarian Hyperstimulation Syndrome / Q000175:diagnosis* / Q000209:etiology* / Q000503:physiopathology / Q000628:therapy; D019152:Paracentesis / Q000379:methods