Ob/Gyn Case Challenge: A 33-Year-Old Woman Trying to Conceive Has Dyspnea, Pain

Ziad R. Hubayter, MD, MPH


May 19, 2022

Interventions to prevent OHSS include the following:[5,6]

  • Decreased hormone dosage and aborting cycles if estrogen levels are too high or too many follicles are present

  • Less-risky ovarian protocols using gonadotropin-releasing hormone (GnRH) or luteinizing hormone-releasing hormone antagonists for ovarian suppression

  • GnRH agonists triggering versus hCG for oocyte maturation

  • Dopamine agonists that reduce VEGF production

  • Metformin use for patients with PCOS

Although rates and severity have decreased with use of these techniques, the problem remains, and efforts to further reduce risk must continue.[7]

The patient in this case was hospitalized and was given enough intravenous normal saline to maintain adequate urine output. The repletion of intravascular volume also corrected the hyponatremia and the hyperkalemia. Upon gentle diuresis, the ascites and the pleural effusion improved.

Because the patient was experiencing shortness of breath and had an elevated hematocrit, arterial blood gas analysis was obtained, despite the normal pulse oximetry results. The arterial blood gas was normal. Heparin was started for thromboembolic prophylaxis, and the patient was eventually discharged in stable condition.

Two weeks later, the patient's symptoms returned, and she had a similar course of events. With similar management and paracentesis, the symptoms ultimately subsided. The recurrence coincided with a positive pregnancy test. Endogenous hormonal production during pregnancy is known to reactivate OHSS. After a brief hospitalization, she was again discharged to home, where her pregnancy has progressed without further complication.


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