Outpatient Management of Severe Ovarian Hyperstimulation Syndrome (OHSS) with Placement of Pigtail Catheter

Keywords:

complication, IVF, OHSS, Pigtail catheter, management, outcome, outpatient


Published online: Apr 24 2014

M. Abuzeid1,3,4, H. Warda2, 4, S. Joseph3, M.G. Corrado3, Y. Abuzeid3, M. Ashraf1,3,4, B. Rizk5

1 Hurley Medical Center, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Flint USA 48503.
2 Hurley Medical Center, Department of Obstetrics and Gynecology, Flint, USA 48503 IVF Michigan, PC, Rochester Hills, USA 48307
3 Michigan State University, Department of Obstetrics and Gynecology and
4 Reproductive Biology, College of Human Medicine, Flint Campus, Flint, USA 48503
5 University of South Alabama, Professor and head, Division of Reproductive Endocrinology and Infertility, Department of Obstetrics and Gynecology, Mobile, USA 36604

Correspondence at: botros4@gmail.com

Abstract

Objective: To evaluate the efficacy and safety of outpatient management of severe ovarian hyperstimulation syndrome (OHSS) requiring placement of a pigtail catheter.
Methods: retrospective analysis of thirty-three consecutive patients who underwent in-vitro fertilization (2003-2009) and developed severe/critical OHSS requiring placement of a pigtail catheter. Patients who were managed on outpatient basis were monitored by frequent office visits, daily phone calls, and received IV normal saline for hydration when required.
Results: In 3 patients (9.1%) OHSS started early, requiring placement of a pigtail catheter 4.3 + 0.6 days after retrieval. In 30 patients (90.9%) OHSS started late (14 + 4 days after retrieval). The mean amount of ascitic fluid drained immediately after placement of the catheter was 2085 + 1018 cc. The pigtail catheter was removed after 7.8 + 5.3 days. Of the 31 patients who had embryo transfer (two had total freeze), 84% conceived. Twenty-nine patients (88%) were managed on outpatient basis without any complications. Four patients required hospital admission for 1-7 days (3.0 + 2.7). One patient with severe OHSS was admitted for work up for chest pain. Three patients with critical OHSS with severe pleural effusion requiring thoracentesis were admitted for supportive measures.
Conclusion: The placement of a pigtail catheter resulted in safe and effective outpatient management for the majority of patients with severe OHSS.