Ovarian hyperstimulation syndrome
ICD-10 N98.1 · ICD-11 GA32.0

Critical and Severe OHSS: Management When Inpatient Supportive Care Has Not Achieved Recovery

In severe or critical ovarian hyperstimulation syndrome, a structured course of inpatient supportive care is the initial management step. When that course does not produce the expected clinical recovery — with persistent haemoconcentration and ongoing dehydration — a more intensive, next-line approach is indicated.

Previous treatment line — targets not reached

The preceding protocol — inpatient supportive care including intravenous crystalloids, human albumin solution, analgesia, anti-embolism measures, paracentesis, and pleural drainage where indicated — is directed toward specific recovery signals.

Recovery goals not achieved: restoration of diuresis, normalisation of haematocrit, normalisation of serum electrolytes and osmolality, and reduction in abdominal girth and body weight.

Failure to meet these targets identifies the need for escalation to the next management line.

Next-line approach — partial overview only

This protocol centres on multidisciplinary critical care, bringing together expertise from anaesthetics, intensive care, renal, respiratory, and haematology specialties. It incorporates specific continuous monitoring strategies to guide management. The complete protocol — including all interventions and the conditions under which each is applied — is set out in full in the structured regimen.

Instant Access to Structured Evidence-Based Regimens

References

DOI: 10.1111/1471-0528.70195
  • Multidisciplinary assistance (anaesthetic, intensivists, renal, respiratory, haematology) should be sought for the care of women with critical OHSS and severe OHSS who have persistent haemoconcentration and dehydration.
  • In these cases, continuous urine output measurement and invasive haemodynamic monitoring may help guide fluid management more accurately.
  • The use of diuretics in managing fluid balance in women with OHSS should only be considered in a multidisciplinary setting and with central venous monitoring in place.
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