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Pulmonary manifestations of severe ovarian hyperstimulation syndrome: a multicenter study
Y Abramov1, U Elchalal, J G Schenker
1Department of Obstetrics and Gynecology, Hadassah Hebrew University Medical Center, Ein-Kerem, Jerusalem, Israel.
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.