In pathogenesis of OHSS, as well as in inflammatory cascade leading to a preterm birth, proinflammatory cytokines such as interleukins 2, 6 and 8 and VEGF could be of importance.4,17 A severe form of hyperstimulation followed by an increased permeability of blood vessels with consequent hemoconcentration
and hemodynamic instability could have had an impact on the placentation process.
The accompanying hemoconcentration
observed in our patient subsided after the aneurysmal SAH was treated.
with hematocrit >45%, white cell count >15000, liver dysfunction, increased blood viscosity, and thromboembolic events occurs in the most severe cases.
Failure of hemoconcentration
during standing to reveal plasma volume decline induced in the erect posture.
Although the amount of Hb can be modified by special situations, such as hemodilution or hemoconcentration
, prematurity, among others, the operational definition is still based on specific concentrations of it.
In the present case, daily decreases in bodyweight were seen from day 4 of administering TPF, and hemoconcentration
, one of the risk factors for NOMI, occurred.
Accordingly, the treatment of OHSS should be conservative and include the regulation of intravascular volume and electrolyte balance and the prevention of complications such as hemoconcentration
, hypovolemia, and coagulation disorders .
days Headache Yes Yes Yes Myalgia Yes Yes Yes Nausea Yes Yes Yes Prostration Yes Yes Yes Retroorbital pain Yes Yes Yes 2 patients Adenomegaly Yes Yes No Chills Yes No Yes Dizziness Yes Yes No Low back pain No Yes Yes Taste alteration Yes Yes No Vomiting Yes No Yes 1 patient Anorexia No No Yes Cold extremities Yes No No Cough Yes No No Dyspnea No Yes No Eye congestion No Yes No Eye redness perception No Yes No ([dagger]) Hemoconcentration
No No Yes Hoarseness No Yes No Leukopenia No Yes No Oropharyngeal pain Yes No No Otalgia No Yes No Pruritus No Yes No Thready pulse Yes No No * No patients had exanthema.
A venous blood sample was collected and submitted for hematologic evaluation, results of which showed hemoconcentration
(suspected to be the result of dehydration), anemia, and leukopenia with a slight monocytosis and lymphocytopenia (Table 1).
Since I saw all of the patients with OSA (but only one patient per week) at that time, I also hit upon the following idea: patients with OSA have increased water and salt excretion during sleep, which normalizes after treatment with continuous positive airway pressure (CPAP) treatment; therefore, before CPAP treatment, hemoconcentration
may occur in patients with OSA in the morning.
In addition to either having or having not presented the following changes: hemoconcentration
, hypoalbuminemia, alterations in liver function tests, as well as coagulation tests and increased urate levels ([greater than or equal to]6 mg dl-1); all of which manifested after the 20th week of pregnancy.