Ascites Index — a novel technique to evaluate ascites in ovarian hyperstimulation syndrome: a concept-proof study
Abstract
Objectives: Controlled ovarian hyperstimulation is an important step in infertility treatment. In some cases, however, ovarian hyperstimulation syndrome (OHSS) can occur. In its severe forms, ascites is likely to develop, associated with dyspnea. The aim of this study was to explore the usefulness of Ascites Index (AsI), a new tool for quantitative determination of ascites in patients with OHSS, to obtain data for planning further trials.
Material and methods: Twelve patients with OHSS and ascites were included in the study. All patients were admitted to the hospital because of abdominal pain and dyspnea due to increasing ascites. Ultrasound measurements of ascites extent were performed in four external quadrants of the abdomen. Pockets of free fluid were measured. The obtained values were totaled, forming the Ascites Index (AsI), similarly to the amniotic fluid index. Because of dyspnea, paracentesis was performed in all cases.
Results: Median AsI at which patients reported dyspnea was 29.0 cm (range 21.6–38.6 cm). At AsI values less than 21.6 cm, no dyspnea was observed in any of the 12 studied patients. To avoid complications, 2000 mL of ascitic fluid was collected in each patient. After paracentesis, range of AsI decreased to 12.1–14.5 cm.
Conclusions: The proposed AsI seems to be a promising tool for estimating and monitoring the ascites extent in OHSS. It can be estimated using basic ultrasound equipment. AsI requires further studies for standardization and transferability to other causes of ascites.
Keywords: Ascites Indexascitesascites evaluationovarian hyperstimulation syndrome
References
- Hou W, Sanyal AJ. Ascites: diagnosis and management. Med Clin North Am. 2009; 93(4): 801–817.
- Saâda E, Follana P, Peyrade F, et al. Pathogenesis and management of refractory malignant ascites. Bull Cancer. 2011; 98(6): 679–687.
- Singhal S, Baikati KK, Jabbour II, et al. Management of refractory ascites. Am J Ther. 2012; 19(2): 121–132.
- Chen CD, Wu MY, Chao KH, et al. Update on management of ovarian hyperstimulation syndrome. Taiwan J Obstet Gynecol. 2011; 50(1): 2–10.
- Corbett S, Shmorgun D, Claman P, et al. The prevention of ovarian hyperstimulation syndrome. J Obstet Gynaecol Can. 2014; 36(11): 1024–1036.
- Grossman LC, Michalakis KG, Browne H, et al. The pathophysiology of ovarian hyperstimulation syndrome: an unrecognized compartment syndrome. Fertil Steril. 2010; 94(4): 1392–1398.
- Nastri CO, Teixeira DM, Moroni RM, et al. Ovarian hyperstimulation syndrome: pathophysiology, staging, prediction and prevention. Ultrasound Obstet Gynecol. 2015; 45(4): 377–393.
- Panagiotopoulou N, Byers H, Newman WG, et al. Spontaneous ovarian hyperstimulation syndrome: case report, pathophysiological classification and diagnostic algorithm. Eur J Obstet Gynecol Reprod Biol. 2013; 169(2): 143–148.
- Zivi E, Simon A, Laufer N. Ovarian hyperstimulation syndrome: definition, incidence, and classification. Semin Reprod Med. 2010; 28(6): 441–447.
- Shifman EM, Pogodin OK, Gumeniuk EG, et al. [Intensive care for ovarian hyperstimulation syndrome]. Anesteziol Reanimatol. 2007(4): 77–81.
- Saris W, Revilla M. Correction for Measurement Errors in Survey Research: Necessary and Possible. Social Indicators Research. 2015; 127(3): 1005–1020.
- Inadomi J, Cello JP, Koch J. Ultrasonographic determination of ascitic volume. Hepatology. 1996; 24(3): 549–551.
- Cattau EL, Benjamin SB, Knuff TE, et al. The accuracy of the physical examination in the diagnosis of suspected ascites. JAMA. 1982; 247(8): 1164–1166.
- Henriksen JH, Møller S. Ascites. Morgan & Claypool. 2013: 106.
- Stanley MM, Ochi S, Lee KK, et al. Peritoneovenous shunting as compared with medical treatment in patients with alcoholic cirrhosis and massive ascites. Veterans Administration Cooperative Study on Treatment of Alcoholic Cirrhosis with Ascites. N Engl J Med. 1989; 321(24): 1632–1638.
- Wapnick S, Grosberg SJ, Evans MI. Randomized prospective matched pair study comparing peritoneovenous shunt and conventional therapy in massive ascites. Br J Surg. 1979; 66(9): 667–670.
- Moore KP, Wong F, Gines P, et al. The management of ascites in cirrhosis: report on the consensus conference of the International Ascites Club. Hepatology. 2003; 38(1): 258–266.
- Edell SL, Gefter WB. Ultrasonic differentiation of types of ascitic fluid. AJR Am J Roentgenol. 1979; 133(1): 111–114.
- Brezinka C. Tipps und Tricks im Gyn-Ultraschall: Der Abdominalschallkopf beim OHSS. J für Gynäkologische Endokrinol. 2014 Jun 12. ; 7(2): 42–43.
- Khalifé S, Falcone T, Hemmings R, et al. Diagnostic accuracy of transvaginal ultrasound in detecting free pelvic fluid. J Reprod Med. 1998; 43(9): 795–798.
- Von Kuenssberg Jehle D, Stiller G, Wagner D. Sensitivity in detecting free intraperitoneal fluid with the pelvic views of the FAST exam. Am J Emerg Med. 2003; 21(6): 476–478.
- Irshad A, Ackerman SJ, Anis M, et al. Can the smallest depth of ascitic fluid on sonograms predict the amount of drainable fluid? J Clin Ultrasound. 2009; 37(8): 440–444.
- Gerbes AL, Gülberg V, Sauerbruch T, et al. German S 3-guideline "ascites, spontaneous bacterial peritonitis, hepatorenal syndrome". Z Gastroenterol. 2011; 49(6): 749–479.
- Alnumeiri MS, Ayad CE, Ahmed BH, et al. Evaluation of ascites and its etiology using ultrasonography. J Res Dev. 2015; 3(1).
- Oriuchi N, Nakajima T, Mochiki E, et al. A new, accurate and conventional five-point method for quantitative evaluation of ascites using plain computed tomography in cancer patients. Jpn J Clin Oncol. 2005; 35(7): 386–390.
- Fairman JG. Pascal’s principle and hydraulics. NASA Official: Tom Benson. 1996. Available from: www.grc.nasa.gov/www/k-12/WindTunnel/Activities/Pascals_principle.html.
- Cavazzoni E, Bugiantella W, Graziosi L, et al. Malignant ascites: pathophysiology and treatment. Int J Clin Oncol. 2013; 18(1): 1–9.
- Adam RA, Adam YG. Malignant ascites: past, present, and future. J Am Coll Surg. 2004; 198(6): 999–1011.
- Becker G, Galandi D, Blum HE. Malignant ascites: systematic review and guideline for treatment. Eur J Cancer. 2006; 42(5): 589–597.
- Gordon FD. Ascites. Clin Liver Dis. 2012; 16(2): 285–299.
- Aoyagi T, Terracina KP, Raza A, et al. Cancer cachexia, mechanism and treatment. World J Gastrointest Oncol. 2015; 7(4): 17–29.
- Magnowski P, Wolski H, Magnowska M, et al. Bone loss in women with malignant genital neoplasms. Ginekol Pol. 2014; 85(12): 955–960.
- Montano-Loza AJ. Clinical relevance of sarcopenia in patients with cirrhosis. World J Gastroenterol. 2014; 20(25): 8061–8071.
