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

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.