Medikamentozno liječenje sindroma hiperstimulacije jajnika

master's thesis

• Title (english): Medical treatment of ovarian hyperstimulation syndrome
• Author: Jelena Galic
• Mentor: Miro Kasum (mentor)
• Committee member: Marina Šprem Goldštajn (predsjednik povjerenstva)
• Committee member: Dinka Pavičić-Baldani (član povjerenstva)
• Committee member: Miro Kasum (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Gynecology and Obstetrics); Zagreb
• Defense date and country: 2017-07-14, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Gynecology and Obstetrics

Abstract

Ovarijski hiperstimulacijski sindrom (OHSS) najozbiljnija je jatrogena komplikacija stimulacije ovulacije u postupku medicinski pomognute oplodnje (MPO) do koje dolazi u lutealnoj fazi ciklusa ili u ranoj trudnoći. Sindrom najčešće nastaje nakon primjene egzogenih gonadotropina ili rjeđe klomifena. Karakteriziran je pomakom tekućine iz intravaskularnog u treći prostor te posljedičnom hemokoncentracijom i nakupljanjem tekućine u trbušnoj šupljini, a rjeđe u perikardijalnom i pleuralnom prostoru. Ovisno o laboratorijskim i kliničkim značajkama, dijeli se na blagi, umjereni i teški stadij. Teži se konzervativnom liječenju jatrogene hiperstimulacije te je ono prilagođeno težini sindroma. Prioritetno je održavanje adekvatnog intravaskularnog volumena s ciljem osiguravanja odgovarajuće perfuzije vitalnih organa. Ako to oklonosti dopuštaju, preporučljivo je korištenje oralnog puta unosa tekućine u pacijentica s blagim i umjerenim oblikom sindroma, dok pacijentice s teškim oblikom sindroma iziskuju intravaskularnu nadoknadu tekućine te se u spomenutu svrhu koriste kristaloidne otopine i plazma ekspanderi. Primjena diuretika može se razmotriti tek nakon što se postigao adekvatni intravaskularni volumen te joj je nužno pristupiti sa značajnim oprezom. Ako dođe do razvoja elektolitnih poremećaja, prvenstveno hiponatremije i hiperkalijemije, nužna je njihova korekcija. Tromboprofilaksa se treba razmotriti u pacijentica s umjerenim i teškim oblikom bolesti. Novije terapijske mogućnosti uključuju upotrebu dopamina i dopaminskih agonista, zatim reinicijaciju GnRH antagonista u lutealnoj fazi te smanjenje rizika tromboze povezane sa sindromom upotrebom inhibitora aromataze.

Abstract (english)

The ovarian hyperstimulation syndrome (OHSS) is the most severe iatrogenic complication of ovarian stimulation occurring during the luteal phase or during early pregnancy. It usually develops after the use of exogenous gonadotropins or, less frequently, clomiphene citrate. It is characterized by a fluid shift from the intravascular space to third space compartments and the consequent hemoconcentration and accumulation of fluid in the abdominal cavity or, in fewer cases, in the pericardial and pleural space. Prevention and early recognition of OHSS are essential in maintaining patient's safety. Conservative management of OHSS is preferable and it is adapted depending on the level of its severity. Maintaining an adequate intravascular volume must remain the first priority in order to ensure proper perfusion of vital organs. It is advisable to use the oral route of fluid replacement in a mild to moderate form of OHSS, while patients with severe OHSS require intravascular fluid management using crystalloid fluids and plasma expanders. The use of diuretics can only be considered after an adequate intravascular volume has been achieved and it is necessary to approach it with considerable caution. If patients present electrolyte imbalance, primarily hyponatremia and hyperkalemia, appropriate correction is necessary. Thromboprophylaxis should be considered in patients with moderate to severe OHSS. Newer therapeutic options encompass the use of dopamine and dopamine agonists, the reinstitution of GnRH antagonists in the luteal phase and the reduction of thrombosis-related risk associated with OHSS using aromatase inhibitors.

• Keywords: ovarijski hiperstimulacijski sindrom; prevencija; terapija; stimulacija ovulacije
• Keywords (english): ovarian hyperstimulation syndrome; prevention; treatment; ovarian stimulation
• Language: croatian
• URN:NBN: urn:nbn:hr:105:437738
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2018-03-23 10:42:06