Ovarian Hyperstimulation Syndrome (OHSS) Imaging Grading

Step-by-step decision

Choose step by step as prompted; reaching an endpoint gives the management recommendation. You can go back a step or restart anytime.

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Full pathway

1. [Decision] Post-stimulation · OHSS grading
   Post-stimulation — OHSS severity grade (imaging + clinical)? (OHSS = an iatrogenic systemic reaction days after ART controlled ovarian hyperstimulation + hCG trigger (raised VEGF causes capillary leak, third-space fluid). US: bilateral enlarged ovaries with multiple follicles/cysts (peripheral spoke-wheel) + ascites ± pleural effusion. Note that post-ART pelvic fluid is not all OHSS (cyst rupture/hemorrhage/torsion can confound).)
   • Severe/critical (ovaries often >12 cm, clinical/tense ascites ± pleural effusion, hemoconcentration/thrombosis/renal failure) → Severe/critical · admission
   • Moderate (ovaries 8–12 cm, ultrasound ascites, moderate symptoms) → Moderate · close monitoring
   • Mild (ovaries <8 cm, mild symptoms, no significant ascites) → Mild · outpatient observation
2. [End] Mild · outpatient observation
   Mild (modified Golan I–II; ovaries <8 cm, mild bloating, no significant ascites): outpatient observation, rest, oral hydration, monitor weight/girth/symptoms; usually self-limited within 1–2 weeks; counsel on return signs (oliguria, dyspnea, severe pain).
3. [End] Moderate · close monitoring
   Moderate (Golan III; ovaries 8–12 cm, ultrasound ascites): close monitoring (Hct/electrolytes/renal function), hydration, VTE prophylaxis awareness; ultrasound-guided paracentesis avoiding the ovaries; avoid vigorous activity (torsion/cyst rupture risk); watch for progression.
4. [End] Severe/critical · admission
   Severe/critical (Golan IV–V; clinical or tense ascites ± pleural effusion, hemoconcentration, thrombosis, ARDS, renal failure): admission — volume expansion/albumin, correct electrolytes, VTE prophylaxis, ultrasound-guided drainage of ascites/effusion, monitor organ function; exclude ovarian torsion/cyst rupture bleeding.

Source guidelines & references

• ART ovarian imaging and OHSS grading (RadioGraphics 2023; modified Golan) · source ↗

This pathway is our own synthesis of the decision logic in the guidelines above (not the guideline verbatim); thresholds and workflows change as guidelines update — in practice follow the latest guideline, your institution's protocol and the individual patient.

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