{"paper_id":"dbab31fb-c76a-438c-982b-6ac60d2865e8","body_text":"Petrenko et al. BMC Women’s Health          (2022) 22:155  \nhttps://doi.org/10.1186/s12905-022-01701-5\nRESEARCH ARTICLE\nAre anthropometric data a tool \nfor determining the severity of OHSS? Yes, it \ncould be!\nAleksei Petrovich Petrenko1,2,4  , Camil Castelo‑Branco1*  , Dimitry Vasilevich Marshalov2,4  , \nAlexander Valerievich Kuligin2  , Efim Munevich Shifman3  , Elena Sergeevna Nesnova4,5   and \nBatsunova Mariia Olegovna4   \nAbstract \nBackground: All  management guidelines of ovarian hyperstimulation syndrome (OHSS) recommend daily moni‑\ntoring of women’s body weight, waist circumference and note that as indicators increase, the severity OHSS also \nincreases. However, the dynamics of abdominal size and its relationship with markers of OHSS severity have not been \nhighlighted. The purpose of this study is to assess the usefulness of various anthropometric indicators for determining \nthe degree of OHSS severity as well as paracentesis indications.\nMethods: Observational study including 76 women complaining with OHSS. Clinical history, physical examination, \nlaboratory tests, and ultrasound measurement of the ovarian volume (OV) and ascites index (AsI) were done in all \ncases. Intra‑abdominal pressure (IAP) was assessed using an intravesical manometer. The anteroposterior diameter of \nthe abdomen (APD) and transverse diameter of the abdomen (TS) were measured with a pelvimeter. The APD/TS ratio \nwas calculated.\nResults: The APD/TS ratio increased progressively and tended to be the highest in the most symptomatic stage of \nOHSS (Kruskal–Wallis test, p < 0.001). The median APD/TS was significantly lower in patients with mild OHSS (0.55 \n[IQR, 0.44–0.64]) compared with severe OHSS (0.87 [IQR, 0.80–0.93]; p < 0.001) or critical OHSS (1.04 [IQR, 1.04–1.13]; \np < 0.001). Similarly, the median APD/TS of the moderate OHSS group (0.65 [IQR, 0.61–0.70]) was significantly lower \nthan that of the severe (p < 0.001) and critical OHSS group (p = 0.001). There was a strong positive correlation between \nAPD/TS and IAP (Spearman’s r = 0.886, p < 0.01). The APD/TS ratio showed a significant positive correlation with AsI \n(Spearman’s r = 0.695, p < 0.01) and OV (Spearman’s r = 0.622, p < 0.01). No significant differences were observed in \nage, height, weight, body mass index, hip circumference or waist circumference between moderate, severe and criti‑\ncal OHSS groups.\nConclusions: The APD/TS ratio is related to the severity of OHSS. Monitoring APD/TS dynamics could be a method of \nindirectly controlling intra‑abdominal volume, compliance of the abdominal wall and IAP . In conjunction with clinical \nand laboratory data, APD/TS might be an indicator for paracentesis.\n© The Author(s) 2022. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which \npermits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the \noriginal author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or \nother third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line \nto the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory \nregulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this \nlicence, visit http:// creat iveco mmons. org/ licen ses/ by/4. 0/. The Creative Commons Public Domain Dedication waiver (http:// creat iveco \nmmons. org/ publi cdoma in/ zero/1. 0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.\nOpen Access\n*Correspondence:  castelobranco@ub.edu\n1 Clinic Institute of Gynecology, Obstetrics and Neonatology, Faculty \nof Medicine, University of Barcelona, Hospital Clinic‑Institut d´Investigacions \nBiomèdiques August Pi i Sunyer (IDIBAPS), Villarroel 170, 08036 Barcelona, \nSpain\nFull list of author information is available at the end of the article\n\nPage 2 of 7Petrenko et al. BMC Women’s Health          (2022) 22:155 \nBackground\nOvarian hyperstimulation syndrome (OHSS) is a largely \niatrogenic condition, associated with significant mor -\nbidity and even mortality of healthy women undergoing \nfertility treatment [1, 2]. Generally, OHSS is triggered \nby human chorionic gonadotropin (hCG) and it’s mainly \ndue to excessive ovarian secretion of vascular endothe -\nlial growth factor and other angiogenic factors, increas -\ning vascular permeability and causing fluid leakage into \nthe third space [3, 4]. Thus, OHSS is characterized by \nenlarged ovaries with hypovolemia and haemoconcen -\ntration, in more severe cases including ascites, hyperco -\nagulation, renal failure and even multiple organ failure in \nthe critical ones [2]. The main principles in moderate and \nsevere OHSS treatment are correction of hypovolemia, \nelectrolyte imbalance, hypoalbuminemia and paracente -\nsis, if necessary [5].\nAscites progression and ovarian enlargement with \nOHSS leads to an increase in intra-abdominal pressure \n(IAP), and in severe and critical formsto the abdominal \ncompartment syndrome (ACS) and associated severe \norgan dysfunction, which is the main factor of poor \noutcome among women with this syndrome [6, 7]. Our \nprevious study revealed OHSS as a classic model of intra-\nabdominal hypertension (IAH) syndrome, where IAP is \nan important diagnostic marker, allied with the OHSS \nseverity [8]. It has been proposed, there was provided to \nuse the IAH level and ascites index (AsI), for paracente -\nsis’s indications in combination with clinical and labora -\ntory data. The IAP measuring through a Foley catheter \nby using a pressure transducer is the gold standard [9], \nbut, unfortunately, it has not yet become widespread in \ngynecological and obstetric practice. Finding a simpler \nand more convenient method for indirect controlling \nintra-abdominal volume (IAV), abdominal wall compli -\nance (Cab) and IAP without the use independently of \ncomplex and expensive techniques would be useful for \nOHSS management.\nAll OHSS management guidelines recommend daily \nmonitoring of women’s body weight, waist circumference \n(WC) and note that as indicators increase, the severity of \nOHSS also increases [5, 10–12]. However, according to \nthe literature data, the dynamics of abdominal size and \nits relationship with markers of OHSS severity have not \nbeen highlighted.\nThe purpose of this study is to assess the usefulness of \nvarious anthropometric indicators in determining degree \nof OHSS severity as well as indications for paracentesis.\nMethods\nSample\nA total of 76 infertile women who were in an in vitro fer -\ntilization program and presented OHSS were included \nin this study. Sample size was established based on the \nfact that according to the Ministry of Health of the Sara -\ntov Region, during the period from 2015 to 2019, 4800 \ncycles of ART were performed in all medical institutions \nof the region. Complications presented by various forms \nof OHSS requiring outpatient monitoring and hospitali -\nzation, were recorded in 95 cases (1.9%). Thus, using the \nstatistical software to calculate the sample size with a \n5% maximum acceptable error, 95% confidence level, we \nobtained a sample size of 76 women with OHSS.  All of \nthem were admitted into the gynaecological department \nof the city clinical hospital No.1 named after Yu.Ya. Gor -\ndeev (Saratov, Russian Federation). Anthropometrical, \nlaboratory and clinical data were recorded in all included \nsubjects (Additional file  1: Table  S1, Additional file  2: \nTable S2 and Additional file  3:  Table S3). The age range \nof the study participants was from 20 to 40 years old and \nthe body mass index (BMI) was from 16.9 to 24.1 kg/m2.\nOHSS was classified according to the Royal College of \nObstetricians & Gynaecologists guidelines [5]. Therefore, \npatients were allocated into four groups depending on \nthe severity of OHSS: mild OHSS (group I, n = 25), mod-\nerate OHSS (group II, n = 25), severe OHSS (group III, \nn = 21), and critical OHSS (group IV, n = 5). Early-onset \nOHSS was defined when the syndrome was initiated dur -\ning the first 9  days after trigger administration of hCG, \nand late OHSS was defined when the syndrome was \ninitiated from 10  days after. The current study included \n19 (25%) women with early OHSS and 57 (75%) women \nwith late OHSS. The IAP was measured 4 [IQR, 3–5] \ndays after hCG administration in case of early OHSS \nand 17 [IQR, 13–19] days after hCG triggering in case of \nlate OHSS. The average length of stay for subjects with \nearly OHSS was 10 [IQR, 7–12] days; the average length \nof a hospital stay for women with late OHSS was 9 [IQR, \n7–11] days. All women admitted with the diagnosis of \nOHSS were considered for inclusion in the study. Those \nwho voluntarily refused to participate were excluded.\nProcedures\nAnthropometrical and clinical data were recorded in all \nincluded subjects (Additional file  2: Table  S2  and Addi-\ntional file  3: Table  S3). The anteroposterior diameter \nof the abdomen (APD) and transverse diameter of the \nKeywords: Ovarian hyperstimulation syndrome, Anthropometic indicators, Intra‑abdominal pressure, Intra‑\nabdominal hypertension, Ascites index, Compliance of the abdominal wall\n\nPage 3 of 7\nPetrenko et al. BMC Women’s Health          (2022) 22:155 \n \nabdomen (TS) were measured with a pelvimeter. The \nAPD was defined as the distance between the spine at \nthe  L3–4  level and the abdomen apex, then the pelvimeter \nbranches were rotated in the same plane, set along the \nmidaxillary lines, and after that, TS measurement was \nmade. The APD/TS ratio was calculated.\nBMI was evaluated by the Quetelet’s equation, and in \nall cases blood and urine samples were obtained. Ovar -\nian size and pelvic and abdominal free fluid were assessed \nby ultrasound (Accuvix XG [Samsung MEDISON Co. \nLtd. Korea]) using 3.5 MHz sectoral sensors. The ovarian \nvolume (OV) using the prolate ellipsoid formula [13] and \nthe AsI [14] was measured as previously described [8]. \nFinally, the IAP was determined using a Foley catheter \nwith a pressure transducer [9].\nStatistical analysis\nThe data were analysed using a personal computer-based \nsoftware package (SPSS 26.0, SPSS Inc. Headquarters, \n233 South Wacker Drive, 11th Floor, Chicago, IL 60606, \nUSA). The Shapiro–Wilk test was used to determine the \nnormal distribution of the sample. Data for non-normally \ndistributed variables are given as the median [interquar -\ntile range]. Homogeneity of within-group variances was \nevaluated by Levene’s test. The Kruskal–Wallis test was \nused to analyse differences between groups. Statistically \nsignificant results were followed by Mann–Whitney \nU-tests with Bonferroni  adjustment to detect subgroup \ndifferences. Spearman’s correlation coefficients were \nused to check the association between continuous vari -\nables. All probability tests were two-sided and a p-value \nof < 0.05 was considered significant.\nResults\nAnthropometrical data are given in Additional file  3: \nTable   S3. The age range of the study participants was \nfrom 20 to 40  years old and the BMI was from 16.9 to \n24.1 kg/m2.\nSignificant differences between groups were observed \nregarding APD measurements (p < 0.001). The median \nAPD of the mild OHSS group (16 [IQR, 15–19]) was \nfound to be significantly lower than that of the severe \n(24 [IQR, 23–27], p < 0.001) and critical OHSS group (26 \n[IQR, 24–28], p = 0.001). Besides that, the median APD \nof the moderate OHSS group (19 [IQR, 17–24]) was sig -\nnificantly lower than that of the severe (p < 0.005) and \ncritical OHSS group (p < 0.05). However, there was no \nsignificant difference in APD between mild and moderate \nor severe and critical OHSS groups (p > 0.05).\nAs expected, APD/TS increased progressively and \ntended to be the highest in the most symptomatic stage \nof OHSS (p < 0.001). Figure  1 represents the intergroup \ncomparison of APD/TS. The median APD/TS was sig -\nnificantly lower in patients with mild OHSS (0.55 [IQR, \n0.44–0.64]) compared with severe OHSS (0.87 [IQR, \n0.80–0.93]; p < 0.001) or critical OHSS (1.04 [IQR, 1.04–\n1.13]; p < 0.001). Similarly, the median APD/TS of the \nmoderate OHSS group (0.65 [IQR, 0.61–0.70]) was sig -\nnificantly lower than that of the severe (p < 0.001) and \ncritical OHSS group (p = 0.001). There was no significant \ndifference in APD/TS between mild and moderate or \nsevere and critical OHSS groups (p > 0.05).\nNo significant differences were observed in age, height, \nweight, body mass index, hip circumference or waist cir -\ncumference between moderate, severe and critical OHSS \ngroups (Additional file  2: Table  S2). There was also no \nsignificant difference between the early and late OHSS \ngroups (p > 0.05).\nCorrelation analysis was used to identify whether \nthe APD/TS was independently associated with other \nanthropometric indicators and IAP , AsI or OV. As antici-\npated, there was a strong positive correlation between \nAPD/TS and IAP (Spearman’s r = 0.886, p < 0.01; Fig. 2a). \nBesides that, APD/TS showed a significant positive cor -\nrelation with AsI (Spearman’s r = 0.695, p < 0.01; Fig. 2b) \nand OV (Spearman’s r = 0.622, p < 0.01; Fig. 2c). No sig -\nnificant correlation was present between APD/TS and \nany of the other anthropometric indicators, except for a \nweak inverse correlation with WC (Spearman’s r = −0.24, \np < 0.05). A significant but weak inverse correlation was \nobserved between APD/TS and the age (Spearman’s \nr = −0.285, p < 0.05).\nDiscussion\nIn a previous study, we made an analogy between OHSS \nand IAH syndrome documenting the importance of \ndynamic monitoring of IAP , AsI and OV. All these \nII II II IV\n0.0\n0.5\n1.0\n1.5\nOHSS\nAPD/TS\nFig. 1 APD/TS according to severity of ovarian hyperstimulation \nsyndrome. Data are plotted as median with range\n\nPage 4 of 7Petrenko et al. BMC Women’s Health          (2022) 22:155 \nparameters were significantly associated with the OHSS \nseverity [8]. In the present research, we studied the \nwomen’s anthropometric data and their relationship with \nOHSS severity.\nAll OHSS management guidelines emphasize the \nimportance of daily monitoring of weight and WC in \nwomen and simply state the fact that the severity of \nOHSS increases with increasing these parameters [5, \n10–12]. In our work, we did not observe significant dif -\nferences in weight, BMI, HC or WC between moderate, \nsevere and critical OHSS groups.  Our data are consistent \nwith those by Ma et al., who noted that increasing BMI is \nnot a risk factor for OHSS severity [15]. Malbrain et al., \nwhen examining patients in intensive care, also stated \nthat there was no significant correlation between abdom-\ninal circumference and IAP level [16].\nIt is a well-known that IAP is determined by two ele -\nments—the IAV and Cab [17]. The WC in women \nreflects approximate IAV, but not Cab and associated \nIAP . Women can have the same ascetic fluid amount, but \ndifferent Cab, different possibilities for abdominal cavity \naccommodation and, as a result, different IAP . According \nto the World Society of Abdominal Compartment Syn -\ndrome (WSACS) experts, Cab plays a key role in under -\nstanding the negative effects of unadapted IAV on IAP \nand organ perfusion, although it is currently one of the \nmost neglected parameters in critically ill patients [18]. \nCab extension indicates a loss of abdominal wall elastic -\nity, while a decrease in Cab means that the same change \nin IAV will result in a larger change in IAP .\nMalbrain et al., in their fundamental work, studied the \nstages of changing in the abdominal shape in critically ill \npatients with IAH/ACS and revealed a change from an \nellipse to a sphere with a maximum increase in IAP val -\nues. The authors described three phases of the ongoing \nprocesses: the reshaping, stretching, and pressurisation \nphases [19].\nIn the presented study, we obtained similar results. In \nthe absence of significant intergroup differences in WC, \nthe median APD in the moderate OHSS group was sig -\nnificantly lower than in the severe and critical OHSS \ngroup. Obviously, with the progression of ascites, APD \nincreases most of all. The APD/TS ratio progressively \nincreased and was highest at the most symptomatic stage \nof OHSS (Fig.  1). When the ratio APD/TS is approach -\ning to 1, i.e. when the transverse and anteroposterior \ndimensions became equal, the abdomen took the sphere \nform with the transition from severe to critical OHSS. \nNo significant difference in the APD/TS between mild \nand moderate OHSS can be explained by the fact that \nin moderate form there is a small amount of ascitic fluid \nwith a sufficient elasticity reserve of the anterior abdom -\ninal wall and APD, as well as TS change insignificantly. \nAlso, between severe and critical OHSS, there was no \nsignificant difference in the APD/TS. It can be due to \nthe fact, that in severe form with exhaustion of abdomi -\nnal stretching allowance, even a small addition of ascitic \na\n01 02 03 0\n0.0\n0.5\n1.0\n1.5\nSpearman’s r = 0.886, p<0.01\nIAP, mmHg\nAPD/TS\nb \n01 00 2003 00 400\n0.0\n0.5\n1.0\n1.5\nSpearman’s r = 0.695, p<0.01\nAscites index, mm\nAPD/TS\nc \n02 00 4006 00 800 1000\n0.0\n0.5\n1.0\n1.5\nSpearman’s r = 0.622, p<0.01\nOvarian volume, ml\nAPD/TS\nFig. 2 Scatter plots of APD/TS related to intra‑abdominal pressure \n(a), ascites index (b) and ovarian volumes (c)\n\nPage 5 of 7\nPetrenko et al. BMC Women’s Health          (2022) 22:155 \n \nfluid slightly changes both, APD and TS, but causes an \nexponential increase in IAP with the transition to critical \nOHSS. Correlation analysis also confirmed a significant \npositive correlation between APD/TS and OHSS sever -\nity markers, where the strongest positive correlation was \nbetween APD/TS and IAP .\nIt can be assumed that women with severe OHSS had \nan initially lower Cab compared with mild OHSS, and \nan increase in additional IAV with limited Cab led to a \nprogressive IAP increase. Unfortunately, Cab measure -\nment and estimation are difficult at the patient’s bed -\nside and can only be done in a case of change (removal \nor addition) in IAV [20]. This limitation also applies to \nIAV, which can be assessed by three-dimensional ultra -\nsound, water-suppressed magnetic resonance imaging \nand computed tomography [19]. These are complex and \nexpensive techniques which have not yet gained access \nto widespread clinical practice. Weak inverse correla -\ntion of APD/TS with WC seems illogical, although it \ncan be explained by the fact that with increasing sever -\nity of OHSS, the median WC and BMI in the groups \ndecreased, and the median Height increased (Additional \nfile 2: Table S2). Thus, it can be stated that, asthenic type \nof constitution prevailed in the groups with severe and \ncritical OHSS. The obtained results are consistent with \nthe literature data, where asthenic habitus is indicated as \none of the leading risk factors for the OHSS development \n[2, 10].\nIn a study assessing the IAV physiology during preg -\nnancy, the authors confirm that the IAV capacity and the \ntensile properties of pregnant women’s abdominal wall \ncan be predicted by the dynamics of the anteroposte -\nrior and transverse abdominal diameters [21]. It should \nbe pointed out that the current clinical guidelines rep -\nresent pregnancy as a chronic compensated state of \nIAP , where the abdominal wall slowly stretches, its Cab \ngradually increases, and the pregnant woman has time \nto adapt to slowly increasing IAP levels [22]. Whereas \nOHSS is a dynamic condition, a rapid increase in volume \nand/or pressure exceeds Cab, because there is no time \nfor tissue adaptation and moderate OHSS can progress \nto severe OHSS within a few hours [6]. Many authors \nconfirm that in such cases, paracentesis is the single \nmost important treatment modality for life-threatening \nOHSS which isn’t controlled by medical therapy [23–26]. \nHaving the absence of the ability to measure IAP and \nCab, the dynamics of the APD/TS ratio can be a surro -\ngate indicator of the IAH degree, IAV increase, reserve \ncapabilities of the abdominal wall’s extensibility and can \nhelp in establishing indications for timely performed \nparacentesis.\nConclusions\nThe APD/TS ratio and its dynamics are important \nmarkers of OHSS severity. The APD/TS ratio increases \nprogressively, reaching the highest values in the most \nsymptomatic stage of OHSS.\nIAP showed the strongest positive correlation with the \nAPD/TS ratio; however, significant correlations were also \nfound between APD/TS and AsI and OV.\nWhen the ratio APD/TS is approaching to 1, and the \nanteroposterior and transverse abdominal dimensions \nbecome equal, the abdomen changes from an ellipse \nto a sphere, the reserve of abdominal wall stretching is \ndepleted, and IAP exponential growth is observed with \nthe transition from severe to critical OHSS. The APD/\nTS monitoring can be a method of indirectly control -\nling IAP , Cab and IAV reserve, without using com -\nplex and expensive techniques. The inclusion of APD/\nTS monitoring in the standard for the management of \nOHSS might be useful in specifying the severity and \ntimely initiation of treatment, including methods to \nreduce IAP , prevent further organ dysfunction, and \navoid the transition to a more severe stage of IAH and \nACS. Finally, in the absence of IAP monitoring capabil -\nities, the APD/TS ratio in conjunction with clinical and \nlaboratory data might be an additional tool for indica -\ntion for paracentesis.\nAbbreviations\nACS: Abdominal compartment syndrome; APD: Anteroposterior diameter \nof the abdomen; AsI: Ascites index; Cab: Compliance of the abdominal wall; \nIAH: Intra‑abdominal hypertension; IAP: Intra‑abdominal pressure; IAV: Intra‑\nabdominal volume; OHSS: Ovarian hyperstimulation syndrome; OV: Ovarian \nvolume; TS: Transverse diameter of the abdomen.\nSupplementary Information\nThe online version contains supplementary material available at https:// doi. \norg/ 10. 1186/ s12905‑ 022‑ 01701‑5.\nAdditional file 1: Table S1. Baseline patients’ characteristics.\nAdditional file 2: Table S2. Clinical and laboratory data according to the \nseverity of ovarian hyperstimulation syndrome.\nAdditional file 3: Table S3. Anthropometric markers according to the \ndegree of severity of the ovarian hyperstimulation syndrome.\nAcknowledgements\nThe authors would like to thank all the women who kindly accepted to partici‑\npate in this study.\nAuthor contributions\nAP , DM and MB took part in patient recruitment for the study and conducted \nclinical trials. AP , CCB, DM, and EN designed the study. AP , CCB, DM, and EN \ntook part in the analysis and interpretation of data and revision of the draft. AP , \nCCB, DM, and EN wrote the manuscript. CCB, AK, and ES revised critically for \nimportant intellectual content. All authors approved the final version of the \nmanuscript. All authors had full access to all of the data in the study (including \nstatistical reports and tables) and can take responsibility for the integrity of the \n\nPage 6 of 7Petrenko et al. BMC Women’s Health          (2022) 22:155 \ndata and accuracy of the data analysis. All authors read and approved the final \nmanuscript.\nFunding\nThis research received no specific grant from any funding agency in the pub‑\nlic, commercial, or not‑for‑profit sectors.\nAvailability of data and materials\nThe study was registered at the ISRCTN registry; identifier: ISRCTN66235250, \nhttp:// www. isrctn. com/ ISRCT N6623 5250 and https:// doi. org/ 10. 1186/ ISRCT \nN6623 5250; Data are available at: Castelo‑Branco, Camil (2021), “Severity Mark‑\ners in Women with Ovarian Hyperstimulation Syndrome” , Mendeley Data, V1, \nhttps:// doi. org/ 10. 17632/ ryhtp s673s.1.\nDeclarations\nEthics approval and consent to participate\nWritten informed consent was obtained from all the patients. The study was \napproved by the Ethics Committee of the Saratov State Medical University \nnamed after V. I. Razumovsky, Saratov, Russian Federation (IORG0004384, P .№7; \n6 March 2018) and was performed in accordance with the Declaration of \nHelsinki II and the ICH Guidelines for Good Clinical Practice.\nConsent for publication\nNot applicable.\nCompeting interests\nOn behalf of all authors, the corresponding author states that there is no \nconflict of interest.\nAuthor details\n1 Clinic Institute of Gynecology, Obstetrics and Neonatology, Faculty \nof Medicine, University of Barcelona, Hospital Clinic‑Institut d´Investigacions \nBiomèdiques August Pi i Sunyer (IDIBAPS), Villarroel 170, 08036 Barcelona, \nSpain. 2 Department of Emergency Anesthesiology‑Resuscitation Care \nand Simulation Technologies in Medicine, Saratov State Medical University \nnamed after V. I. Razumovsky, Saratov, Russian Federation. 3 Department \nof Anesthesiology and Critical Care, State Budgetary Healthcare Institution \nof Moscow Region M.F. Vladimirsky Moscow’s Regional Research Clinical Insti‑\ntute, Moscow, Russian Federation. 4 City Clinical Hospital №1 named after Yu.\nYa. Gordeev, Saratov, Russian Federation. 5 Department of Hospital Surgery, \nSaratov State Medical University named after V. I. Razumovsky, Saratov, Russian \nFederation. \nReceived: 3 November 2021   Accepted: 5 April 2022\nReferences\n 1. Nelson SM. Prevention and management of ovarian hyperstimulation \nsyndrome. Thromb Res. 2017;151:S61–4. https:// doi. org/ 10. 1016/ S0049‑ \n3848(17) 30070‑1.\n 2. Timmons D, Montrief T, Koyfman A, Long B. Ovarian hyperstimula‑\ntion syndrome: a review for emergency clinicians. Am J Emerg Med. \n2019;37(8):1577–84. https:// doi. org/ 10. 1016/j. ajem. 2019. 05. 018.\n 3. Blumenfeld Z. The ovarian hyperstimulation syndrome. Vitam Horm. \n2018;107:423–51. https:// doi. org/ 10. 1016/ bs. vh. 2018. 01. 018.\n 4. 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BMC Women’s Health          (2022) 22:155 \n \n•\n \nfast, convenient online submission\n •\n  \nthorough peer review by experienced researchers in your field\n• \n \nrapid publication on acceptance\n• \n \nsupport for research data, including large and complex data types\n•\n  \ngold Open Access which fosters wider collaboration and increased citations \n \nmaximum visibility for your research: over 100M website views per year •\n  At BMC, research is always in progress.\nLearn more biomedcentral.com/submissions\nReady to submit y our researc hReady to submit y our researc h  ?  Choose BMC and benefit fr om: ?  Choose BMC and benefit fr om: \n 25. Makino H, Furui T, Shiga T, Takenaka M, Terazawa K, Morishige KI. Manage‑\nment of ovarian hyperstimulation syndrome with abdominal compart‑\nment syndrome, based on intravesical pressure measurement. Reprod \nMed Biol. 2016;16(1):72–6. https:// doi. org/ 10. 1002/ rmb2. 12005.\n 26. Petrenko AP , Castelo Branco C, Marshalov DV, et al. Alternative strate‑\ngies for the management of ovarian hyperstimulation syndrome, the \nrole of intra‑abdominal hypertension control. Gynecol Endocrinol. \n2020;36(3):197–203. https:// doi. org/ 10. 1080/ 09513 590. 2019. 16838 22.\nPublisher’s Note\nSpringer Nature remains neutral with regard to jurisdictional claims in pub‑\nlished maps and institutional affiliations.","source_license":"CC0","license_restricted":false}