Síndrome de hiperestimulación ovárica: clasificación, fisiopatología y manejo

Autores/as

  • Jaime Saavedra Saavedra

DOI:

https://doi.org/10.18597/rcog.640

Palabras clave:

gonadotropinas, hiperestimulación ovárica, clasificación, tratamiento

Resumen

El síndrome de hiperestimulación ovárica es una complicación iatrogénica de la inducción de la ovulación con gonadotropinas y puede resultar en una grave amenaza para la vida por sus complicaciones; como son: accidente cerebro-vascular debido a trombosis venosa, disfunción hepática, falla renal aguda, complicaciones respiratorias y torsión anexial. El mayor factor predisponente de la forma severa del SHO es el ovario poliquístico.

El síndrome se caracteriza por una salida del fluido del espacio intravascular, con acumulación de líquido en espacio peritoneal y pleural, produciéndose hipotensión y una disminución del flujo sanguíneo renal y, por consiguiente, una disminución del volumen urinario. El aumento de la permeabilidad capilar es la hipótesis más aceptada para el inicio de la fisiopatología del evento. El factor de crecimiento endotelial y la presencia de otras citoquinas es crucial en la patogénesis del SHO.

La clasificación del síndrome nos permite realizar esquemas de tratamiento lógicos, así tenemos que el SHO leve únicamente amerita reposo e hidratación oral. El SHO moderado se trata conservadoramente con observación ambulatoria, analgésicos, antieméticos, monitorización ecográfica, evaluación de la función renal, hepática, hematocrito y coagulación. El SHO severo, sin cambios anormales del perfil bioquímico, es tratado con aspiración del líquido ascítico, suministro de líquidos endovenosos sobre la base de los cuidados diarios del tratamiento. En caso de SHO con disbalance hidroelectrolítico u otras complicaciones, la paciente debe ser hospitalizada para un manejo apropiado. El manejo quirúrgico se reserva para casos de torsión o ruptura de quiste, o tratamiento de embarazo ectópico.

Biografía del autor/a

Jaime Saavedra Saavedra

 Profesor titular, Departamento de Obstetricia y Ginecología, Universidad del Valle. Jefe del Servicio de Ginecología y Obstetricia del Hospital universitario del Valle. Director General del Centro de Biomedicina Reproductiva, FECUNDAR. Director del Programa de entrenamiento de Cirugía Endoscópica Ginecológica, Clínica Los Andes, Cali, Colombia. Presidente de la Sociedad Colombiana de Cirugía Endoscópica; Secretario para Colombia de la Sociedad Iberoamericana de Endoscopia Ginecológica e Imagenología.

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Cómo citar

1.
Saavedra Saavedra J. Síndrome de hiperestimulación ovárica: clasificación, fisiopatología y manejo. Rev. colomb. obstet. ginecol. [Internet]. 30 de septiembre de 2002 [citado 29 de marzo de 2024];53(3):263-78. Disponible en: https://revista.fecolsog.org/index.php/rcog/article/view/640

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2002-09-30

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