OHSS after IVF pregnancy - paracentesis

We did IVF- ICSI and conceived!. Read here about the IVF
Then started the OHSS symptoms.

26-06-2011    10 pm

Yesterday (25th) late at night, a nurse came to put IV cannula and tried to get a vein in both my hands so they can administer various drugs along with saline IV during tapping (The process of draining excess amniotic fluid in case of severe OHSS is called paracentesis). Ramesh had told me during the day that a fluid called Albumin had to be administered during tapping. It was very expensive and hospital did not have enough bottles in stock, so it had to be bought from outside. Albumin is thick and solidifies very fast in the vein and that’s why they needed both hands’ veins. It proved to be very difficult. My veins just won’t show. Two or three junior nurses tried by sticking needles at various parts of my hands. I cried out in pain, tears flowing down my cheeks. I felt lonely, helpless and miserable. Midnight, all alone, pain shooting through me, I wept. They did not do it deliberately, they were just inexperienced. They called another nurse from a nearby ward and she was slightly more experienced. (I would later see all these girls many times over, learn their names, and befriend them). At long last they managed to find two veins and left after putting the cannula.

At around 7 a.m., I was taken in a stretcher to the operation theater. A group of nurses came along, I closed my eyes and one nurse was saying, ’..I was planning to take a break today- Saturday, and this darn tapping..’ She did not realize that I was listening to her. When I saw the Operation Theater, I was scared suddenly, but then the thought that this immense bloating in the stomach could be relieved made me feel better. One hand cannula had IV saline fluid and the other had Albumin. Doctor came with big gang of nurses. One elderly sister whom I met yesterday night came forward to clean the vaginal area. Although it was shaved for embryo transfer, she had given it a quick shave last night. Now she came with Betadine solution or some such thing and put both my legs up so she could have easy access and view. She then dipped cotton in the antiseptic solution and cleaned inside out. It was like the area was burning. The unexpected pain made me cry out.  Doctor tried to calm me by saying that if it s not done it might cause infection inside. I trusted him but the pain would not stop. Both my hands and legs were firmly held by nurses and there were strainers too. Still I moved horribly. It must have looked like a movie scene where they administer electric shock to mentally unstable people. But the pain was only during the wash. The moment the cotton was removed the pain stopped and I breathed. The whole process might have lasted 2 minutes at most. Then doctor inserted a catheter in the vagina to the uterus. It hurt, but only very slightly. He was looking at an ultrasound scanner while placing it, and then the tapping started.

DrTC explained to me that Paracentesis is the process of removing or draining excess amniotic fluid in the uterus. When the baby starts growing inside, a lot of hormone is produced which causes more amniotic fluid to be generated, especially if there is a history of hormone induced infertility treatments, and/or if there is more than one baby. This excess fluid sometimes comes out from the thin vessels and starts filling up in the stomach and sometimes even in the lungs. This excess fluid needs to be removed, at the same time making sure that there is enough fluid to ensure the baby’s survival. This fluid generation gradually stops in a week or two, but if it stops abruptly before that, it means that something is wrong with the baby inside, most probably it is dead, and one can expect a period in 2-3 days. And because of this one cannot pray that ‘Oh God, Please stop this fluid filling..’  It is a good thing, and a horrible thing, at the same time.

It took around 30-45 minutes to finish the tapping. During the time a few doctors came and left the OT. DrTC was talking to me and to the nurses in general, cracking some jokes and talking about movies and all. Last night he watched ‘Salt and Pepper’ it seems, and ‘Adaminte Makan’ which was made by all youngsters except the hero Salim Kumar, and still turned out to be a great movie, he was saying. Slowly, gradually,the heaviness and uneasiness in my stomach lessened. I felt much better by the end of the process,though not fully recovered. That day 3.5 liters of fluid was removed. I saw the fluid filled in bottles and it looked like blood. Doctor instructed the nurses to test the nature and culture of the fluid, whatever that meant. They attached a urine bag and catheter to my bladder to check my kidney functioning and urine color (Last night at GICU I put a lot of effort to urinate, and red liquid only came out. Doctor had seen it and instructed the nurse to collect, measure and test it. During the whole night I passed 2-3 times , each time 5-10 ml at the most, and blood red in color). The insertion of the catheter and urine bag hurt, but only a bit. It was like an expert job. But the thought that this bag was attached to me was very uncomfortable. I was taken outside and I was dead tired. I longed to go to the GICU and lie down so Ramesh also can be bystander there. Instead I was taken to the Surgical ICU where DrTC came with the urologist DrKM who is a very well known expert doctor and also my friend's husband. Presently he looked at the red urine in the bag, gave some medication through the drip (I could not see what he was doing), and soon the urine became clear. ‘Don’t worry, I think she’s started producing urine’, DrKM told DrTC who looked absolutely relieved at the news and said a heartfelt ‘Thank you’. (Only later when Ramesh said I realized that DrTC was anxious that probably my kidneys failed after dehydration from the vomiting, and was thinking that in that case, I should be shifted to some multi-specialty hospital. By God’s grace, that was not needed.)

I am given the bed facing the door in SICU. There is one bed to my left and two to my right, and again a nurses’ station and a toilet. The room is nice, the nurses are quite friendly. I can see people moving outside when the curtain is not drawn, and I can see all the traffic to and from the room. There is a picture of Lord Ganesha on the wall across me and I can lie down looking at it. Doctor gave some instructions to the nurse there, and told me that I should eat egg whites and drink a lot of water. Albumin and IV fluid is constantly being injected inside. Albumin causes blood to clot in the vein, and so it needs to be constantly shifted. Getting a vein is so difficult and this is causing a lot of pain for me, but never like the one at the first time in GICU, mostly because the nurses here are more experienced. I told Ramesh about details of the tapping, and he is sitting outside and typing away.

NEXT.. Paracentesis