What criteria should I use to determine when to refer a patient with moderate to severe OHSS to secondary care?

Refer a patient with moderate to severe ovarian hyperstimulation syndrome (OHSS) to secondary care if they exhibit any of the following criteria: significant abdominal distension or pain, evidence of ascites, rapid weight gain, severe nausea or vomiting, reduced urine output, breathlessness, or any signs of complications such as thromboembolism or renal impairment. These symptoms indicate the need for specialist assessment and management beyond primary care.

While the provided UK guidelines do not explicitly list referral criteria for OHSS, the presence of ascites and abdominal distension are key signs warranting urgent evaluation, as highlighted in ovarian cancer guidelines for similar presentations. Additionally, the severity of symptoms and potential complications in moderate to severe OHSS necessitate secondary care involvement for monitoring and treatment.