Ultrasound Detection of a Molar Pregnancy in the Emergency Department (original) (raw)
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Atypical presentation of molar pregnancy
BMJ case reports, 2018
The classic features of molar pregnancy are irregular vaginal bleeding, hyperemesis, enlarged uterus for gestational age and early failed pregnancy. Less common presentations include hyperthyroidism, early onset pre-eclampsia or abdominal distension due to theca lutein cysts. Here, we present a case of molar pregnancy where a woman presented to the emergency department with symptoms of acute abdomen and was treated as ruptured ectopic pregnancy. The woman underwent laparoscopy and evacuation of retained products of conception. Histological examination of uterine curettage confirmed the diagnosis of a complete hydatidiform mole. The woman was discharged home in good general condition with a plan for serial beta-human chorionic gonadotropin (beta-hCG) follow-up. Complete follow-up includes use of contraception and follow-up after beta-hCG is negative for a year.
Journal of ultrasound in medicine : official journal of the American Institute of Ultrasound in Medicine, 2016
In modern practice, the diagnosis of molar pregnancy is made at an early gestational age. The opportunity to diagnose gestational trophoblastic disease (GTD) using sonography alone occurs less frequently. The classic appearance of a "snowstorm" in the endometrial cavity and bilateral theca lutein cysts still applies to the diagnosis of second-trimester GTD. The diagnosis of first-trimester GTD requires increased clinical suspicion. If the sonographic appearance of the pregnancy is atypical, GTD should be included in the differential diagnosis. Additional nonimaging criteria such as serial quantitative β-human chorionic gonadotropin levels, pathologic examination, and p57 (cyclin-dependent kinase inhibitor 1C protein) immunostaining can accurately confirm the diagnosis of GTD.
The Obstetrician & Gynaecologist, 2008
• Molar pregnancies are rare, occurring at a rate of approximately 1 for every 700 live births. • Most cases of molar pregnancy are diagnosed in the first trimester by ultrasound or as early pregnancy losses. • The initial management is by evacuation and registration with one of the followup services, which are based in Sheffield, Dundee and at Charing Cross Hospital, London. • Approximately 15% of cases of complete moles and 0.5% of cases of partial moles require further treatment with chemotherapy: second evacuations are generally unhelpful. • The cure rate for molar pregnancies, including for those women requiring chemotherapy, is Ͼ99%. Learning objectives: • To learn about the aetiology and diagnosis of molar pregnancy. • To be aware of the initial management and importance of patient registration. • To be able to discuss the diagnosis with women, including an outline of indications and practicalities of chemotherapy. Ethical issues: • Calling the condition 'persistent trophoblast disease' rather than 'cancer' is appropriate, given the near 100% cure rate.
Prevalence of molar pregnancy (a three year retrospective study) in a tertiary care ho
2016
Hydatidiform mole is an abnormal gestation characterized by trophoblastic hyperplasia and overgrowth of placental villi. H. mole is classified as complete (CHM) and partial (PHM). The diagnosis is based on histopathology and genetic origin. In our set up, we used only histopathological diagnostic criteria. The incidence of molar pregnancy varies in different parts of the world. The malignant potential of the disease is higher in South East Asia as compared to western countries. Objective of the present study was to determine the frequency, clinical presentation and morphological features of H. mole and compare them with those of other studies. This is a 3 year retrospective descriptive case series conducted in the Department of Pathology, SKIMS Medical College, Bemina from 31 st December 2011 to 31 st December 2014. The case records of all the molar pregnancies during the study period were analysed regarding patient’s history, clinical presentation and morphological features. A to...
Cervical Partial Hydatidiform Molar Pregnancy
Gynecologic and Obstetric Investigation, 2008
Background: Cervical hydatidiform molar pregnancy is an exceedingly rare occurrence that has been reported only twice before. Case: We report a 25-year-old, G4P1D&C2 woman with a positive pregnancy test and vaginal bleeding. A cervical pregnancy with hydatidiform mole was detected on transvaginal ultrasound and color Doppler examinations. Magnetic resonance imaging was used to localize the lesion. Dilatation and curettage was performed and bleeding that was initially brisk ceased after bimanual pressure. Histopathological examination revealed a partial hydatidiform molar pregnancy. Serial β-hCG measurements showed a decline without need for adjuvant chemotherapy. Conclusion: Conservative fertility-sparing management was successful in this potentially fatal rare case.
Gestational trophoblastic tumors are a range of tumors that arise from the trophoblast in early pregnancy, after an embryo has failed to develop. The degenerated trophoblast has a vesicular appearance and has been described to resemble a " bunch of grapes ". These tumors produce large amount of beta-HCG and therefore, it is the mainstay for diagnosis of gestational trophoblastic diseases. A hydatidiform mole is an abnormal pregnancy that is characterized by trophoblastic proliferation and villous edema within the placenta [1]. There are two distinct entities of molar pregnancy: partial and complete mole. Partial moles are characterized by the presence of fetal or embryonic tissues, chorionic villi of different sizes featured by their focal trophoblastic hyperplasia and focal swelling, and marked villous scalloping [2]. However, complete moles are characterized by the absence of embryonic or fetal tissues, diffuse trophoblastic hyperplasia and hydropic swelling of villi, and marked atypia of trophoblast at the implantation site. Complete hydatidiform mole is an abnormal pregnancy that usually presents with vaginal bleeding and markedly elevated serum ß-hCG levels. However, at times excessive beta-HCG production may produce a false negative result due to a phenomenon known as the " hook effect ". We report a rare case of complete molar pregnancy who presented with an enlarged uterus and symptoms related to the compression on adjacent organs, severe anemia despite the absence of vaginal bleeding, and a relatively low serum ß-hCG level owing
A Rare Case of Large Hydatidiform Mole Mimicking a Term Pregnancy
Kathmandu University Medical Journal
Molar pregnancy is a type of abnormal pregnancy that usually presents with amenorrhea, vaginal bleeding and elevated serum ß-hCG levels. We report a rare case of complete hydatidiform mole occurring in a 46-year-old P2L2 lady who presented with a term size uterus and elevated serum ß-hCG level (> 15,00,000 per deciliter, anemia (hemoglobin: 8.1 g/dL), difficulty in breathing and minimal vaginal bleeding. During the course of her evaluation, she had profuse vaginal bleeding, she underwent suction and evacuation, but bleeding was not controlled despite measures to control it. She was given uterotonics and antifibrinolytic agents and uterine artery ligation. But was proceeded with emergency hysterectomy for uncontrolled hemorrhage. The content of suction and evacuation was vesicles with blood clots and histopathology was reported as complete hydatidiform mole. The patient received a total of 4 units of packed red blood cells. She was discharged from hospital on 5th postoperative day...
Journal of gynecology and womens health, 2017
Hydatidiform mole (HM) is a complication of pregnancy, genetically abnormal, characterized by several degrees of trophoblastic proliferation and hydropic degeneration of chorionic villi with potential for malignant transformation. The HM is classified as complete hydatidiform mole (CHM) and partial hydatiform mole (PHM). The distinction between CHM and PHM and non-molar abortions (NM) is very important since the risk for the development of postmolar gestational trophoblastic neoplasia is higher in CHM. This article is a brief review of relevant topics about genetic, histological and clinical features of molar pregnancy.