R.L., 38 y.o., G5P5 (5-0-0-5) was admitted at Ospital ng Maynila today June 27, 2012 because of on and off vaginal spotting for 3 weeks. LMP- April 1, 2012 PMP- March 3, 2012. Pregnancy test was done 3 weeks ago and revealed positive result. A TVS was done and revealed a complex echogenic uterine mass with numerous cystic spaces, No fetus or amnionic sac seen. A 6 cm theca lutein cyst was seen at the left ovary.
* BP- 120/70 mmHg. PR- 75bpm RR- 18 cpm wt.- 135 ibs * HEENT, Neck, Chest, Lungs, Heart, Breast –Normal
* ABDOMEN- globularly enlarged, fundic height- 20 cms, fetal parts and fetal heart tones were not appreciated * Speculum exam- minimal to moderate bleeding
* I.E.- Cervix was soft, closed, non-tender, uterus was enlarged to 20 weeks AOG.
Working Diagnosis: G5P5(5-0-0-5) 12 wks AOG with complete h-mole
on and off vaginal spotting for 3 weeks
Positive pregnancy test
a complex echogenic uterine mass with numerous cystic spaces *
No fetus or amnionic sac seen
6 cm theca lutein cyst was seen at the left ovary
ABDOMEN- globularly enlarged, fundic height- 20 cms, fetal parts and fetal heart tones were not appreciated *
Speculum exam- minimal to moderate bleeding
I.E.- Cervix was soft, closed, non-tender, uterus was enlarged to 20 weeks AOG
Approach to Diagnosis
Gestational Trophoblastic Disease
The term gestational trophoblastic disease refers to pregnancy-related trophoblastic proliferative abnormalities. Molar pregnancy is characterized histologically by abnormalities of the chorionic villi that consist of trophoblastic proliferation and edema of villous stroma. Moles usually occupy the uterine cavity, however, occasionally they develop in the oviduct and even the ovary. The absence or presence of a fetus or embryonic elements has been used to describe them as complete and partial moles
Hydatidiform mole is more common at the extremes of reproductive age. Women in their early teenage or perimenopausal years are most at risk. Women older than 35 years have a 2-fold increase in risk. Women older than 40 years experience a 5- to 10-fold increase in risk compared to younger women.By studying elective pregnancy terminations, hydatidiform moles were determined to occur in approximately 1 in 1200 pregnancies.
In complete hydatiform mole, the chorionic villi transform into a mass of clear vesicles (Fig. 11–1). The vesicles vary in size from barely visible to a few centimeters and often hang in clusters from thin pedicles. The histological structure typically shows:
Hydropic degeneration and swelling of the villous stroma. 2.
Absence of blood vessels in the swollen villi.
Proliferation of the trophoblastic epithelium to a varying degree (Fig. 11–2). 4.
Absence of fetus and amnion.
The clinical presentation of molar pregnancy has changed appreciably during the past 20. The availability of ultrasonography and quantitative measurement of serum hCG levels now allows earlier diagnosis. Symptoms are more likely to be dramatic with a complete mole than with a partial mole.
Uterine bleeding is almost universal, and may vary from spotting to profuse hemorrhage. It may begin just before abortion or, more often, these women may bleed intermittently for weeks and even months. At times there may be considerable hemorrhage concealed within the uterus. Iron-deficiency anemia is common, and a dilutional effect from appreciable pregnancy-induced hypervolemia is present in some women with larger moles.
The growing uterus often enlarges more rapidly than usual, exceeding in about half of cases that expected from the gestational age. The uterus may be difficult to identify precisely by palpation because of its soft consistency. At times, ovarian...
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