Molar pregnancy: Difference between revisions
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==Clinical Features== | ==Clinical Features== | ||
Due primarily to elevated levels of hCG | Due primarily to elevated levels of hCG<ref>Cavaliere A et al. Management of molar pregnancy. J Prenat Med. 2009 Jan-Mar; 3(1): 15–17.</ref> | ||
*[[Vaginal bleeding in pregnancy (less than 20wks)|Vaginal bleeding]] (75-95%) | *[[Vaginal bleeding in pregnancy (less than 20wks)|Vaginal bleeding]] (75-95%) | ||
*[[Hyperemesis gravidarum]] ( | *[[Hyperemesis gravidarum]] (10-25%) | ||
*[[Hypertension]], [[preeclampsia]] | *[[Hypertension]], [[preeclampsia]] | ||
**Suspect molar pregnancy when pregnancy-induced hypertension occurs at <24 weeks | **Suspect molar pregnancy when pregnancy-induced hypertension occurs at <24 weeks | ||
*Larger than usual uterine size | *Larger than usual uterine size (25%) | ||
*Signs/symptoms of [[hyperthyroidism]] (rarely) | *Signs/symptoms of [[hyperthyroidism]] (rarely) | ||
*Vaginal discharge of grape-like vesicles (10%) | |||
*[[Hyperthyroidism]] (5%) | |||
*Early [[preeclampsia]] (5%) | |||
==Differential Diagnosis== | ==Differential Diagnosis== | ||
Revision as of 11:15, 21 November 2017
Background
- Type of gestational trophoblastic disease
- Neoplasm of placental hCG-producing trophoblast cells
- Non-invasive (invasive form is choriocarcinoma, can metastasize to brain, liver, lung)
- Non-viable fertilized egg implants in uterine wall
- Complete: all chorionic villi are vesicular, swollen, with no embryonic development
- Partial: some vesicular chorionic villi, +/- (nonviable) embryonic development
Clinical Features
Due primarily to elevated levels of hCG[1]
- Vaginal bleeding (75-95%)
- Hyperemesis gravidarum (10-25%)
- Hypertension, preeclampsia
- Suspect molar pregnancy when pregnancy-induced hypertension occurs at <24 weeks
- Larger than usual uterine size (25%)
- Signs/symptoms of hyperthyroidism (rarely)
- Vaginal discharge of grape-like vesicles (10%)
- Hyperthyroidism (5%)
- Early preeclampsia (5%)
Differential Diagnosis
- Vaginal bleeding
- Ectopic Pregnancy, heterotopic pregnancy
- First Trimester Abortion (complete, threatened, incomplete, septic, etc.)
- Implantation bleeding
- Fibroids
- Cervicitis
- Gestational trophoblastic disease
Nausea and vomiting in pregnancy
- Hyperemesis gravidarum
- Gastroenteritis
- Biliary disease
- Ectopic pregnancy
- Gastroenteritis
- Pancreatitis
- Appendicitis
- Hepatitis
- Peptic ulcer disease
- Pyelonephritis
- Acute fatty liver of pregnancy
- HELLP syndrome
- Gestational trophoblastic disease (may present with intractable vomiting)
- Thyrotoxicosis (may present with intractable vomiting)
Evaluation
- Serum hCG > 100,000 mIU/mL suggest excessive trophoblastic growth[2]
- Normal hCG level does not exclude molar pregnancy
- Partial molar pregnancies are more likely to produce lower hCG levels
- Evaluate for other causes of or electrolyte derangements due to vomiting
- Ultrasound: enlarged uterus with interspersed lucent and brighter areas ("snowstorm" appearance)
Management
- Ob/gyn consult
- Suction curettage as inpatient (due to risk of bleeding)
- Resuscitate if severe bleeding
- Treat preeclampsia
- Symptomatic resuscitation of nausea/vomiting
Disposition
- Admit
See Also
External Links
References
- ↑ Cavaliere A et al. Management of molar pregnancy. J Prenat Med. 2009 Jan-Mar; 3(1): 15–17.
- ↑ Diagnosis and treatment of gestational trophoblastic disease: ACOG Practice Bulletin No. 53. Soper JT, Mutch DG, Schink JC, American College of Obstetricians and Gynecologists. Gynecol Oncol. 2004 Jun; 93(3):575-85.