Molar pregnancy

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

• Vaginal bleeding (75-95%)
• Hyperemesis gravidarum (26%]]
• Hypertension, preeclampsia
  • Suspect molar pregnancy when pregnancy-induced hypertension occurs at <24 weeks
• Larger than usual uterine size
• Signs/symptoms of hyperthyroidism (rarely)

Differential Diagnosis

• Vaginal bleeding
  • Ectopic Pregnancy, heterotopic pregnancy
  • First Trimester Abortion (complete, threatened, incomplete, septic, etc.)
  • Implantation bleeding
  • Fibroids
  • Cervicitis
  • Gestational trophoblastic disease
• Nausea Vomiting in Pregnancy
  • Biliary disease, hepatic disease (e.g. fatty liver of pregnancy, HELLP syndrome
  • Pancreatitis
  • Appendicitis
  • Hepatitis
  • Gastroenteritis
  • Pyelonephritis
  • Thyrotoxicosis

Evaluation

Molar pregnancy on ultrasound

• Serum hCG
• 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

• Vaginal bleeding in pregnancy (less than 20wks)
• Hyperemesis gravidarum
• Pregnancy (main)