Molar pregnancy: Difference between revisions

Line 8: Line 8:


==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]] (26%)
*[[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]

Differential Diagnosis

Nausea and vomiting in pregnancy

Evaluation

Molar pregnancy on ultrasound
  • 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

  1. Cavaliere A et al. Management of molar pregnancy. J Prenat Med. 2009 Jan-Mar; 3(1): 15–17.
  2. 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.