A Case of a Patient with Hydatidiform Mole
The Case
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.
P.E. * 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
Working Diagnosis: G5P5(5-0-0-5) 12 wks AOG with complete h-mole
Salient Features: * on and off vaginal spotting for 3 weeks * Positive pregnancy test * Transvaginal Sonography * 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 * PE * 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
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.
P.E. * 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
Working Diagnosis: G5P5(5-0-0-5) 12 wks AOG with complete h-mole
Salient Features: * on and off vaginal spotting for 3 weeks * Positive pregnancy test * Transvaginal Sonography * 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 * PE * 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