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Case 5 - A 20-Year-Old with a Molar Pregnancy at 8 Weeks

from Section 1 - Antepartum (Early Pregnancy)

Published online by Cambridge University Press:  08 April 2025

Peter F. Schnatz
Affiliation:
The Reading Hospital, Pennsylvania
D. Yvette LaCoursiere
Affiliation:
University of California, San Diego
Christopher M. Morosky
Affiliation:
University of Connecticut School of Medicine
Jonathan Schaffir
Affiliation:
The Ohio State University College of Medicine
Vanessa Torbenson
Affiliation:
Mayo Clinic Alix School of Medicine
David Chelmow
Affiliation:
Virginia Commonwealth School of Medicine
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Summary

Molar pregnancies, characterized by abnormal placental tissue growth, are rare but clinically significant conditions. Advancements in ultrasound and hCG assays have transformed the diagnosis of molar pregnancies. Maintaining a high index of suspicion is important for proper diagnosis, especially in cases of first-trimester vaginal bleeding. Certain clinical and laboratory features help distinguish between complete and partial molar pregnancies, including subtle sonographic findings and hCG levels. Histologic confirmation remains essential. The primary therapeutic approach for molar pregnancies is suction dilation and curettage, often with ultrasound guidance. Rhogam administration is important for Rhesus-negative patients, and uterotonics and blood products should be made immediately available during evacuation procedures. Hysterectomy is considered for presumed complete molar pregnancies in patients who have completed childbearing. Postoperative surveillance of serum hCG levels is critical for detecting postmolar gestational trophoblastic neoplasia. This case outlines diagnostic criteria for postmolar GTN, including hCG trends and potential complications. It also emphasizes the importance of contraception for accurate postoperative monitoring. Despite an increased risk of recurrence with a history of molar pregnancy, subsequent normal pregnancies are common following treatment. Early first-trimester ultrasounds and post-pregnancy hCG assessments are recommended for favorable outcomes in future pregnancies.

Type
Chapter
Information
Pregnancy Complications
A Case-Based Approach
, pp. 13 - 15
Publisher: Cambridge University Press
Print publication year: 2025

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References

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