Molar pregnancy - Revision history

Rossdonaldson1: /* Evaluation */

2020-09-17T19:35:05Z

Evaluation

← Older revision		Revision as of 19:35, 17 September 2020
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	[[File:Molar pregnancy.jpg\|thumb\|Molar pregnancy on ultrasound (transvaginal)]]		[[File:Molar pregnancy.jpg\|thumb\|Molar pregnancy on ultrasound (transvaginal)]]
	[[File:Molar pregnancy 0001.jpg\|thumb\|Molar pregnancy on ultrasound (transabdominal)]]		[[File:Molar pregnancy 0001.jpg\|thumb\|Molar pregnancy on ultrasound (transabdominal)]]
			[[File:Blasenmole Computertomographie sagittal.jpg\|thumb\|Hydatidiform mole on CT, sagittal view (not study of choice)]]
	*Serum hCG > 100,000 mIU/mL suggest excessive trophoblastic growth<ref>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.</ref>		*Serum hCG > 100,000 mIU/mL suggest excessive trophoblastic growth<ref>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.</ref>
	**Normal hCG level does not exclude molar pregnancy		**Normal hCG level does not exclude molar pregnancy

Rossdonaldson1: /* Evaluation */

2020-09-17T19:33:27Z

Evaluation

← Older revision		Revision as of 19:33, 17 September 2020
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	==Evaluation==		==Evaluation==
	[[File:Molar pregnancy.jpg\|thumb\|Molar pregnancy on ultrasound (transvaginal)]]		[[File:Molar pregnancy.jpg\|thumb\|Molar pregnancy on ultrasound (transvaginal)]]
	[[File:Molar pregnancy 0001.jpg\|Molar pregnancy on ultrasound (transabdominal)]]		[[File:Molar pregnancy 0001.jpg\|thumb\|Molar pregnancy on ultrasound (transabdominal)]]
	*Serum hCG > 100,000 mIU/mL suggest excessive trophoblastic growth<ref>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.</ref>		*Serum hCG > 100,000 mIU/mL suggest excessive trophoblastic growth<ref>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.</ref>
	**Normal hCG level does not exclude molar pregnancy		**Normal hCG level does not exclude molar pregnancy

Rossdonaldson1: /* Evaluation */

2020-09-17T19:33:12Z

Evaluation

← Older revision		Revision as of 19:33, 17 September 2020
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	==Evaluation==		==Evaluation==
	[[File:Molar pregnancy.jpg\|thumb\|Molar pregnancy on ultrasound]]		[[File:Molar pregnancy.jpg\|thumb\|Molar pregnancy on ultrasound (transvaginal)]]
			[[File:Molar pregnancy 0001.jpg\|Molar pregnancy on ultrasound (transabdominal)]]
	*Serum hCG > 100,000 mIU/mL suggest excessive trophoblastic growth<ref>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.</ref>		*Serum hCG > 100,000 mIU/mL suggest excessive trophoblastic growth<ref>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.</ref>
	**Normal hCG level does not exclude molar pregnancy		**Normal hCG level does not exclude molar pregnancy

Athorne: /* Clinical Features */

2020-09-17T16:48:15Z

Clinical Features

← Older revision		Revision as of 16:48, 17 September 2020
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	*[[Vaginal bleeding in pregnancy (less than 20wks)\|Vaginal bleeding]] (75-95%)		*[[Vaginal bleeding in pregnancy (less than 20wks)\|Vaginal bleeding]] (75-95%)
	*[[Hyperemesis gravidarum]] (10-25%)		*[[Hyperemesis gravidarum]] (10-25%)
	*[[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 (25%)		*Larger than usual uterine size (25%)
	*Signs/symptoms of [[hyperthyroidism]] (rarely)
	*[[Vaginal discharge]] of grape-like vesicles (10%)		*[[Vaginal discharge]] of grape-like vesicles (10%)
	*[[Hyperthyroidism]] (5%)		*[[Hyperthyroidism]] (5%)

ClaireLewis at 01:41, 4 October 2019

2019-10-04T01:41:05Z

← Older revision		Revision as of 01:41, 4 October 2019
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	*Larger than usual uterine size (25%)		*Larger than usual uterine size (25%)
	*Signs/symptoms of [[hyperthyroidism]] (rarely)		*Signs/symptoms of [[hyperthyroidism]] (rarely)
	*Vaginal discharge of grape-like vesicles (10%)		*[[Vaginal discharge]] of grape-like vesicles (10%)
	*[[Hyperthyroidism]] (5%)		*[[Hyperthyroidism]] (5%)
	*Early [[preeclampsia]] (5%)		*Early [[preeclampsia]] (5%)

	==Differential Diagnosis==		==Differential Diagnosis==
	*Vaginal bleeding		*[[Vaginal bleeding]]
	**[[Ectopic Pregnancy]], heterotopic pregnancy		**[[Ectopic Pregnancy]], heterotopic pregnancy
	**[[First Trimester Abortion]] (complete, threatened, incomplete, septic, etc.)		**[[First Trimester Abortion]] (complete, threatened, incomplete, septic, etc.)
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	**CBC		**CBC
	**BUN/Cr/Electrolytes		**BUN/Cr/Electrolytes
	**LFTs		**[[LFTs]]
	**~~TFTs~~		**Thyroid function tests
	*Consider CXR or CT chest if there is suspicion of pulmonary metastases<ref>Initial management of hydatidiform mole. Schlaerth JB, Morrow CP, Montz FJ, d'Ablaing G. Am J Obstet Gynecol. 1988 Jun; 158(6 Pt 1):1299-306.</ref>		*Consider [[CXR]] or CT chest if there is suspicion of pulmonary metastases<ref>Initial management of hydatidiform mole. Schlaerth JB, Morrow CP, Montz FJ, d'Ablaing G. Am J Obstet Gynecol. 1988 Jun; 158(6 Pt 1):1299-306.</ref>
	*~~Ultrasound~~		*[[Pelvic ultrasound]]
	**Complete mole - enlarged uterus with interspersed lucent and brighter areas ("snowstorm" appearance)		**Complete mole - enlarged uterus with interspersed lucent and brighter areas ("snowstorm" appearance)
	**Before 12 weeks, may show a fine vascular or honeycomb appearance		**Before 12 weeks, may show a fine vascular or honeycomb appearance
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	*Resuscitate if severe bleeding		*Resuscitate if severe bleeding
	*Treat [[preeclampsia]]		*Treat [[preeclampsia]]
	*Symptomatic ~~resuscitation~~ of nausea/vomiting		*Symptomatic treatment of [[nausea/vomiting]]

	==Disposition==		==Disposition==

Kxl328: /* Background */

2018-10-07T23:10:36Z

Background

← Older revision		Revision as of 23:10, 7 October 2018
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	*''Non-viable'' fertilized egg implants in uterine wall		*''Non-viable'' fertilized egg implants in uterine wall
	**Complete: all chorionic villi are vesicular, swollen, with no embryonic development		**Complete: all chorionic villi are vesicular, swollen, with no embryonic development
			***46, XX karyotype
	**Partial: some vesicular chorionic villi, +/- (nonviable) embryonic development		**Partial: some vesicular chorionic villi, +/- (nonviable) embryonic development
			***69, XXX or 69, XXY

	==Clinical Features==		==Clinical Features==

Kxl328: /* Evaluation */

2017-11-21T11:20:58Z

Evaluation

← Older revision		Revision as of 11:20, 21 November 2017
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	**Before 12 weeks, may show a fine vascular or honeycomb appearance		**Before 12 weeks, may show a fine vascular or honeycomb appearance
	**Ovaries may contain multiple large theca-lutein cysts due to excessive beta-hCG		**Ovaries may contain multiple large theca-lutein cysts due to excessive beta-hCG
	**Partial mole - more difficult to diagnose, with the fetus ~~may still~~ being viable		**Partial mole - more difficult to diagnose, with the fetus possibly being viable
	***Scattered cystic spaces within placenta		***Scattered cystic spaces within placenta
	***Ovarian cystic changes less pronounced than in complete mole		***Ovarian cystic changes less pronounced than in complete mole

Kxl328: /* Evaluation */

2017-11-21T11:20:35Z

Evaluation

@@ Line 36: / Line 36: @@
 **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)
+*Other serum lab workup
 ==Management==

Kxl328: /* Clinical Features */

2017-11-21T11:15:05Z

Clinical Features

← Older revision		Revision as of 11:15, 21 November 2017
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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]] (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==

Kxl328: /* Evaluation */

2017-11-21T11:12:56Z

Evaluation

← Older revision		Revision as of 11:12, 21 November 2017
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	==Evaluation==		==Evaluation==
	[[File:Molar pregnancy.jpg\|thumb\|Molar pregnancy on ultrasound]]		[[File:Molar pregnancy.jpg\|thumb\|Molar pregnancy on ultrasound]]
	*Serum hCG		*Serum hCG > 100,000 mIU/mL suggest excessive trophoblastic growth<ref>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.</ref>
			**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]]		*Evaluate for other causes of or electrolyte derangements due to [[vomiting]]
	*Ultrasound: enlarged uterus with interspersed lucent and brighter areas ("snowstorm" appearance)		*Ultrasound: enlarged uterus with interspersed lucent and brighter areas ("snowstorm" appearance)