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Vaginal Bleeding

History:

A 42-year-old female who is G2 P1 and approximately 6 weeks pregnant is sent from clinic to the ED for 1 week of vaginal spotting  and 4 weeks of left-sided pelvic pain. She denies any fever, dysuria, or other complaints.

Exam:

Vitals are normal.  There is mild suprapubic tenderness

Initial Concerns:

  • Ectopic
  • Threatened abortion

Testing:

  • CBC normal
  • Beta HCG = ~270,000 (see normal values around 6 weeks below)
  • See ultrasound image below

Questions:

  1. What does the image show? 
  2. What additional concerns should it raise?

molar-pregnancy

Normal hCG levels by week:

  • 4 weeks: 5 – 426
  • 5 weeks: 18 – 7,340
  • 6 weeks: 1,080 – 56,500
  • 7 – 8 weeks: 7, 650 – 229,000
  • 9 – 12 weeks: 25,700 – 288,000 (PEAK)
  • 13 – 16 weeks: 13,300 – 254,000

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ANSWERS:

  1. What does the image show? A molar pregnancy
  2. What additional concerns should it raise?  A molar pregnancy

 

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Case Conclusion: The patient was admitted for a D&C.  Pathology showed placental villi with cystic changes and atypical trophoblasts c/w a complete hydatidiform mole

 

 

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