OBG - Molar Pregnancy

Question 1

Clinical settings in which you should consider a molar pregnancy?

Answer 1

• Continuous or intermittent bloody discharge by about 12 weeks, not copious, often more brown than red
• Uterine enlargement out of proportion to duration of pregnancy (~50% of cases)
• No fetal parts or heart sounds even though uterus may be enlarged at/above umbilicus
• Serum hCG levels higher than expected for stage
• Preeclampsia/eclampsia before 24 weeks
• Hyperemesis gravidarum
• Thyrotoxicosis
• Embolization (trophoblast can embolize)
• Hydatid vesicles that resemble grapes passed before the mole is passed
• Spontaneous expulsion usually at 16 weeks, rare beyond 28 weeks

Question 2

What is a pathognomonic finding of molar pregnancy?

Answer 2

Preeclampsia/eclampsia

Question 3

Imaging modalities useful for evaluating molar pregnancy?

Answer 3

U/S (characteristic appearance - seen in <2/3 of cases); improved accuracy if combined with serum beta-hCG

Question 4

What structures can occasionally appear similar to a mole on U/S?

Answer 4

Intrauterine myoma

Pregnancies with multiple fetuses

Question 5

Imagin findings of molar pregnancy (complete hydatiform mole)?

Answer 5

Uterine cavity filled with multiple sonoluscent areas of varying size and shape (snowstorm pattern)
No embryonic or fetal structure
No amniotic fluid
Theca lutein cysts (bilateral multilocular ovarian cysts >6 cm in diameter)

Question 6

True or false - it is possible to have a twin/triplet CHM with a normal fetus in a normal placenta coexisting.

Answer 6

True (also possible for partial)

Question 7

Imagin findings of molar pregnancy (partial hydatiform mole)?

Answer 7

Enlarged placenta containing multi-cystic, avascular, sonoluscent spaces, “swiss cheese” appearance
Fetal or embryonic tissue is present, may be viable, is often growth restricted
Amniotic fluid present but reduced
Theca lutein cysts absent