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Diagnostic Impression

Complete

Partial

  • Ovaries appear unremarkable with small follicles.
  • A 1.4cm right ovarian cyst is appreciated likely representing a corpus luteal cyst.
  • Abnormal gestation with an intrauterine sac measuring 9 weeks 1 day.
  • A complex solid mass with a gestational sac measuring2.8c diameter is identified. This could represent a molar pregnancy but other abnormalities are not excluded.
  • Small echogenic focus versus fetal pole adjacent to the above described mass within the gestational sac measuring 7 weeks 5 days with no cardiac activity and no somatic activity.

CT

Differential Diagnoses

  • Hyperemesis Gravidarum- severe form of persistent nausea and vomiting in pregnancy
  • Hyperthyroidism
  • Hypertension
  • Malignant Hypertension- acute emergency condition where elevated blood pressure results in target organ damage
  • Spontaneous abortion with hydropic change
  • Ovarian theca lutein cysts
  • Leiomyomas (fibroids)
  • Uterine Adenomyosis
  • Endometrial carcinoma
  • Uterine sarcoma

Conclusion

20 year old female presented to the ED with pelvic pain and a possible abnormal pregnancy. Lab values were not completed by the time of the ultrasound, but beta HCG would be helpful in diagnosing. A transvaginal ultrasound was performed according to protocol and showed what appeared to be a partial molar pregnancy, (1 in 1000 pregnancies), with the fetus having no cardiac activity. The patient scheduled an exam for the following week to confirm a nonviable pregnancy. The patient then had surgery to remove the products of conception and complex mass, with samples sent to the lab. Following surgery, the patient was advised to avoid pregnancy for 6-12 months and was discharged in good health.

Partial Molar Pregnancy

Normal Placenta

Molar

Background

  • Molar Pregnancy (Hydatidiform Mole)
  • ~1 in 1000 pregnancies
  • Partial: Ovum + 2 sperm, 96 chromosomes
  • Complete: Ovum (no DNA) + sperm

Patient History

Signs, Symptoms and Treatment

  • Nausea and Vomiting
  • Hypertension
  • Swelling of lower extremities
  • Surgical Removal (D&C)
  • Hysterectomy
  • Avoid pregnancy for 6-12 months

20 year old female presents to ED on January 15 with pelvic pain and a questionable abnormal ultrasound from the doctor. OB <14 weeks was ordered stat.

  • LMP was October, 2015
  • G3P1 (1 miscarriage)

Lab Values

• Quantitative beta-HCG

• CBC w/ platelets

• Clotting Function

• LFTs

• BUN & Creatinine

• Blood Type & Rh Factor

Protocol for Transvaginal US

• Empty Bladder

• Place gel on TRDX

• Cover TRDX with probe cover

• Place Sterile gel on probe cover

• Have patient in lithotomy position

• Insert probe

• Sweep through uterus in sagittal plane

• Obtain images of uterus in 2D and Color

• Obtain images of rt & lt ovaries in 2D and Color

• Rotate probe 90 deg counterclockwise

• Sweep through uterus in transverse plane

• Obtain images of uterus with gestational sac in 2D

• Obtain Color images of uterus and gestational sac

• Measure gestational sac

• Measure fetus

• Assess fetus for cardiac activity

• Obtain image of yolk sac

• Remove probe and follow through with

proper disinfection practices

Works Cited

Berkowitz, Ross S., MD, Donald Peter Goldstein, MD, and Neil S. Horowitz, MD. "Hydatidiform Mole: Epidemiology, Clinical Features, and Diagnosis." Hydatidiform Mole: Epidemiology, Clinical Features, and Diagnosis. UpToDate, 5 Dec. 2014. Web. 18 June 2016. <http://www.uptodate.com/contents/hydatidiform-mole-epidemiology-clinical-features-and-diagnosis#H2161400003>.

"Hydatidiform Mole: MedlinePlus Medical Encyclopedia." U.S National Library of Medicine. U.S. National Library of Medicine, 7 June 2016. Web. 21 June 2016.

"Molar Pregnancy." Diseases and Conditions. Mayo Clinic, 24 Oct. 2014. Web. 18 June 2016. <http://www.mayoclinic.org/diseases-conditions/molar-pregnancy/basics/symptoms/con-20034413>.

Moore, Lisa E. "Hydatidiform Mole Differential Diagnoses." Hydatidiform Mole Differential Diagnoses. Medscape, 30 Nov. 2015. Web. 18 June 2016. <http://emedicine.medscape.com/article/254657-differential>.

"Partial Molar Pregnancy." Partial Molar Pregnancy. Cleveland Clinic, n.d. Web. 19 June 2016.

"What Is Endometrial Cancer?" What Is Endometrial Cancer? American Cancer Society, 10 Feb. 2016. Web. 18 June 2016. <http://www.cancer.org/cancer/endometrialcancer/detailedguide/endometrial-uterine-cancer-what-is-endometrial-cancer>.

"What Is Gestational Trophoblastic Disease?" What Is Gestational Trophoblastic Disease? American Cancer Society, 9 Feb. 2016. Web. 19 June 2016.

Francesca Chambers, Sarah Smither, Jenna Holmes, Lee Hammond, Taylor Daugherty, Angela Stockhauser

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