Summary
Definition
History and exam
Key diagnostic factors
- first trimester of pregnancy
- missed period
- vaginal bleeding
- unusually large uterus for gestational age
Other diagnostic factors
- headache and photophobia
- shortness of breath and respiratory distress
- severe nausea and emesis
- tachycardia, tremor, insomnia, and diarrhea
- hypertension
- pallor
- pelvic pain
- uterine bleeding
- peripheral edema
Risk factors
- extremes of maternal age
- prior gestational trophoblastic disease (GTD)
- blood group A, B, AB
- tobacco use
- diminished dietary fat and carotene
Diagnostic investigations
1st investigations to order
- serum beta human chorionic gonadotropin (hCG)
- CBC
- serum PT, PTT
- serum metabolic panel
- serum thyroid-stimulating hormone (TSH)
- blood type with antibody screen
- pelvic ultrasound
- CXR
- histologic exam of placental tissue
Treatment algorithm
singleton molar pregnancy: desiring fertility
singleton molar pregnancy: not desiring fertility
viable twin fetus: elective termination not desired
viable twin fetus: elective termination
following initial management: high risk of gestational trophoblastic neoplasia with completed follow up unlikely
Contributors
Authors
John Soper, MD
Professor
Department of Obstetrics and Gynecology
University of North Carolina
Chapel Hill
NC
Disclosures
JS is an author of references cited in this topic.
Emma Rossi, MD
Assistant Professor
Department of Obstetrics and Gynecology
University of North Carolina
Chapel Hill
NC
Disclosures
ER declares that she has no competing interests.
Peer reviewers
Jane Stewart, PhD, MSc
Consultant Gynecologist
Subspecialist in Reproductive Medicine
Newcastle Fertility Centre at Life
Bioscience Centre
International Centre at Life
Newcastle upon Tyne
UK
Disclosures
JS declares that she has no competing interests.
Philip Savage, PhD, FRCP
Consultant in Medical Oncology
Department of Medical Oncology
Charing Cross Hospital
London
UK
Disclosures
PS declares that he has no competing interests.
Aparna Sundaram, DO, MBA, MPH
Physician Consultant
Preventive Medicine
Private Practice
Atlanta
GA
Disclosures
AS declares that she has no competing interests.
Differentials
- Spontaneous abortion
- Multiple gestation
- Pelvic tumor
More DifferentialsGuidelines
- Ultrasound in pregnancy
- Diagnosis and treatment of gestational trophoblastic disease
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