20-year-old gravida 1, para 0 presents at 10 weeks gestation for her initial prenatal appointment

Complete blood count, blood type with antibody screen

Educational Objective:

Discuss the preoperative evaluation of a patient with a complete hydatidiform mole.

Key Point:

The preoperative diagnostic studies appropriate for patients with hydatidiform mole depend upon whether the diagnosis is made in the first or the second trimester of pregnancy.

Explanation:

For patients in whom hydatidiform moles are suspected before evacuation, the following tests are recommended by ACOG: complete blood count with platelets, clotting function studies, renal and liver function studies, blood type with antibody screen, serum quantitative hCG level, and pre-evacuation chest x-ray. In the case described, the serum hCG level is already known to be above 100,000 mIU/mL. Serial beta hCG levels would be indicated after the evacuation to monitor the patient for the development of gestational trophoblastic neoplasia. Chest CT is not part of the pre-evacuation workup but would be indicated if metastatic gestational trophoblastic neoplasia is suspected. Other experts recommend pre-evacuation thyroid studies. In the second semester, liver, renal function, and thyroid studies would be added.

References:

Committee on Practice Bulletins-Gynecology, American College of Obstetricians and Gynecologists. ACOG practice bulletin no. 53. Diagnosis and treatment of gestational trophoblastic disease. Obstet Gynecol. 2004;103(6):1365-1377.

Goff B. Gestational trophoblastic disease: management of hydatidiform mole. http://www.uptodate.com/contents/gestational-trophoblastic-disease-management-of-hydatidiform-mole

Link to Hydatiform mole: epidemiology, clinical features and diagnosis (https://www.uptodate.com/contents/hydatidiform-mole-epidemiology-clinical-features-and-diagnosis?topicRef=3194&source=see_link. Accessed January 24, 2013.