December 31, 2024

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

By Med-Challenger · 2 minute read

A 20-year-old gravida 1, para 0 presents at 10 weeks gestation for her initial prenatal appointment. Her pregnancy dating is by certain last menstrual period. On physical examination, no fetal heart tones are audible, and the uterus is larger than expected by clinical dating. She reports having nausea and vomiting for the last few weeks and a small amount of vaginal bleeding. Her serum quantitative beta human chorionic gonadotropin (hCG) level is above 100,000 mIU/mL.

Ultrasonography findings reveal a vesicular pattern secondary to diffuse hydropic swelling and no fetus. Based on these results, you diagnose complete molar pregnancy and decide to proceed with suction curettage in the operating room.

Which of the following correctly describes the recommended preoperative evaluation studies that are appropriate for this patient in the first trimester of pregnancy?

Clotting functions, chest computed tomography (CT), blood type with antibody screen, renal and liver functions
Complete blood count, chest x-ray, thyroid studies, blood type with antibody screen, urine hCG
Complete blood count, blood type with antibody screen
Serial beta hCG levels, complete blood count, blood type with antibody screen, chest x-ray

The correct answer is:

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.

This question appears in Med-Challenger OBGYN Exam Review with CME

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