This 40 year old woman presented with severe nausea and vomiting. She also notes pelvic discomfort and vaginal bleeding the color of "prune juice." Her heart rate is 104, blood pressure is 152/91. She has a mild tremor. Her urine dipstick shows 1+ protein. Her hCG is quite elevated. Her TSH is low.
Challenge: What is this disease, first described by Hippocrates in 400BC?
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Gestational Trophoblastic Diseases (GTD)
Vaginal bleeding: prune juice color or bright red
Anemia due to loss of blood
Hydropic vesicles may be passed vaginally by 16 weeks
Uterine size doesn't match gestational dates
Absent fetal heart tones
Elevated serum hCG levels (>1-2 million IU)
Hyperemesis gravidarum
Preeclampsia symptoms present in 1st trimester
No fetal movement detected; no fetal outline
(Avogadros) molar pregnancy?
you're right! nice review of the constellation of findings
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Avogadro
This is a complete hydatidiform mole, a premalignant disease occurring after aberrant fertilization. The majority of complete moles are 46XX, resulting from duplication of the haploid sperm genome after fertilization of an ovum in which maternal chromosomes are lost. Complete mole is associated with hyperemesis gravidarum, early development of preeclampsia, and hyperthyroidism. Sonographic features include lack of an embryo or fetus, absence of amniotic fluid, central heterogeneous mass with numerous discrete anechoic spaces (“snowstorm”), and ovarian theca lutein cysts.
Source: UpToDate.
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