Ultrasound in Molar Pregnancy

A Case of Molar Pregnancy in a 27-Year-Old Female: Insights and Ultrasound Findings

Introduction

Molar pregnancy, a type of gestational trophoblastic disease, is a rare but significant condition that requires prompt diagnosis and management. This blog post discusses a case of a 27-year-old female with a molar pregnancy, highlighting the clinical presentation, ultrasound findings, and management plan. The case underscores the importance of ultrasound in diagnosing and guiding the treatment of such conditions.

Case Presentation

A 27-year-old female, gravida 5 para 4+0, presented with a history of per vaginal bleeding for one day. The bleeding was spontaneous in onset, associated with mild abdominal pain radiating to the back, and no passage of vesicles. She reported not feeling fetal movements since the start of her pregnancy. Her last normal menstrual period (LNMP) was approximately 8 months ago, and she was clinically estimated to be around 35 weeks of gestation.

The patient had a history of using family planning methods and no significant past medical or surgical history. On examination, she was in fair general condition, afebrile, and had no signs of anemia, jaundice, or edema. Her vital signs were stable: blood pressure (110/89 mmHg), pulse rate (18 bpm), axillary temperature (36.6°C), and oxygen saturation (98% in room air). Abdominal examination revealed a palpable bulky uterus corresponding to approximately 20 weeks of gestation. On pelvic examination, the cervical os accommodated one finger, and a normal discharge was noted.

Ultrasound Images

Ultrasound Findings

The patient was referred for an ultrasound scan to evaluate the cause of per vaginal bleeding and the absence of fetal movements. The ultrasound findings were as follows:

• Uterine Findings:

  • A large echo-complex mass with multiple cystic areas was noted within the uterine cavity.

  • The mass measured 15.49 x 12.90 x 15.23 cm, with a calculated volume of 1593 ml.

  • No identifiable fetal parts or fetal heartbeat was detected.

• Placental Findings:

  • A formed fundo-posterior placenta with grade II maturity was observed.

• Color Doppler Evaluation:

  • Showed internal vascularity with a low impedance flow (RI=0.38)

• Adnexa and Pelvic Structures:

  • No adnexal masses or free fluid was noted in the pelvis.

Conclusion:

The ultrasound findings were consistent with a complete molar pregnancy, characterized by the absence of a viable fetus and the presence of a large cystic mass within the uterine cavity.

Management Plan

Based on the clinical presentation and ultrasound findings, the following management plan was initiated:

1. Consultation with the Gynecologist: The radiology team promptly informed the gynecologist about the findings.

2. Patient Counseling: The patient was counseled about the diagnosis, implications, and the need for immediate intervention.

3. Preparation for Dilatation and Curettage (D&C): The patient was consented and prepared for D&C to evacuate the molar tissue.

4. Follow-Up: Post-procedure, the patient was advised to undergo regular follow-up with serial beta-hCG measurements to monitor for persistent trophoblastic disease or complications.

Discussion

Molar pregnancy is a rare condition that occurs due to abnormal fertilization, leading to the proliferation of trophoblastic tissue. It is classified into complete and partial moles, with complete moles being more common and characterized by the absence of fetal tissue.

In this case, the absence of fetal movements, the large cystic mass on ultrasound, and the absence of a viable fetus were key diagnostic features. The patient’s stable vital signs and lack of severe symptoms, such as hyperemesis or preeclampsia, were reassuring but did not diminish the urgency of intervention.

Ultrasound remains the cornerstone of diagnosis, as it provides detailed imaging of the uterine contents and helps differentiate molar pregnancy from other causes of first or second-trimester bleeding. Early diagnosis and management are crucial to prevent complications such as hemorrhage, trophoblastic malignancy, or uterine perforation.

Conclusion

This case highlights the critical role of ultrasound in diagnosing molar pregnancy and guiding appropriate management. For healthcare providers, maintaining a high index of suspicion in cases of abnormal bleeding or absent fetal movements is essential. Timely intervention and follow-up can significantly improve outcomes and reduce the risk of complications.

For patients, understanding the condition and adhering to follow-up care is vital for ensuring long-term health and well-being.

References

1. American College of Obstetricians and Gynecologists (ACOG). Gestational Trophoblastic Disease.

2. Royal College of Obstetricians and Gynaecologists (RCOG). Management of Gestational Trophoblastic Disease.

3. Ultrasound in Obstetrics and Gynecology: A Practical Approach.

This blog post aims to educate healthcare professionals and patients about the importance of early diagnosis and management of molar pregnancy, emphasizing the role of ultrasound in achieving optimal outcomes.