Ultrasound of a Molar Pregnancy

Ultrasound Case Study: Molar Pregnancy in a 27-Year-Old Female

Patient Presentation:

A 27-year-old female, Gravida 5 Para 4+0 at approximately 35 weeks of amenorrhea, presented to the Radiology Department for an ultrasound evaluation due to per vaginal bleeding lasting one day. The bleeding was spontaneous in onset, accompanied by mild abdominal pain radiating to the back. She denied the passage of vesicles and reported an absence of fetal movements since the beginning of the pregnancy. Her past gynecologic history included the use of family planning methods.

Clinical Examination:

• General Condition: Fair, afebrile, with no signs of anemia, jaundice, or edema.

• Vital Signs:

  • Blood Pressure: 110/89 mmHg

  • Pulse Rate: 18 bpm

  • Axillary Temperature: 36.6°C

  • SpO2: 98% on room air

• Abdominal Examination: Palpable bulky abdomen corresponding to approximately 20 weeks' gestation.

• Pelvic Examination: Cervical os accommodated one finger, normal vaginal discharge, normal urine output, and

• Stable mental status.

Ultrasound Images:

Ultrasound Findings:

• The uterus contained an echo-complex mass with multiple cystic areas, measuring 15.49 x 12.90 x 15.23 cm, with an estimated volume of 1593 mL.

• No identifiable fetal pole or cardiac activity was noted.

• Color Doppler evaluation showed internal vascularity with a low impedance flow (RI=0.38)

• The placenta was formed in the fundo-posterior region, showing Grade II maturity.

• No free fluid or adnexal masses were observed.

Ultrasound Report:

Patient Name: [Redacted]

Age: 27 years

Gravidity & Parity: G5P4+0

Last Normal Menstrual Period (LNMP): 8 months ago

Indication: Per vaginal bleeding, absent fetal movements

Findings:

• Uterus is bulky, harboring an echo-complex intrauterine mass with numerous cystic spaces, consistent with a hydatidiform mole.

• No fetal parts or cardiac activity detected.

• A formed fundo-posterior placenta with Grade II maturity noted.

• No significant adnexal pathology or free fluid in the pelvis.

Conclusion:

• Findings are highly suggestive of Molar Pregnancy (Hydatidiform Mole).

• Recommend urgent referral to Gynecology for further evaluation and management.

Management Plan:

1. Immediate Gynecologic Consultation: The case was reported to the attending gynecologist for urgent review.

2. Patient Counseling and Consent: The patient was counseled regarding the findings and the need for surgical intervention.

3. Preparation for Uterine Evacuation: The patient was prepped for dilation and curettage (D&C).

4. Post-Evacuation Monitoring and Follow-Up: Serial beta-hCG monitoring recommended to track resolution and rule out persistent trophoblastic disease.

5. Histopathological Examination: The removed tissue was planned for histopathological analysis to confirm the diagnosis and exclude gestational trophoblastic neoplasia (GTN).

6. Contraceptive Counseling and Follow-Up: Long-term follow-up was emphasized, including contraceptive planning and future pregnancy counseling.

Discussion:

Molar pregnancy is a gestational trophoblastic disease characterized by abnormal proliferation of placental trophoblasts. Ultrasound plays a crucial role in diagnosing this condition, often revealing a characteristic 'snowstorm' appearance with numerous cystic spaces. Prompt diagnosis and management are essential to prevent complications such as persistent gestational trophoblastic neoplasia (GTN), which may necessitate chemotherapy.

In this case, the absence of fetal movements, significantly enlarged uterus, and classic ultrasound findings led to a timely diagnosis and subsequent management.

Key Takeaways for Sonographers:

• Recognizing the classic ultrasound features of a molar pregnancy, such as a heterogeneous intrauterine mass with cystic spaces, is crucial.

• Early detection and timely referral improve patient outcomes and help prevent complications.

• Comprehensive patient counseling is essential to prepare for management and long-term follow-up.

Conclusion:

This case highlights the importance of ultrasound in diagnosing molar pregnancy. The timely identification of an echo-complex mass with cystic changes facilitated appropriate gynecologic intervention, ensuring optimal patient care. As sonographers, recognizing and promptly reporting such critical findings can significantly impact maternal health outcomes.