DrVirgo
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19. A 23-year-old woman, gravida 2, para 0, has had vaginal spotting and abdominal cramps for 2 days. Her last menstrual period was 8 weeks ago. A home pregnancy test was positive 2 weeks ago. She underwent a salpingectomy4 years ago following an ectopic pregnancy. Examination shows a closed cervix, an enlarged uterus, and no adnexal masses. Transvaginal ultrasonography shows an empty uterus. Serum 3-hCG level is 8000 mIU1mL.
O A)Abortion of a blighted twin
O B)Cervicitis
O C)Ectopic pregnancy
O D)Focal decidual necrosis
O E) Gestational trophoblastic disease
0 F) Incomplete abortion
0 G) Ovarian torsion
0 H) Ruptured ovarian cyst
0 I) Threatened abortion
Closed cervix, enlarged uterus (U/S shows its EMPTY), no adnexal mass.
bHCG is 8000! She had a salpingectomy previously.
Could it be C. Ectopic (on the other tube)
OR E. GTD –can also have high BHCG (but if this was the case, would U/S show it? –here the US is showing uterus empty)
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| Aashi
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C)Ectopic pregnancy
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| DrVirgo
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How can you rule out GTD? is it because of the empty uterus?
In case of GTD, the U/S would show it I guess, correct?
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| Tuscani
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CCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCCC!!!
well i guess that if it was GTD the US would show intrauterine tissue and the px would have also trophoblastic tissue coming out of the vagina....
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| Pioglitazone
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ectopic? where? on the other tube? but then USG shows no adenxal mass! How about the enlarged uterus?
could it be a gestational choriocarcinoma?
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| yukti_5
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Answer anyone ?
I think its GTD .
Absence of fetal tissue is possible in incomplete mole. No adnexal mass and enlarged uterus rules out ectopic.
The presentation of Incomplete mole can be with a large uterus and first trimester bleed.
:no eople .. comments ??
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| yukti_5
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i mean ... 
comments ??
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| gpatama
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I would like to discuss ectopic pregnancy V/S GTD
Ectopic pregnancy by definition is any implantation outside uterus.
It's remarkable that at betahCG level above 1500 transvaginal US should detect intrauterine conceptus (incule mole tissue).
since TVS adnexa mass finding about 60% ,it could not use to R/O ectopic pregnancy.
from : http://www.medscape.com/viewarticle/568521_4
in addition..
normal hCG level of GA 6-8 wk should be about 50,000 miu/ml
--ectopic preg ussually produce lower while GTD should be produce higher than normal.
Edited by gpatama on 10/24/08 - 03:43 AM
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| Tiff
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U/S is whats used to diagnose molar pregancies. In this case shows empty uterus. Ectopic pregnancies means pregnancy outside uterus. Doesn't mean that it always has to be in the adnexa which is why exam shows no adnexal masses.
So I go with C - ectopic pregnancy
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