A 34-Week Size Uterus with a Complete Hydatidiform Mole: Hook Effect and Severe Anemia with No Vaginal Bleeding

Complete hydatidiform mole is an abnormal pregnancy that usually presents with vaginal bleeding and markedly elevated serum ß-hCG levels. We report a rare case of complete hydatidiform mole occurring in a 16-year-old nulligravid who presented with a 34-week size uterus and a relatively low serum ß-hCG level (722 IU/L)—likely related to the “hook effect”—and severe anemia (hemoglobin: 6.1 g/dL) despite the absence of vaginal bleeding. She also reported right flank pain and was diagnosed with moderate right hydronephrosis owing to the compression exerted by the enlarged uterus on the right ureter. The patient received a total of 6 units of packed red blood cells and was managed by dilation and evacuation followed by serial monitoring of serum ß-hCG levels. Therefore, complete mole can present with symptoms related to an enlarged uterus and severe anemia before the occurrence of vaginal bleeding. It is also important to note that a negative urine pregnancy test or relatively low serum ß-hCG level should prompt repeating the measurement on diluted sample to prevent the “hook effect.”

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Trend of Complete Hydatidiform Mole

Journal of Nepal Medical Association ◽

10.31729/jnma.123 ◽

2010 ◽

Vol 49 (177) ◽

Author(s):

K Thapa ◽

M Shrestha ◽

S Sharma ◽

S Pandey

Keyword(s):

Medical Records ◽

Vaginal Bleeding ◽

Clinical Presentation ◽

Hydatidiform Mole ◽

Abdominal Hysterectomy ◽

Gestational Trophoblastic Disease ◽

Complete Hydatidiform Mole ◽

Younger Women ◽

Main Complaint ◽

Complete Mole

INTRODUCTION: Complete Hydatidiform mole is one of the most frequent abnormal pregnancies. This review studies the trend of complete mole in Paropakar Maternity and Women's hospital and clinical ability to detect it. METHODS: This is a retrospective study of 504 cases of complete hydatidiform mole recorded at Paropakar maternity and women's hospital, Kathmandu, during 2058-2065 B.S. Medical records were reviewed and incidence, clinical presentation and method of diagnosis were studied. RESULTS: During the study period, there were 13,9117 births and 504 complete moles, 12 partial moles, 48 persistent gestational tumours, six choriocarcinoma and four invasive moles recorded in the hospital. The incidence of complete mole was one per 276 births. It was prevalent among women younger than 29 years (80%) and among the primigravidae (36.7%). More than 90% women presented in the first half of their pregnancy and vaginal bleeding was the main complaint (68.3%). Suction evacuation, dilation and evacuation followed by sharp curettage and abdominal hysterectomy were performed in 80.6%, 17.6% and 1.2% of the women respectively. Persistent mole and choriocarcinoma developed in 9.5% and 0.4% respectively. CONCLUSIONS: Complete mole has the highest incidence. It affects mostly younger women and presents with vaginal bleeding most of the time, usually in the first half of their pregnancy. Keywords: complete hydatidiform mole, gestational trophoblastic disease, persistent gestational tumours.

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Haemorrhage in early pregnancy: unusual presentation of placenta increta as complete mole

International Journal of Reproduction Contraception Obstetrics and Gynecology ◽

10.18203/2320-1770.ijrcog20174477 ◽

2017 ◽

Vol 6 (10) ◽

pp. 4734

Author(s):

Priyanka B. Varwatte ◽

Michelle Fonseca ◽

Deepali Kharat ◽

Jyotsna Dwivedi

Keyword(s):

Early Pregnancy ◽

Hydatidiform Mole ◽

Rare Event ◽

Unusual Presentation ◽

Placenta Increta ◽

Complete Hydatidiform Mole ◽

Morbidly Adherent Placenta ◽

Adherent Placenta ◽

Complete Mole

We report a case of haemorrhage in early pregnancy following suction evacuation for a complete hydatidiform mole which later turned out to be case of placenta increta. Morbidly adherent placenta in early pregnancy a is rare event. There are few reported cases of obstetric hysterectomy in early pregnancy due to undiagnosed morbidly adherent placenta.

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Clinicopathological study of Gestational Trophoblastic Disease

International Journal of Research in Pharmaceutical Sciences ◽

10.26452/ijrps.v11ispl4.4467 ◽

2020 ◽

Vol 11 (SPL4) ◽

pp. 2344-2349

Author(s):

Ramesh M. Oswal ◽

Mahendra A. Patil ◽

Sujata M. Kumbhar ◽

Jyoti S. Tele ◽

Atul B. Hulwan

Keyword(s):

Risk Factors ◽

Maternal Age ◽

Hydatidiform Mole ◽

Gestational Trophoblastic Disease ◽

Histopathological Study ◽

Molar Pregnancy ◽

Complete Hydatidiform Mole ◽

Trophoblastic Disease ◽

Complete Mole ◽

Clinicopathological Study

Several potential etiologic risk factors have been evaluated for the development of complete hydatidiform mole. The two established risk factors that have emerged are extremes of maternal age and prior molar pregnancy. Advanced or very young maternal age has consistently correlated with higher rates of complete hydatidiform mole. Compared to women aged 21- 35 years, the risk of a complete mole is 1.9 times higher for women both more than 35 years and less than 21 years as well as 7.5 times higher for women more than 40 years. (49, 50) The risk of repeat molar pregnancy after 1 mole is about 1% or about 10-20 times the risk for the general population. The present study on the gestational trophoblastic disease (GTD) was carried out as it is one of the fascinating gynaecological tumours. Hence a clinicopathological study of gestational trophoblastic disease was undertaken with relevance to the histopathological study of GTD and clinical correlation.

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Falsely Low Serum hCG Level in a Patient With Hydatidiform Mole Caused by the “High-Dose Hook Effect”

Laboratory Medicine ◽

10.1309/6mgr-qnqd-e8hp-5mgb ◽

2000 ◽

Vol 31 (8) ◽

pp. 431-435 ◽

Cited By ~ 3

Author(s):

Alice Yoo ◽

Joseph Zaccaro

Keyword(s):

Hydatidiform Mole ◽

High Dose ◽

Hook Effect ◽

Low Serum

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Ovarian hyperstimulation syndrome following surgical removal of a complete hydatidiform mole: a case report

Journal of Medical Case Reports ◽

10.1186/s13256-019-2181-x ◽

2019 ◽

Vol 13 (1) ◽

Author(s):

Hiroaki Tsubokura ◽

Yohei Ikoma ◽

Takuya Yokoe ◽

Tomoo Yoshimura ◽

Katsuhiko Yasuda

Keyword(s):

Ovarian Cyst ◽

Ovarian Hyperstimulation Syndrome ◽

Histopathological Examination ◽

Hydatidiform Mole ◽

Ovarian Cysts ◽

Surgical Removal ◽

Ovarian Hyperstimulation ◽

Complete Hydatidiform Mole ◽

Multilocular Cyst ◽

The Right

Abstract Background Generally, ovarian hyperstimulation syndrome develops after superovulation caused by ovulation-inducing drugs in infertile patients. However, ovarian hyperstimulation syndrome associated with natural pregnancy is rare, and most cases of ovarian hyperstimulation syndrome have been associated with a hydatidiform mole. Case presentation We describe a case of a 16-year-old Japanese girl with a complete hydatidiform mole. The patient was referred for intensive examination and treatment of the hydatidiform mole and underwent surgical removal of the hydatidiform mole at 9 weeks, 5 days of gestation. Histopathological examination revealed a complete hydatidiform mole. The patient’s blood human chorionic gonadotropin level decreased from 980,823 IU/L to 44,815 IU/L on postoperative day 4, and it was below the cutoff level on postoperative day 64. Transvaginal ultrasonography on postoperative day 7 revealed a multilocular cyst measuring 82 × 43 mm in the right ovary and a multilocular cyst measuring 66 × 50 mm in the left ovary. Both ovarian cysts enlarged further. Magnetic resonance imaging on postoperative day 24 revealed that the right multilocular ovarian cyst had enlarged to 10 × 12 cm and that the left multilocular ovarian cyst had enlarged to 25 × 11 cm. Blood examination showed an elevated estradiol level as high as 3482 pg/ml. We diagnosed the patient with bilateral giant multilocular cysts accompanied by ovarian hyperstimulation syndrome because of the rapid increase in the size of the cysts. The patient complained of mild abdominal bloating; however, symptoms such as nausea, vomiting, dyspnea, and abdominal pain were not observed. Therefore, we chose spontaneous observation in the outpatient clinic. The cysts gradually decreased and disappeared on postoperative day 242. Conclusion Physicians should be aware that ovarian cysts can occur and can increase rapidly after abortion of a hydatidiform mole. However, the ovarian cyst can return to its original size spontaneously even if it becomes huge.

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Viable Intrauterine Pregnancy and Coexisting Molar Pregnancy in a Bicornuate Uterus: A Rare Presentation

Journal of Clinical Imaging Science ◽

10.4103/2156-7514.184541 ◽

2016 ◽

Vol 6 ◽

pp. 26 ◽

Cited By ~ 1

Author(s):

Kavitha Krishnamoorthy ◽

Sabrina Gerkowicz ◽

Usha Verma

Keyword(s):

Vaginal Bleeding ◽

Hydatidiform Mole ◽

Molar Pregnancy ◽

Intrauterine Pregnancy ◽

Rare Presentation ◽

Bicornuate Uterus ◽

First Case ◽

Dilation And Curettage ◽

Β Hcg ◽

The Right

A complete hydatidiform mole with a viable coexisting fetus (CMCF) is a rare occurrence. Similarly, Mullerian anomalies such as a bicornuate uterus are uncommon variants of normal anatomy. We report a case of a 40-year-old female with a known bicornuate uterus presenting at 13 weeks gestation with vaginal bleeding. Ultrasound findings showed a healthy viable pregnancy in the right horn with complete molar pregnancy in the left horn. After extensive counseling, the patient desired conservative management, however, was unable to continue due to profuse vaginal bleeding. The patient underwent suction dilation and curettage under general anesthesia and evacuation of the uterine horns. Postoperatively, the patient was followed until serum beta-human chorionic gonadotropin (β-hCG) level dropped to <5 mU. This is the first case of a CMCF reported in a bicornuate uterus, diagnosed with the use of ultrasound imaging.

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HYDATIDIFORM MOLE IN A VIRGIN: A CASE REPORT

Caliphate Medical Journal ◽

10.47837/cmj.19770126.nma.20131410124 ◽

2013 ◽

Vol 1 (4) ◽

Author(s):

Shehu CE ◽

Panti AA ◽

Ukwu AE ◽

Adoke AU

Keyword(s):

Vaginal Bleeding ◽

Hydatidiform Mole ◽

Lower Abdominal Pain ◽

Pelvic Mass ◽

Rare Occurrence ◽

Complete Hydatidiform Mole ◽

History Of ◽

Abdominal Examination ◽

Altered Blood

Virginity, for females, is defined by an intact hymen. Pregnancy in the presence of an intact hymen is a rare occurrence. We report a case of hydatidiform mole in a 26 year old single lady with intact hymen. She presented with three months history of amenorrhea, lower abdominal pain, vaginal bleeding with passage of vesicles. The patient denied any history of penetrative sexual intercourse but volunteered a history of two episodes of intense romance with her boyfriend with resultant ejaculation of semen on her thighs. A pelvic mass of about 22 weeks size, without discernible fetal parts was palpable on abdominal examination while pelvic examination revealed a normal vulva and vagina smeared with altered blood, with an intact hymenal ring. She had suction evacuation and histology confirmed complete hydatidiform mole. The hymen was torn during the procedure and she is on follow up. The intention of this report is to alert clinicians that an abnormal, premalignant tumour can be a complication of pregnancy in a virgin. Intact hymen, pregnancy, hydatidiform mole Keywords

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GROSSESSE GEMELLAIRE ASSOCIANT UNE MOLE COMPLETE ET UNE GROSSESSE SINGLETON NORMALE: A PROPOS DUN CAS

International Journal of Advanced Research ◽

10.21474/ijar01/12258 ◽

2020 ◽

Vol 8 (12) ◽

pp. 1096-1099

Author(s):

Fouzia El Hilali ◽

◽

Salahedine Achkif ◽

Sanaa Erraghay ◽

Mohamed Karam Saoud ◽

...

Keyword(s):

Twin Pregnancy ◽

Hydatidiform Mole ◽

Gestational Trophoblastic Disease ◽

Rare Entity ◽

Pelvic Ultrasound ◽

Complete Hydatidiform Mole ◽

Singleton Pregnancy ◽

Trophoblastic Disease ◽

Complete Mole ◽

Normal Placenta

Twin pregnancy involving a complete mole and a normal singleton pregnancy with its own healthy trophoblast is a rare entity. The most serious complication is the progression to gestational trophoblastic disease. Reporting the case of a 38-year-old pastry, G5P4, consultant for bleeding after pregnancy of 16 weeks not followed, whose pelvic ultrasound showed the appearance of an association of a complete hydatidiform mole and a normal singleton pregnancy .The patient had a spontaneous abortion 48 hours after her hospitalization. The anathomopathologic study confirmed the diagnosis of the association of a complete mole and a normal placenta. The evolution is marked by the non-evolution towards gestational trophoblastic disease. ï»¿

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