0071643192.pdf

OBSTETRICS AND GYNECOLOGY

594

HELLP syndrome:

Hemolysis

ElevatedLiver enzymes

LowPlatelets

■ Treat preeclampsia, as above.

■ Correct coagulopathy, as needed (FFP, platelets, blood transfusion).

A 20-year-old, 10-week pregnant woman presents with severe nausea and

vomiting. Her BP is 160/100 and her fundus is palpable at her umbilicus.

What test do you perform to confirm your diagnosis?

Ultrasound to look for the “snowstorm” pattern of a molar pregnancy, and β-hCG.

HYDATIDIFORM MOLE

Gestational trophoblastic disease occurs when a nonviable embryo implants and

trophoblastic cells proliferate in the uterus. The noninvasive form (no invasion of

uterine wall) of GTD is the hydatidiform mole.

Hydatidiform moles are defined as either complete or partial.

■ Partial mole: Triploid (two sets of paternal chromosomes/one set of maternal);

has fetal parts and a higher tendency to progress to choriocarcinoma

■ Complete mole: Diploid (two sets of paternal chromosomes) with the

absence of fetal parts

SYMPTOMS/EXAM

■ Severe nausea/vomiting

■ Uterus larger than expected for dates

■ Vaginal passage of “grapelike” clusters of vesicles

■ Intermittent vaginal bleeding during early pregnancy

■ Preelampsia prior to 20 weeks gestation

DIAGNOSIS

■ β-hCG is higher than expected for dates and a characteristic snowstorm

appearance is seen on older ultrasound models (see Figure 12.3).

■ Once a hydatidiform mole is diagnosed, a CXR should be obtained.

Trophoblastic tumors metastasize to lung, liver, and brain.

TREATMENT

■ Dilation and curettage in the hospital and monitoring of β-hCG levels are

indicated. Failure of β-hCG to decrease to zero suggests choriocarcinoma

or invasive disease.

HYPEREMESIS GRAVIDARUM

A severe form of morning sickness, with excessive pregnancy-related nausea

and/or vomiting that prevents adequate intake of food and fluids.

SYMPTOMS/EXAM

■ Intractable nausea/vomiting

■ Weight loss (from prepregnancy weight; >5% = severe)

■ Hypokalemia

Higher β-hCG and larger

uterine size than expected by

dates should raise suspicion of

molar pregnancy.