USMLE Step 2 CK Lecture Notes 2019: Obstetrics/Gynecology (Kaplan Test Prep)

Clinical Findings.

Diagnosis. “Snowstorm” ultrasound. The diagnosis is confirmed with sonogram
showing homogenous intrauterine echoes without a gestational sac or fetal parts.

Management. Baseline quantitative β-hCG titer; chest x-ray to rule out lung
metastasis; and suction D&C to evacuate the uterine contents.

Place the patient on effective contraception (oral contraceptive pills) for the
duration of the follow-up period to ensure no confusion between rising β-hCG
titers from recurrent disease and normal pregnancy.

Table II-6-3. Gestational   Trophoblastic   Neoplasia—Basic Approach

β-hCG   titer Baseline  for future  comparison

Chest   x-ray Lung  metastasis  is  ruled   out

Suction D&C Empty   uterus  contents

Oral    contraceptive   pills   for 1   year Prevent    confusion:  recurrent   disease and normal  pregnancy

Treatment is then based on histology and location of metastasis.

The most    common symptom  is  bleeding    prior   to  16  weeks’  gestation   and

passage of  vesicles    from    the vagina. Other   symptoms    of  a   molar   pregnancy

include hypertension,   hyperthyroidism,    hyperemesis gravidarum, and no  fetal

heart   tones   appreciated.

The most    common signs    are fundus  larger  than    dates,  absence of  fetal   heart

tones,  and bilateral   cystic  enlargements    of  the ovary   known   as  theca-lutein

cysts.

The most    common  site    of  distant metastasis  is  the lungs.