0071643192.pdf

(Barré) #1

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.
Free download pdf