Patient is a 30 yo female G5P2022 9 weeks pregnant presenting for medical checkup. Patient was sent in by her OBGYN doctor for evaluation for possible molar pregnancy. 3 days prior, her HCG level was significantly elevated to 482,579. Patient reports of passing blood clots multiple times a day for a week. VS stable, exam shows gravid abdomen with mild suprapubic tenderness.
Transabdominal ultrasound done at bedside showed:
You can see here an intrauterine heterogeneous cystic mass with diffuse hypoechoic vesicles. This is classically described as a cluster of grapes or snowstorm appearance. There is no evidence of a fetal pole or yolk sac. In this clinical picture with significantly elevated HCG levels, this is highly concerning for a complete molar pregnancy. OBGYN was consulted, and Transvaginal US was done, confirming high suspicion for molar pregnancy. Patient was stable for discharge with scheduled D&C procedure in 1 day. D&C pathology confirms complete molar pregnancy.
Key Facts: A complete molar pregnancy is a rare phenomenon that results from a sperm fertilizing an empty egg. it has 46 XX or 46 XY chromosomes, all paternal DNA. Molar pregnancies are usually pretty obvious on ultrasound. However, in early pregnancy, findings may be subtle. If serum HCG is high (e.g., >100,000), patients will need close follow up for repeat ultrasounds.