A 36-year-old G1P0 woman presents for her first prenatal visit late in her first trimester of pregnancy; she complains of persistent vaginal bleeding, nausea, and pelvic pain. Physical examination is notable for a gravid uterus larger than expected for gestational age. Fetal heart tones are absent. The patient has a medical history significant for herpes and gonorrhea infections.Which of the following is most likely to be true:
Correct Answer: β hcg levels will be higher than normal
Description: In the given question patient is presenting late in her first trimester of pregnancy with complains of persistent vaginal bleeding, nausea, and pelvic pain. Physical examination is notable for a gravid uterus larger than expected for gestational age. Fetal heart tones are absent.
D/D of height of uterus larger than the period of gestation:
Wrong dates
Twin pregnancy
Molar pregnancy
Concealed variety of Abruptio placenta
Polyhydramnios.
Twin pregnancy can be ruled out because it doenot explain persistent vaginal bleeding and moreover in twin/multiple pregnancy fetal heart tones are not absent…2 or more FHS are heard depending on the number of fetuses.
Concealed variety of APH doesnot occur in late first trimester. APH by definition means any bleeding which occurs after 28 weeks of pregnancy and uptil the birth of the child and hence it can be ruled out although absent fetal tones and Fundal height more than the gestational age are seen.
Polyhydramnios again can be ruled out since bleeding cannot be explained by it …so we are left with molar pregnancy which explainds all the findings.
Category:
Gynaecology & Obstetrics
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