Diagnosis Of Molar Pregnancy Research Articles

Molar Pregnancy and Its Associated Risk Factors: A Case-Control Study in Qazvin, Iran

Background & Objective: Hydatidiform Mole (HM) is a type of gestational trophoblastic disease which causes serious complications and recognizing risk factors can play an important role in reducing the incidence. The aim of this study is to evaluate HM risk factors in Kowsar hospital in Qazvin, Iran. Materials & Methods: In this case-control study, 77 pregnant women, by complete enumeration method with sonographic and pathological diagnosis of molar pregnancy in Qazvin Kowsar hospital in 2016-2017, were assigned to the case group and 77 pregnant women with no delivery problems were assigned to the control group. All demographic and midwifery data were extracted from the records in the hospital archive. Before patients were enrolled in this study, written consent was obtained. Data were analyzed by t-test and chi-square in SPSS software version 22. P<0.05 was considered significant. Results: Mean age in both case and control groups was 27.16 ± 7.26. There was no significant difference in preeclampsia, multiple pregnancy, blood groups, Rhesus (Rh) and contraceptive methods in case and group groups (P>0.05). There was a significant relationship between HM and history of molar pregnancy and multiparity (OR: 2.1; CI: 1.77-2.48; p=0.01, OR: 1.85; CI: 1.07-3.6: p=0.04). Conclusion: The present study also showed that HM was more likely to occur in multipara patients and patients with history of molar pregnancy. Therefore, it is recommended that women should undergo health care before pregnancy and further studies are required to provide solutions to reduce the cases of HM.

Video Hysteroscopy in the Diagnosis of Molar Pregnancy in two Challenging Situations: Complete Mole with Normal hCG and Partial Mole with Early Gestational Age

To present the first hysteroscopic findings of 2 cases of complete hydatidiform mole (CHM) and partial hydatidiform mole (PHM) within the context of the patients' clinical histories. Presentation of 2 hysteroscopic videos with narration of the intrauterine findings of molar pregnancy (MP) from Rio de Janeiro Gestational Trophoblastic Disease Reference Center. MP is characterized by abnormal fertilization that generates 2 clinical syndromes: CHM and PHM [1]. In the first case, the patient was aged 50 years, and hysteroscopy was indicated to assess abnormal uterine bleeding in the presence of normal serum human chorionic gonadotropin (hCG) and transvaginal ultrassonography showing an endometrial cavity with heterogeneous content. Hysteroscopy found translucent hydropic structures diagnosed as CHM. The negative hCG value was due to the hook effect (hCG after dilution: 2 240 000 IU/L). In the second case, an 18-year-old patient underwent hysteroscopy to assess the endometrial cavity with retained abortion at 7 weeks in which, during conservative management, the hCG level increased over 4 weeks from 25 000 IU/L to 58 000 IU/L. Hysteroscopy visualized the embryo with its umbilical cord and hydatidiform vesicles diagnosed as PHM. MP can be an incidental finding during hysteroscopy for abnormal uterine bleeding or retained abortion [2-4]. Knowing its morphology during hysteroscopy is helpful for the correct management of this uncommon clinical situation. Hysteroscopy as an adjunct diagnostic tool (not as first-line treatment for MP) can be of significant benefit in challenging clinical scenarios. Further studies should assess the possible risk of spreading molar cells into the peritoneal cavity owing to hysteroscopic fluid.

EP16.07: Two cases of twin pregnancy with a hydatidiform mole and a coexisting live fetus, especially with high levels of βhCG

Twin pregnancy with a hydatidiform mole and a coexisting live fetus is rare occurrence associated with the increased risk of obstetric complications and poor perinatal outcome. Here we reported two cases of twin molar pregnancy opted for conservative management resulted with unfavourable consequences. The first case is a 31-year-old primigravida woman undergoing in-vitro fertilisation and two embryos transfer. The diagnosis of molar pregnancy was made on ultrasound imaging and elevated levels of βhCG (630,278mIU/mL) at 11 weeks of gestation. She came with abdominal pain, vaginal bleeding, βhCG level greater than 1,000,000mIU/mL, and intrauterine fetal death at 15 weeks of gestation. After termination of pregnancy, the βhCG level normalised after additional 3 courses of chemotherapy. The second case is a 29-year-old primigravida woman in natural conception. At 11 weeks of gestation, she was diagnosed with molar pregnancy by abnormal ultrasound imaging and high levels of βhCG (above 200,000mIU/mL). At 22 weeks of gestation, she came to the hospital with massive vaginal bleeding and the elevated βhCG level up to 896,503mIU/mL. The pregnancy was to be terminated immediately. The βhCG level showed rapid regression and reached normal in 2 months without any treatment. Diagnosis in such cases can be simply made by ultrasound examination and high levels of βhCG. But the decision to continue or terminate pregnancy is always problematic. There are some case reports associated with poor perinatal outcome as shown in our cases. Some authors also report cases of successful delivery of live fetus, but they have relatively lower levels of βhCG. Suksai suggest in the recent meta-analysis that the cut-off value of βhCG is 400,000mIU to enable the pregnancy reaching fetal viability. We propose that the best option may be to terminate the pregnancy when the level of βhCG were extremely high at the time of diagnosis.

HDlive Flow with HDlive silhouette mode in diagnosis of molar pregnancy.

HDlive Flow with HDlive silhouette mode in diagnosis of molar pregnancy.

OP16.08: The proportion of women with a histological diagnosis of molar pregnancy who are diagnosed with ultrasound prior to uterine evacuation

OP16.08: The proportion of women with a histological diagnosis of molar pregnancy who are diagnosed with ultrasound prior to uterine evacuation

OC08.02: Ultrasound diagnosis of molar pregnancy

OC08.02: Ultrasound diagnosis of molar pregnancy

Utility of p57 immunohistochemistry in differentiating between complete mole, partial mole & non-molar or hydropic abortus.

Background & objectives:There is considerable inter-observer variability in the diagnosis of molar pregnancies by histomorphological examination of products of conception (POC). The p57KIP2 gene is paternally imprinted and expressed from the maternal allele. On immunohistochemistry (IHC) with p57, complete mole (CM) shows absent staining whereas hydropic abortus (HA) and partial mole (PM) show positive staining. This study was undertaken to evaluate the role of p57 IHC along with histomorphology in differentiating between CM, PM and non-molar or HA.Methods:This was a cross-sectional study over a period of three and a half years on archival material. Detailed histomorphological review along with p57 IHC was carried out in 28 diagnosed cases (23 CM, 4 PM and 1 molar pregnancy not categorized) and 25 controls of four normal placentas and 21 POC (8 non-hydropic and 13 HA).Results:In 14.8 per cent (4/27) cases, there was discordance in accurate subtyping of molar pregnancy. One case of CM showed inconsistent IHC pattern. In 15.4 per cent (2/13) HA, molar pregnancy was final diagnosis. After final review, there were 25 CM, five PM, 22 non-molar controls including 10 HA and one not assigned (PM/HA). IHC with p57 was negative in 96 per cent CM and positive in 100 and 95 per cent PM and non-molar controls, respectively.Interpretation & conclusions:This study showed that negative p57KIP2 immunostaining reliably identified CM and could be used in association with the histological findings to distinguish CM from its mimics.

Molar Gebeliğin Ayırıcı Tanısında Genetik Yöntem

Genetik yöntemler gestasyonel trofoblastik hastalıkların (GTH) tanısında son yıllarda giderek artan bir şekilde yer almaktadır. Komplet hidatiform molün parsiyel hidatiform molden ve nonmolar gebelik materyalinin molar gebelik materyalinden doğru şekilde ayrılması, bu hastalıkların izlem ve tedavisinde büyük önem arz etmektedir. Ancak, sadece morfolojik kriterlere göre ayırıcı tanı yapılmaya çalışılması, bazı zorlukları da beraberinde getirebilmektedir. p57 immün boyama komplet molü parsiyel molden ayırmada kullanılmakla birlikte, bu yöntemin de yeterli olmadığı durumlar söz konusudur. Genomda bulunan polimorfik tekrar bölgelerine özgü belirteçlerin araştırılması, ''short tandem repeat'' (STR) genotiplendirme olarak adlandırılmaktadır. STR analizi morfolojik tanıda yetersiz kalınan durumlarda tanıya yardımcı bir genetik yöntemdir ve son zamanlarda molar gebeliklerin değerlendirmesinde rutin bir yaklaşım haline gelmeye başlamıştır. Bu çalışmada, tanısında güçlük çekilen, ancak STR genotiplendirme ile tanısı kesinleştirilen ve izlem sırasında persistan trofoblastik hastalık gelişen bir olgu, GTH'de genetik tanı yöntemlerine dikkat çekmek amacıyla sunulmuştur.

Molar Gebeliğin Ayırıcı Tanısında Genetik Yöntem

Genetik yöntemler gestasyonel trofoblastik hastalıkların (GTH) tanısında son yıllarda giderek artan bir şekilde yer almaktadır. Komplet hidatiform molün parsiyel hidatiform molden ve nonmolar gebelik materyalinin molar gebelik materyalinden doğru şekilde ayrılması, bu hastalıkların izlem ve tedavisinde büyük önem arz etmektedir. Ancak, sadece morfolojik kriterlere göre ayırıcı tanı yapılmaya çalışılması, bazı zorlukları da beraberinde getirebilmektedir. p57 immün boyama komplet molü parsiyel molden ayırmada kullanılmakla birlikte, bu yöntemin de yeterli olmadığı durumlar söz konusudur. Genomda bulunan polimorfik tekrar bölgelerine özgü belirteçlerin araştırılması, ''short tandem repeat'' (STR) genotiplendirme olarak adlandırılmaktadır. STR analizi morfolojik tanıda yetersiz kalınan durumlarda tanıya yardımcı bir genetik yöntemdir ve son zamanlarda molar gebeliklerin değerlendirmesinde rutin bir yaklaşım haline gelmeye başlamıştır. Bu çalışmada, tanısında güçlük çekilen, ancak STR genotiplendirme ile tanısı kesinleştirilen ve izlem sırasında persistan trofoblastik hastalık gelişen bir olgu, GTH'de genetik tanı yöntemlerine dikkat çekmek amacıyla sunulmuştur.

Experience of Persistent Gestation Trophoblastic Disease in a Tertiary Medical College Hospital, Bangladesh

Objectives: To study the clinical presentation and risk factors of persistent trophoblastic disease and its outcome of treatment with chemotherapy.Materials and methods: This observational study was carried out on fifty patients of persistent trophoblastic disease who were admitted in the Department of Obstetrics & Gynaecology, Mymensingh Medical Hospital (MMCH) during one year period. Evaluation of disease was done by thorough clinical examination and a set of investigations including chest radiography, ultrasound scan of abdomen and pelvis and estimation of serum â hCG. The four factors under analysis of PTD were age of the patient, clinical presentation, gestational age at diagnosis of molar pregnancy and nature of antecedent pregnancy. Patients with non-metastatic trophoblastic disease and low risk metastatic trophoblastic disease were offered single agent chemotherapy with methotrexate and folinic acid rescue in consultation with the oncologist. When â hCG response was inadequate, multi-agent chemotherapy was given. Complications of chemotherapy were also observed and supportive treatment was given.Results: Out of 50 patients, 49 (98%) patients had antecedent molar pregnancy and 1(2%) had missed abortion. In cases of post molar trophoblastic disease, 28 (57.58%) were in 20-30 yrs. Mean ± SD was 31.35 ± 7.25. In these cases gestational size of molar pregnancy was between 16-20 weeks in 24 (48.98%), <16 wks in 19 (38.78%) and >20 wks in 6 (12.24%) cases. Mean ± SD was 16.78 ± 4.45 wks (p<0.001). Associated theca lutein cysts were present among higher number of cases (57.14%) but not statistically significant. Regarding clinical presentation, 40 (80%) patients presented with irregular pervaginal bleeding, 3(6%) patients with features of metastasis. Most of the of the study subjects 43 (86%) were treated with chemotherapy and 7 (14%) had undergone both hysterectomy and chemotherapy. Single agent methotrexate was given in 47 (94%) cases and multiple agent (EMA-CO) in 3 (6%). After giving 4 cycles of chemotherapy 11 (22%) patients were cured, 38 (76%) had declining â hCG level and one had static â hCG level. Overall remission was 98 %. Complication of chemotherapy was observed in 5 (10%) patients.Conclusion: Theca lutein cyst are important in the prediction of persistent disease after molar pregnancy. Methotrexate chemotherapy is effective and well tolerated in treating patients with nonmetastatic and low risk metastatic gestational trophoblastic neoplasia.Bangladesh J Obstet Gynaecol, 2012; Vol. 27(2) : 50-56

Transabdominal and transvaginal ultrasonography in uterine masses

The present study was undertaken to evaluate the role of trans-abdominal and transvaginal ultrasonography in the diagnosis of uterine mass. To evaluate the accuracy of trans-abdominal sonography (TAS) and trans vaginal ultrasonography (TVS) for the diagnosis of uterine mass. A total of 81 cases were evaluated. Majority of uterine masses were leiomyomas (56.79%). In the present study TAST Endometrial carcinoma 2 and 3; Endometrial polyp 3 and 5; Molar pregnancy 12 and 12; invasive Mole 4 and 4; Carcinoma cervix 5and 5 cases respectively. In present study the number of Benign mass was67 (82.72%) and Malignant mass14 (17.28%). The incidence of uterine mass was highest in parous woman (60.5%).The sensitivity and accuracy of both TAS & TVS in the diagnosis of molar pregnancy was 100%. Overall, TVS is found to be superior to TAS in the diagnosis of uterine mass.

Timing of referral to the New England Trophoblastic Disease Center: Does referral with molar pregnancy versus postmolar gestational trophoblastic neoplasia affect outcomes?

Objective To assess if referral of patients with molar pregnancy who then developed postmolar gestational trophoblastic neoplasia (PMGTN) is associated with different outcomes when compared to referral of patients already with a diagnosis of PMGTN. Study design The records of the New England Trophoblastic Disease Center (NETDC) were queried for all patients with molar pregnancy or PMGTN from 1993-2013. Retrospective chart review was performed to extract relevant clinical and demographic data. Parametric and nonparametric tests were utilized to compare variables. Results From 1993-2013, 429 women with molar disease were evaluated at the NETDC. Of those, 68% were referred with molar pregnancy and 32% were referred with PMGTN. Comparing women with PMGTN who were referred with a molar pregnancy versus referred with PMGTN, the women were of equivalent stage and World Health Organization (WHO) score. Additionally, referral with molar pregnancy or PMGTN did not associate with time to persistence, time to remission, or number of lines of chemotherapy administered. Conclusion In this trophoblastic disease specialty center in the United States, referral at the time of PMGTN as opposed to at diagnosis of molar pregnancy did not appear to affect the stage or WHO score at diagnosis, the need for multiple chemotherapy lines, or time to remission.

Use of hormonal contraception after hydatidiform mole.

Effective contraception is important during monitoring of human chorionic gonadotrophin (hCG) levels after uterine evacuation for hydatidiform mole (HM), to avoid confusion between a rising hCG associated with ongoing gestational trophoblastic disease (GTD) and that resulting from a new pregnancy. Contraception should be started as soon as possible: conception can occur before menses are re-established. But how do women achieve effective contraception in the immediate aftermath of molar pregnancy? Typically, condom use is associated with an 18% contraceptive failure rate over a year of use. Intrauterine contraception has been avoided in GTD because of concerns about possible increased risk of bleeding and uterine perforation. Hormonal contraception (HC) is effective: the progestogen-only implant has a typical use failure rate of only 0.05% over a year, oral contraception 9% and injectables 6%. On discontinuation of HC (except injectables), there is a rapid return to fertility – important to many women after an episode of GTD. However, guidelines regarding use of HC during follow up of HM have been inconsistent. Royal College of Obstericians and Gynaecologists guidance (Green Top Guideline 38, London: RCOG; March 2010) recommended that HC be avoided until hCG levels normalised because of concern that use of combined HC after molar pregnancy might increase the risk of gestational trophoblastic neoplasia. However, a systematic review by Gaffield et al. (Contraception 2009;80:363–71) found no evidence of an effect of combined HC on the course of GTD after HM. On this basis, the 2009 World Health Organization Medical Eligibility Criteria for Contraceptive Use recommended that there should be no restriction on use of HC while hCG levels are elevated in GTD. In line with this, the Faculty of Sexual and Reproductive Healthcare (UK Medical Eligibility Criteria for Contraceptive Use, London: FSRH; 2009) and Centers for Disease Control (US Medical Eligibility Criteria for Contraceptive Use, Atlanta: CDC; 2010) advise that HC can safely be used while hCG remains elevated. In the current retrospective database study, Braga et al. find no association between use of HC started while hCG levels are still raised after uterine evacuation for complete HM and time to hCG regression, development of gestational trophoblastic neoplasia or FIGO risk score. The study includes 2423 women with complete HM. However, only 154 used HC (100 combined oral contraception, 43 progestogen-only pill, 11 progestogen-only injectable). Because numbers of women using each contraceptive were small, methods are considered together as ‘hormonal contraception’. The study is not powered to detect different effects of individual HC methods on GTD outcomes. Progestogen-only implants and non-oral combined contraceptives are not considered. Contraceptive method was not randomised. Prescribing might have been influenced by plateaued or rising hCG levels or by bleeding problems in the weeks following uterine evacuation so there is a potential prescribing bias. Despite its limitations, this study adds to the weight of evidence that suggests HC can safely be used after molar pregnancy before hCG levels normalise. Clinicians caring for women with a diagnosis of molar pregnancy should not forget about contraception and can advise women that the limited evidence is that HC is safe to start. None declared. Completed disclosure of interests form available to view online as supporting information. Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article.

The utility of molecular and immunohistochemical techniques in diagnosing molar pregnancies

Based on established morphological and cytogenetic criteria, molar pregnancy is divided into partial and complete. The risk of persistent trophoblastic disease is higher in complete moles. The aim of this study was to assess the importance of additional molecular and immunohistochemical methods to accurately determine the presence and type of molar pregnancy. This study examined 30 cases of hydropic abortion and molar pregnancies, which were also analyzed with immunohistochemical methods using p57 and p63 antibodies. Molecular analysis of the placental tissue was done in 25 of the cases. The results showed that chromosomal abnormalities were found in 82% of the cases. Of these, 27.3% showed triploidy, whereas maternal tissue was not found in one analyzed case of complete mole. Trisomy was found in 40% and 9% were consistent with Turner syndrome. The immunohistochemical analysis revealed absence of p57 positivity in both cases of complete mole, but there was no difference in p63 positivity between the different molecular groups. In order to obtain accurate and clinically relevant diagnosis of molar pregnancy, the products of conception should be analyzed by an experienced pathologist, using additional immunohistochemical and molecular analyses.

P04.08: Cesarean scar pregnancy managed conservatively: case series

CT chest abdomen pelvis revealed right pleural effusion, bilateral multicystic ovaries and large ascites. 2.7 litres peritoneal fluid was drained with no malignant cells on cytology. She responded well to supportive measures. Histopathology of product of conception demonstrated oedematous appearance of chorionic villi, normal trophoblast proliferation and no evidence of molar changes. Recent identification of FSH receptor gene mutations which increased FSH receptors sensitivity to structurally similar HCG is responsible for spontaneous OHSS. It induces follicular growth, activates LH receptors on granulosa cells and causes the release of vasoactive molecules. Clinical presentation, biochemical tests and ultrasound findings strongly supported the diagnosis of molar pregnancy but it was a non-molar miscarriage. This case would create awareness of this unusual presentation of spontaneous OHSS mimicking a partial molar pregnancy as it could cause major emotional impact on the patient and financial impact on the healthcare system.

The Immunohistochemical Analysis of RCAS1, HLA-G, and B7H4-Positive Macrophages in Partial and Complete Hydatidiform Mole in Both Applied Therapeutic Surgery and Surgery Followed by Chemotherapy

The suppressive microenvironment developing around the implantating ovum in normal pregnant women may correlate with the development in cancer patients of a suppressive microenvironment of neoplasmatic cells derived from trophoblasts, such as occurs in molar lesions. Macrophages are suitable candidates for mediating not only the balance of the maternal defensive immune responses to external antigens, but also a tolerance to tumor cells. The aim of our study has been to gain information about the expression of RCAS1, B7H4, and HLA-G within the macrophages present in the microenvironment of the molar lesion. We analyzed the immunoreactivity of such antigens as B7H4, RCAS1, and HLA-G on the macrophages present in tissue samples derived from patients on whom curettage was performed after a diagnosis of molar pregnancy. These patients were then divided into two subgroups according to whether or not they required chemotherapy after the surgical procedure. We observed a statistically significant increase in the RCAS1-positive macrophage infiltration within the microenvironment of the molar lesions in patients with partial hydatidiform mole in comparison with those patients who exhibited complete hydatidiform mole. There were no such differences, however, in the infiltration of HLA-G- and B7H4-positive macrophages between the two groups of patients. Additionally, we showed that RCAS1- and HLA-G-positive macrophages are more distinct in those cases of complete molar pregnancy where chemotherapy was necessary after surgical treatment while no such differences with respect to B7H4-positive macrophages were observed. The immune-suppressive endometrial microenvironment represented by suppressive macrophages may have an influence on the clinical course of hydatidiform mole.

Roles of p57KIP2 immunohistochemistry and flow cytometry in diagnosis of molar pregnancy

To study the value of combined use of paternally imprinted gene product p57(KIP2) immunohistochemistry and flow cytometry in the differential diagnosis of placental hydropic diseases. A total of 32 cases of hydropic placenta with DNA polymorphism information were collected, and the genetic results were used as basis for the diagnosis of complete hydatidiform moles (CHM), partial hydatidiform moles (PHM) or hydropic abortions. All cases were examined by histology, p57(KIP2) immunohistochemical staining (EnVision method) and flow cytometry DNA ploidy analysis. The p57(KIP2) immunohistochemical staining and DNA ploidy results were compared with the genetic results. In CHM, p57(KIP2) negative rates were 95.2% (20/21), whereas all the 11 cases of non-CHM (7 cases PHM and 4 cases hydropic abortions) were positive (11/11). In 11 p57(KIP2) -positive cases, 7 cases with triploidy and 4 cases with diploidy by flow cytometry were proven to be PHM and hydropic abortions by genetic analysis, respectively. Overall, 96.9% (31/32) cases of hydropic placentas were correctly diagnosed by combined use of p57(KIP2) immunohistochemistry and flow cytometry. p57(KIP2) immunohistochemical negativity is a reliable index for the diagnosis of CHM. Combined flow cytometry DNA ploidy and p57(KIP2) immunohistochemistry are useful in the pathological differentiation of CHM, PHM and hydropic abortions.

Recognising gestational trophoblastic disease

Gestational trophoblastic disease (GTD) is a group of interrelated tumours originating from the placenta. Hydatidiform molar (HM) pregnancy is the most common form of GTD; this includes both partial hydatidiform molar (PHM) and complete hydatidiform molar (CHM) pregnancies. The importance of such a condition derives from its potential for persistent trophoblastic disease; this is noted to be more common after a CHM (10-20%) compared to a PHM (0.1-11%). The recent routine use of high-resolution trans-vaginal ultrasound (TVS) in early pregnancy has improved the recognition and thus pre-surgical diagnosis of molar pregnancy. Pre-surgical recognition aids planning of surgery, decreases intra-operative complications and identifies women with potential persistent trophoblastic disease. Despite the introduction of TVS, its performance in preoperative diagnosis is quite poor. This is primarily because of the histomorphometric features of the hydropic villi. A significant proportion of HM cases demonstrates minimal hydropic change in the first trimester and therefore is likely to remain unidentifiable by ultrasound examination prior to surgical evacuation, even with improved sonographer expertise. The overall sensitivity for the ultrasound diagnosis of HM is 50-86%. Ultrasound diagnosis of CHM can be made in approximately 80% of the cases, whilst ultrasound diagnosis of PHM is less accurate and nearly 70% of cases will be missed. Correlation of the ultrasonographic findings with human chorionic gonadotropin levels can further improve the recognition of HM pregnancy pre-surgery. Although ultrasound can be helpful in the diagnosis of molar pregnancies, histological confirmation is mandatory. Histological confirmation post-curettage is still the gold standard for the diagnosis of GTD. In this article, we critically evaluate the role of TVS in the pre-surgical recognition of GTD.

Characteristics of Patients Who Present to the Emergency Department with Molar Pregnancy

The purpose of this study was to determine presenting signs/symptoms and risk factors in emergency department (ED) patients ultimately diagnosed with molar pregnancy. A retrospective review of ED medical records using a standardized abstraction sheet was conducted over a 10-year period (1995-2005) from three EDs. Records were available on 44 patients (mean age 25.2 years, 75% African-American) with a diagnosis of molar pregnancy who had been seen in the ED. Almost half presented with abdominal pain, nausea/vomiting, and/or vaginal bleeding. Forty-three percent had a history of sexually transmitted disease; 41% had a history of abdominal or gynecological surgery; and three patients had a documented prior molar pregnancy. Of 22 ultrasounds performed, 68% were noted to have a molar pregnancy. Only five patients had molar pregnancy listed in the differential diagnosis at their initial visit. Patients who presented with molar pregnancy tended to be young, multiparous, and African-American. The most common presenting complaint was vaginal bleeding, and the ultrasound was not diagnostic of molar pregnancy in almost one-third of the cases.

P35.09: Accuracy of ultrasound in the diagnosis of molar pregnancy

P35.09: Accuracy of ultrasound in the diagnosis of molar pregnancy