A 28-year-old gravida 2, para 1 woman presented with vaginal bleeding for 2 days. Her last menstrual period was approximately 9 weeks prior, however, she stated that she had vaginal spotting off and on throughout the course of her pregnancy. No abdominal pain or cramping, fevers, chills, nausea, or vomiting were reported by the patient. She had no past medical or surgical history and was not taking any medications. The vital signs were normal. Pelvic examination revealed a closed os with no discharge, no active bleeding, and no pooling of blood. Bimanual examination revealed a uterus larger than expected by dates at approximately 12 weeks in size. There was no cervical motion tenderness, adnexal tenderness, masses or fullness. A bedside transvaginal ultrasound was performed by the emergency physician that revealed a uterus filled with grape-like structures (Figure 1). The patient was Rh positive and the quantitative Beta HCG was 353,740. The presumptive diagnosis of molar pregnancy was made by the emergency physician. A scheduled dilatation and curettage of the uterus within 24 h could be a treatment option, especially since this patient was pain free and without significant bleeding. However, complications of molar pregnancies may include hemorrhage, intra-uterine infection, local infiltration of adjacent tissues, and occasionally, metastasis to distant sites. Considering these factors, and since our facility favors a more aggressive approach, this patient was immediately admitted and taken to the operating room for dilatation and curettage of the uterus (which is the definitive diagnostic and therapeutic treatment). Gross (Figure 2) and microscopic pathology findings confirmed a molar pregnancy. The patient had a favorable outcome and was scheduled for follow up Beta HCG levels.