This document describes the case of a 17-year-old female patient who presented with profuse vaginal bleeding. Her physical examination revealed an enlarged uterus consistent with 18 weeks gestation and a non-dilated cervix. She was diagnosed with a hydatidiform mole based on her symptoms of metrorrhagia and abdominal mass without pressure signs, as well as ultrasound findings. She underwent dilation and suction curettage for management of the molar pregnancy, and will require follow-up hCG monitoring to check for any persistent gestational trophoblastic disease.

2. Patient profile
J.Y.
17 y/o
Single
Roman Catholic
Sta Lucia Agdao,
Davao City
G1P0

3. Chief Complaint
Profuse vaginal bleeding

4. OB History
No. Year Sex Indication for
C/S
Place of
Delivery
Attending B
W
Complications
n/a n/a n/a n/a n/a n/a n/a n/a
G1P0
LMP- December 26, 2008 AOG- 18 weeks 3/7
PMP- November 26, 2008 EDC- October 2, 2009

5. Menarche: 13 y/o
Subsequent Menstrual Period:
regular, lasting for 5 days soaking 1-2 pads/day
Coitarche: 17 y/o, with 1 sexual partner
Papsmear: none
Family Planning Method: none
Gyne history

6. (+) childhood measles & chickenpox
(-) DM
(-)HPN
(-)BA
 (-)CA
Past Medical Hx

7. (+) HPN – father
(+) Ovarian Cancer – maternal
(+) Brochial Asthma – patenal side
(-) Heart disease
(-) PTB
(-) DM
Family Hx

8. Does not smoke
Slight alcoholic beverage drinker
No known food & drug allergies
Fresh graduate from HS
Personal/Social History

9. Review of Systems
HEENT: No history of head injury, good vision, good
hearing occasional mild colds, occasional canker sores
and no alarming complaints on the bucal cavity and
pharynx
Neck: no pain and difficulty in swallowing, no
complaints of tender lymph nodes
Cardio: no chest pain, no palpitations

10. Pulmo: no dyspnea, no cough
Gastrointestinal: abdominal pain on the hypogastric
region, no vomiting, claimed to have mild diarrheic
stools, no hematochezia
Urinary: no frequency, no hematuria, no dysuria
Review of Systems

11. History of Present IllnessHistory of Present Illness
4 months
PTA
(+) vaginal bleeding soaking 2 pads per
day
metrorrhagia
(+) increase in abdominal girth
no associated sings and symtoms
2 months
PTA
(+) metrorrhagia soaking 2 pads per day
(+) palpable abdominal mass between the
symphysis pubis and the umbilicus
no associated sings and symtoms

12. History of Present IllnessHistory of Present Illness
1 day PTA
Profuse vaginal bleeding
(+) nausea
(+) pallor
Palpable abdominal mass almost at the
level of the umbilicus
Admission

13. PHYSICAL
EXAMINATION

14. conscious, coherent, not in
cardiorespiratory distress
BP: 120/80
CR: 70 bpm
RR: 20 cpm
T: 36.8
o
C

15. Palms warm and dry. no rashes.
Nails without clubbing and
cyanosis.
 Hair of average texture. Scalp without
lesions

16. Physical Examination
 Conjunctiva pink, anicteric sclerae.
Extraocular movements intact.
 Acuity good. No gross ear deformities,
no ear discharges
Nasal mucosa pink, septum midline.
No sinus tenderness

17. Physical Examination
Oral mucosa pink. Moist lips and
tongue, no tonsillar enlargement,
pharynx without exudate.
 No palpable masses, No enlargement
of thyroid gland. No carotid bruit,
Trachea midline.

18. Physical Examination
 symmetrical chest expansion, no
intercostals retraction, equal tactile
fremitus, lung fields are resonant,
vesicular breath sounds w/ no added
adventitious
sounds

19. adynamic precordium, good S1 and S2, no
murmurs, regular rhythm and normal heart rate.
Symmetric, without masses,
Nipples w/out discharges and retraction.
Physical Examination

20. flat, Normoactive bowel sounds (16/min)
tympanitic no hepatomegaly or splenomegaly
Palpable abdominal mass at the level of the
umbilicus
Physical Examination

21. No edema
No varicosities, no ulcers
Physical Examination
Radial Femoral Popliteal Dorsalis
pedis
Posterior
tibial
Right +2 +2 +2 +2 +2
Left +2 +2 +2 +2 +2

22. alert and cooperative, thought coherent, oriented to
person, place and time.
(+) Nystagmus
 able to do nose pointing and rapid alternating
movements.
Intact cranial nerves
Intact pinprick, light touch, position, and vibration
sensation
Physical Examination

23. +2 +2 +2 +2
+2 +2
+2 +2
+2 +2
R L
Upper
extremities:
5/5 5/5
Lower
extremities
5/5 5/5

24. Speculum
Smooth, pinkish cervix with no lesions found
Cervix is non-dilated
Internal Examination
Corpus enlarged to ~20 wks size, fixed
No adnexal mass/tenderness
Pelvic examination

25. Metrorarrgia
Nausea
pallor
Gradually Increasing abdominal mass
4 months PTA- increase in abdominal girth
2 months PTA- palpable abdominal mass between the symphysis
pubis and the umbilicus
1 day PTA- palpable abdominal mass almost at the level of the umbilicus
No pressure signs and symptoms
Salient Features
Pelvic Examination
Corpus enlarged to ~20 wks size, fixed
Non-dilated cervix

26. Impression
Pregnancy Uteri G1P0
18 3/7 weeks AOG
Hydatidiform Mole

28. Differential Diagnosis
Submucous myoma
Ectopic pregnancy
Threatened Abortion

29. Differential DiagnosisFeatures Patient Submucous
myoma
Ectopic
Pregnancy
Threatened
Abortion
Age/incidence 17 years old >35 years old 2% 15%*
Metrorrargia (+) (-) * (+/-) * (+)
abdominal
mass
(+) (+) * (+) * (+)
Pressure
signs and
symptoms
(-) (+)* (-) (+/-)
Nausea and
pallor
(+) (+/-) (+) (+/-)
Pain (-) (+/-) (+) * (+)
Enlarged
globular
corpus
(+)
20 weeks
AOG
(+) * (+/-) (+)
Cervical
dilatation
(+) (+) (+) (+)*

30. Differential Diagnosis
Features Patient H-mole
Age/incidence 17 years old 1 0f 1500 pregnancies
Metrorrargia (+) (+)
abdominal mass (+) (+)
Pressure signs and
symptoms
(-) (-)
Nausea and pallor (+) (+) *
Pain (-) (-)
Enlarged globular corpus (+) 20 weeks AOG (+) *
Non-dilated cervix (+) (-)

31. Management
Diagnostic studies:
Quantitative B-hCG
Transvaginal Ultrasound
Dilation and suction curettage
IV oxytocin should be administered
Follow-up for development of GTT
hCG determinations (48 hours, 3 consecutive weeks, every 6
months, and then yearly)
PE (Pelvic exam at regular intervals)
Birth control (1 year- OCP, Depo Provera)

32. Discussion
H-mole
Molar pregnancy is characterized histologically by
abnormalities of the chorionic villi that consist of
trophoblastic proliferation and edema of villous
stroma
2 forms: Complete & Partial

33. Discussion
COMPLETE
1. Hydropic degeneration and swelling
of the villous stroma
2. Absence of blood vessels in the
swollen villi.
3. Proliferation of the trophoblastic
epithelium to a varying degree
4. Absence of fetus and amnion.

35. Management
Dilatation and Suction curettage
bHCG monitoring

36. Good day