Dr Shannon’s Ultrasound Case

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The Case:

The patient is a 23 yo female,  G3P2002 @ 13 wks by LMP with spotting for one month who presents with heavy vaginal bleeding today.  The physical exam suggests fundal height at 5 cm above umbilicus, non-peritoneal/tender abdomen.  Stable VS.  Hgb 7.3.  (+) urine bhcg.

The following Transabdominal US images were obtained:

 

 

 

What is your diagnosis?

How would you manage this patient?

Do you need a hint?

4 Comments

  • Selbs

    Looks like a cluster of grapes to me, or a molar pregnancy.
    I’d want to know about her prior pregnancies and if she has seen an OBGYN with this pregnancy, and specifically if she has had an ultrasound yet.
    Her VS are apparently stable, but her Hg is low, so I’d cross her for blood (need Rh too for possible Rhogam) and give her IVFs in the mean time. I’d call OBGYN for heavy bleeding and evacuation of a molar pregnancy. OBGYN would appreciate the bHCG level in order to follow the number to zero. The concern is for invasive molar pregnancies that can invade the uterine wall and also cause choriocarcinoma.
    Overall, they get admitted to OBGYN!

  • himynameisvince

    I agree with Selbs. It looke like a molar pregnancy. Even without an ultrasound, the case sounds pretty classic – the giveaways being a uerus way larger than gestational age, and of course bleeding. Then of course you have the hazy, cluster of grapes pattern on ultrasound.
    If bloodwork is done the B-hCG is going to be super high. These patients also sometimes have a lot of nausea due to the high hCG levels. D&C is treatment for mole, but they should be typed and crossed because they can bleed like crazy during the procedure.
    Awesome case – let’s do more!

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