[khanar]

A G1P0 28 year old Taiwanese woman presented with moderate vaginal bleeding during her 14th week of gestation. Fundal height was appropriate to date and pelvic examination was normal. Fetal heart sounds were not detected. Beta hCG level was 7523 mIU/ml. Transabdominal ultrasound is shown below. What is the next best step in the management?

click to enlarge

A- Chest X ray
B- Pelvic CT scan
C- D&C curettage
D- Pelvic radiotherapy
E- Transvaginal hysterectomy

 

[ismail]

i thinks its molar pregnancy.next stp would be chest xray to rule out chorioca. if suction and curettage is in optin it would be the rx of molar pregnancy

 

[ath.pantelis]

(Sorry for being late, Dr. Farqad; during my first attempt to reply to this post I was interrupted & didn't manage to complete my thought.)

Where is the baby? (just kidding, though I shouldn't!)

Well, the differential should be between ectopic pregnancy & gestational trophoblastic disease. The absence of hypertension, normal-for-dates uterine size & relatively low hCG levels should draw us away from the diagnosis of GTN, however there is no 100% in Medicine. On the other hand, this pt's nationality is compatible with high prevalence of GTN. What is more, the U/S shows "snowstorm" pattern. So, before proceeding to any intervention, such as D&C, I would order a chest x-ray, just to be on the safe side (thanx Dr. ismail for your prompt reply!).

However, I am not convinced that I am correct. Dr. Farqad, please confirm (or discard!)

 

[khanar]

Again you are right

@ ath.pantelis

Once again you are absolutely right
I will keep bringing questions in the hope you miss one of them

You are USMLE superman

 

[ath.pantelis]

Don't be so mean, Dr. Farqad, because I'll turn into Shrek .

I am not a superman, just a poor IMG chasing his future in Ob-Gyn!

 

[rasheed]

Snowstorm as a buzzword

Speaking of snowstorm appearance that reminded me when patients with acute retinal detachment sees dozens of floaters (snowstorm floaters)