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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?

Obstetric ultrasonography Font Medical Triangle Medical imaging

click to enlarge

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

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(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!:eek:)

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!) :cool:
 
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