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Soru

Zorluk: OrtaGynecologic Oncology

Evaluated in the emergency department for severe nausea, vomiting, and vaginal bleeding, a 22-year-old primigravida reports her last menstrual period occurred 1010 weeks ago. Her blood pressure is 155/95155/95 mm Hg, and her pulse is 110110/min. Physical examination reveals a uterus that is palpable midway between the pubic symphysis and the umbilicus. Fetal heart tones cannot be auscultated by Doppler. Quantitative serum β\beta-hCG is 250,000250,000 mIU/mL. Pelvic ultrasonography demonstrates a heterogeneous, echogenic intrauterine mass containing multiple small cystic spaces, with no fetal pole identified. Which of the following is the most appropriate next step in the management of this patient?

  1. Suction curettageCevap
  2. B
    Administration of vaginal misoprostol
  3. C
    Intramuscular methotrexate therapy
  4. D
    Total abdominal hysterectomy
  5. E
    Reassurance and repeat ultrasonography in one week

Cevap

Suction curettage is the correct next step in management.
Suction curettage is correct because it is the standard, definitive initial management for a complete hydatidiform mole. This patient exhibits classic signs of a complete mole, including size greater than dates, an abnormally high β\beta-hCG level, hyperemesis, early-onset preeclampsia, and a 'snowstorm' appearance on ultrasound. Prompt evacuation via suction curettage removes the source of the excessive hormone production, immediately mitigates maternal risks (like preeclampsia and hemorrhage), and preserves the uterus for future childbearing. Following evacuation, she will require serial β\beta-hCG monitoring to ensure the tissue does not progress to gestational trophoblastic neoplasia (choriocarcinoma).

Adım Adım Çözüm

1
Analyze the patient's clinical presentation, vital signs, and laboratory values.
The patient has severe hyperemesis, early-onset hypertension (suggestive of preeclampsia before 20 weeks), a uterus larger than expected for gestational dates, and a markedly elevated beta-hCG level.
These findings point away from a normal pregnancy and raise high suspicion for an abnormal trophoblastic process.
2
Interpret the pelvic ultrasound findings in the context of the clinical picture.
The heterogeneous, echogenic mass with cystic spaces ('snowstorm' pattern) and absence of a fetal pole confirms the diagnosis of a complete hydatidiform mole.
Complete hydatidiform moles are a form of gestational trophoblastic disease (GTD) with malignant potential.
3
Determine the optimal primary management for a complete hydatidiform mole in a young, nulliparous patient.
Suction curettage is identified as the definitive standard of care.
This surgical approach safely and rapidly evacuates the trophoblastic tissue, minimizes the risk of hemorrhage and pulmonary embolization, and preserves the patient's future fertility.

Anahtar Kavram

Diagnosis and primary management of Gestational Trophoblastic Disease (Complete Hydatidiform Mole).
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Konular

Gynecologic Oncology

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