An 18-year-old nulliparous woman, at 14 weeks' gestation comes to the physician because of a 6-hour history of light vaginal bleeding and lower abdominal discomfort. Her pulse is 92/min, respirations are 18/min, and blood pressure is 134/76 mm Hg. Abdominal examination shows no tenderness or masses; bowel sounds are normal. On pelvic examination, there is old blood in the vaginal vault and at the closed cervical os. Transvaginal ultrasound demonstrates an intrauterine gestational sac without fetal cardiac activity, and a dilation and curettage is performed. Pathology shows fetal tissue, focal trophoblastic hyperplasia, and some enlarged villi interspersed with normal villi. Which of the following is the most likely diagnosis?

Question

An 18-year-old nulliparous woman, at 14 weeks' gestation comes to the physician because of a 6-hour history of light vaginal bleeding and lower abdominal discomfort. Her pulse is 92/min, respirations are 18/min, and blood pressure is 134/76 mm Hg. Abdominal examination shows no tenderness or masses; bowel sounds are normal. On pelvic examination, there is old blood in the vaginal vault and at the closed cervical os. Transvaginal ultrasound demonstrates an intrauterine gestational sac without fetal cardiac activity, and a dilation and curettage is performed.  Pathology shows fetal tissue, focal trophoblastic hyperplasia, and some enlarged villi interspersed with normal villi.  Which of the following is the most likely diagnosis?

Quizplus · Accepted Answer

Eductional Objective: A partial mole will have a triploid karyotype (eg, 69,XXX or XXY) and contain fetal tissue with some edematous villi with focal trophoblastic proliferation, and normal-appearing villi.  Patients present with vaginal bleeding, and prior miscarriage is a risk factor.

An 18-Year-Old Nulliparous Woman, at 14 Weeks' Gestation Comes to the Physician