Molar Pregnancy: A case report

Paulin Jenila1, Sonya mercy anbu. S. J2, R. Ruby3

1Staff Nurse, Kauvery Hospital, Maa Kauvery, Trichy, Tamil Nadu

2Nurse Educator, Kauvery Hospital, Maa Kauvery, Trichy, Tamil Nadu

3DNS, Kauvery Hospital, Maa Kauvery, Trichy, Tamil Nadu

Case Presentation

A 26-year-old female with 3 months of amenorrhea (13 weeks) presented to the emergency department with complaints of bleeding PV on and off for the past 15 days, associated with epigastric pain, nausea, and burning micturition. On evaluation, she was found to be desaturations (SpO2 85% on room air).

ON EXAMINATION

Patient conscious, oriented, afebrile

Pale and pedal edema

PR:90/min

BP:160/100mmhg

CVS: S1S2(+)

RS: NUBS (+)

P/A: uterus over distended for GA, FH (+)

P/V: cervix uneffaced/os closed, Dirty discharge (+), vulvar edema Present

Menstrual History

Age at menarche 15yrs/irregular cycle, 3-4 months once for 5 to 6 days

Marital History

  • Married since 3Yrs
  • Non consanguineous marriage.

Obstetric History

LMP:16.02.2025

EDD: -23.11.2025

Primi/IVF conception (donor ovum)/triplets spontaneously reduced to singleton.

Past History

  • H/O Hysteroscopy Done-Last Year (2024)
  • K/C/O Premature Ovarian Failure (Folicular Study -14.12.2023)

Patient presented with the following signs and symptoms

  • Vaginal bleeding for 15 days
  • Nausea
  • Vomiting
  • PV discharge
  • Increased HCG level
  • Pre-eclampsia
  • Pallor
  • Pain and pressure in pelvic area

Investigations

USG Antenatal & Abdomen Scan Report – 03.06.2025

  • Right mild hydroureteronephrosis
  • Due to distal ureteric obstruction by the enlarged uterus
  • Single live intra uterine fetus corresponding to 14-15 weeks of gestational age
  • Gestational sac B&C could not be visualized in the present study which could be replaced by a large well defined heteroechoeic lesion with intervening multiple cystic foci within occupying the major portion of uterine cavity – Likely molar pregnancy.
  • Suggested MRI correlation for further evaluation to r/o infiltration of molar pregnancy into the viable gestational sac.

Multislice CT Scan Pulmonary Angiogram – 03.06.2025

  • Cardiomegaly with left atrial and ventricular enlargement
  • Dilated pulmonary artery.
  • No evidence of pulmonary thromboembolism
  • Extensive consolidation bilateral lung fields predominantly in the left upper lobe, lingular lobe and bilateral lower lobes
  • Bilateral minimal pleural effusion with bilateral basal atelectasis infective etiology.
  • Mild hepatomegaly.

Lab Investigations

DateInvestigationsValues
05.06.2025Serum beta HCG286820 mIU /mL
07.06.2025Serum beta HCG162110 mIU /mL
09.06.2025Serum beta HCG78494 mIU /mL
03.06.2025Haemoglobin6.1g/dl
04.06.2025Haemoglobin10.3g/dl
05.06.2025Haemoglobin11.7g/dl
06.06.2025haemoglobin11.2g/dl
09.06.2025Haemoglobin8.2g/dl
13.06.2025Haemoglobin10.0g/dl

MRI of Pelvis Plain Report – 03.06.2025

Gravid uterus with single intrauterine fetus and large heterogeneous intra uterine mass lesion with multiple cystic areas of varying Sizes-Possibility of partial molar pregnancy more likely

Focal myometrial thinning in left antero lateral wall of uterus -? Due to myometrial invasion

No Focal myometrial bulge/Parametria invasion.

Abdomen Scan Report – 10.06.2025

 

Bilateral mild pleural effusion (Right > Left)

Blood Investigations

Histopathology extra-large – 12.06.2025

Specimen: Uterus with bilateral fallopian tubes and ovaries.

Impression

Total abdominal hysterectomy with bilateral salpingo-oophorectomy: Consistent with invasive complete hydatiform mole.

 

Remarks

Adjacent placenta tissue represents the placenta of non molar pregnancy of the triplet pregnancy

Diagnosis

  • Late booked primi
  • Premature ovarian failure
  • IVF conception
  • Triplets reduced to singleton
  • 3 months’ amenorrhea
  • Anemia
  • Severe pre-eclampsia
  • Gestational Tropoblastic Neoplasia-invasive mole (molar pregnancy) for further management.

Impression

Total abdominal hysterectomy with bilateral salpingo-oophorectomy: Consistent with invasive complete hydatiform mole.

Remarks

Adjacent placenta tissue represents the placenta of non molar pregnancy of the triplet pregnancy.

Blood Transfusion

  • 3 unit PRBC totally transfused.
  • 1 FFB Transfused.
  • 7 Unit Albumin totally transfused.

Treatment Given

Drug DoseRouteFrequency
Inj. Dytor20mgIV10mg-05mg
Inj. Calcium gluconate1gmIV1-0-1
Inj. Fentanyl100mcgIVstat
Inj. Midazolam5mgIV stat
Inj. Piptaz4.5gmIV1-1-1
Inj. Tigecycline50mg IVstat
Inj. Avitas2.25+2 gmIV1-0-1
Inj. Dexona8mgIVstat
Inj. Metrogyl500mgIV1-1-1
Inj. Pan40mgIV1-0-1
Inj. Emeset2ccIV1-0-1
Inj. Vecuronium20mg in 20 mlIVInfusion
Inj. LabetalolIVInfusion
Inj. Clindamycin600mgIV1-1-1
Inj. H. albumin100mlIV0-1-0
Inj. Clexane60mgS/C0-1-0
Tab. Labetalol200mgP/O1-0-1-
Tab. Dytor5mgP/O1-0-0
Tab.Esomeprazole40mgP/O1-0-0
Tab.Dolo650mgP/O1-1-1
Tab.Nicardia20mgP/O1-1-1
Neb.DuolinINH1-1-1-1
Tab.Clonidine0.3mgP/O1-1-1

Surgery Notes

  • Hysterotomy proceeded to Total Abdominal Hysterectomy with Bilateral salpingo-oophorectomy done on 03.06.2025, 
  • under GA fetal demise- removed
  • Intraop 2 units PRBC & 1 unit FFP transfused.

Post-Operative Period

  • Post op period was uneventful. Then patient shifted to icu with ventilator support.
  • Followed all HIC bundle care & documentation done.
  • Drain tube insitu and drain was monitored.
  • Bedside ECHO done. Showed good LV function, IVC adequate, B/L basal consolidation(resolving).
  • No soakage from incision site.
  • Patient was treated with IV fluids, IV antibiotics, PPI, antiemetic, anticoagulant, antihypertensive, Diuretics, albumin infusion and other supportive measures.
  • Specimen sent for HPE.
  • Patient was on continuous BP monitoring for severe pre-eclampsia.
  • ABG showed mild metabolic acidosis with hypoalbuminemia corrected
  • She was further weaned and extubated to NIV, O2 support and weaned from O2 support . Patient clinically improved, hence shifted to ward.
OpinionDoctorReason
General PhysicianDr. ParthibanSevere Pre-Eclampsia
HematologistDr. SubbaiahSevere Anemic
IntensivistDr. SaravanakumarSudden Desaturation, To rule out Pulmonary Embolism
CardiologistDr. NandhiniDesaturation and Surgical Fitness
oncologistDr.Anisfor Gestational Trophoblastic Neoplasia

Condition at Discharge

Patient was symptomatically better, Vitals stable, general condition good, hence discharged home with following advice and Review   in Intensivist OPD with CBC , TSH , urine routine report.

Advise on Discharge

S. NoDrug name Strength
1inj. Avitas2.25+2 gm
2tab. Esomeprazole40mg
3inj. Clexane60mg
4tab .Arkamin300mg
5tab. Labetalol100mg
6tab. Nicardia20mg

Discussion

Introduction

A molar pregnancy, also known as a hydatidiform mole, is a rare complication of pregnancy where abnormal tissue develops in the uterus instead of a healthy fetus. This abnormal tissue, derived from the trophoblast cells that would normally form the placenta, grows into a mass of fluid-filled sacs resembling a cluster of grapes

Definition

Molar Pregnancy is a type of gestational trophoblastic disease (GTD) characterized by the abnormal growth of throphoblast cells in the uterus, resting in anon –viable, tumor like mass that can cause severe complication.

Two types of Molar Pregnancy

Complete molar pregnancy

  • No normal Fetal tissue is present.
  • Occurs when an egg with no gentic material is fertilized by a sperm, which the duplicates its DNA.
  • Only placental tissue grows, and it becomes swollen and cystic.

Partial Molar Pregnancy

Some fetal tissue may develop, but it is not viable

Happens when an egg is fertilized by two sperms or by one sperm that duplicates, resulting in an abnormal number of chromosomes (typically 69 instead of 46).

Sign and Symptoms

  • Vaginal bleeding
  • Nausea
  • Vomiting
  • Grapes like cyst in vagina
  • Increased HCG level
  • Pre-eclampsia
  • Anemia
  • Pain and pressure in pelvic area

Diagnostic Tests

  • Ultrasound
  • Serum beta HCG
  • Histalogical examination.

Treatment

  • Dilation and curettage(D&C) to remove molar tissue
  • Monitoring HCG levels regularly after removal to ensure they return to normal ( to detect persistent disease or choriocarcinoma).
  • Avoid pregnancy for 6-12 months after treatment.

Complications

  • Gestational trophoblastic neoplasia(GTN): A rare, malignant form of trophoblastic disease
  • Uterine perforation: A risk during surgical removal of the molar tissue
  • Hemorrhage: Excessive bleeding or after surgery

Risks and Follow-Up

  • Most Women Recover Fully.
  • Small risk of persistent gestational trophoblastic disease(GTD) or Choriocarcinoma, which may require chemotherapy.

Future pregnancies are usually safe, but early ultrasound and HCG monitoring are recommended.

 

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