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Gestational trophoblastic disease — DRCOG MCQ

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HardEarly PregnancyGestational trophoblastic diseaseDRCOG

A 19-year-old woman has vaginal bleeding at 10 weeks, severe nausea and a uterus larger than dates. Ultrasound shows a mixed echogenic intrauterine mass without a viable fetus. Serum hCG is markedly raised. What is the most likely diagnosis?

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Correct answer: B — Hydatidiform molar pregnancy

Bleeding, excessive nausea, enlarged uterus, very high hCG and abnormal intrauterine tissue suggest molar pregnancy. Hyperemesis may accompany molar pregnancy but does not explain the scan findings. Ectopic pregnancy would not usually show an intrauterine molar mass. The pearl is that confirmed molar pregnancy requires evacuation and specialist hCG follow-up.

Reference: RCOG Green-top Guideline No. 38