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Title: Molar Pregnancy in the Emergency Department

Reference: Masterson, L. MD., Chan, S. B. MD. MS., Bluhm, B. MD. (2018). Molar
Pregnancy in the Emergency Department. Retrieved March 5,
2020, from https://westjem.com/case-report/molar-pregnancy-in-
the-emergency-department.html?
Summary:
A molar pregnancy – also known as hydatidiform mole – is a rare complication o f
pregnancy characterized by the abnormal growth of the trophoblasts, the cells that
normally develop into the placenta this complication in the United States is in 0.63 to 1.1
per 1000 pregnancy incidence. Apparently, there are two types of molar pregnancy,
complete molar pregnancy and partial molar pregnancy. In a complete molar
pregnancy, the placental tissue is abnormal and swollen and appears to form fluid-filled
cysts and there’s also no formation of fetal tissue while in partial molar pregnancy, there
may be normal placental tissue along with the abnormally forming placental tissue and
that there may be also formation of a fetus but it will still not able to survive.
The incidence of the 15 year old female patient who complained of vaginal
bleeding and weakness for seven days and upon physical examination she was also
cool and clammy and has also mild labored breathing, she also admitted that she was
engaged in sex activity and her last menstrual period was a month prior to admission
but her abdomen was gravid appearing and looks like the mid-second trimester in size
however with her pelvic examination there was blood discharge, clots which are all
champagne-colored grapelike spongy material but there were no fetal parts identified.
This was more proved when her laboratory results came out and there were numerous
data that showed elevation than the normal values count specifically her beta HCG
count which was 460,318 mIU/mL, 64 times the upper limit of normal for an estimated
gestational age of a five-week fetus. With this findings she was rushed to the obstetric
to perform dilatation and curettage which is actually a procedure that is perform for the
management of molar pregnancy because according to the surgical pathology she was
confirmed with complete molar pregnancy and after the procedure she actually suffered
postoperative complications.
This kind of pregnancy complication is rare yet comes with more several
complications if not detected earlier. This early detection may reduce the chances to
making it more severe by transvaginal ultrasound and increasingly sensitive β-hcg
assays. Numerous studies evaluating the efficacy of ultrasound in detecting molar
pregnancy demonstrate a 57–95 percent sensitivity for the detection of complete molar
pregnancy compared to only 18–49 percent sensitivity for partial molar pregnancy and
these serves as a reminder that patients who delay medical attention may develop this
complication and may worsen it.
Reaction:
I agree on this article on how it presented a case of the said complication and it
also fully discusses the reason why such complication appears and happens on a
pregnant woman considering her age and also her lifestyle which a contributory factor to
molar pregnancy. As for my insights, suffering from this rare complication is not easy
specifically on the maternal side for this may result to other complications that could
actually lead us to death considering the 15 year old female in the article where she
actually suffered postoperative complications, as young as 15 if engaged in sex there
were always be a possibility to have this complication which according to the article
“The most well characterized risk factor for complete molar pregnancy is extreme of
maternal age. Maternal ages less than 20 or greater than 40 years have been
associated with relative risks for CM as high as 10- and 11-fold greater respectively.”
The nega tive impact on this article is the how the article have their teenager
patient to be the example where it just shows how teenagers engaged themselves into
sexual activity though it also has a good impact where it is to open the eyes of the
teenagers on the complications that they may have if they engage themselves into sex
and one of it is the molar pregnancy and having this kind of complication may lead them
same as the teenager patient in the article. As a student nurse and which also happens
to be in the age bracket which is in the risk of having this complication I may apply this
to myself not just by not engaging myself to sex which is a great factor to prevent this
complication but with my lifestyle also which is actually not a good lifestyle of a student
with my education in nursing yes, I may apply it to myself but most importantly on my
patients in this rotation on how I will educate them about the preventive measures they
could do to prevent such complication to happen because I truly believed when patients
who delay medical attention is the most at risk to develop complications.