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Francisco Case 6
Francisco Case 6
Francisco Case 6
Vaginal bleeding
PAST MEDICAL/SURGICAL HISTORY
Patient had history of allergies to seafood
and Ibuprofen.
No history of asthma, diabetes mellitus,
hypertension, heart disease, seizure
disorders, thyroid disorders nor sexually
transmitted disease.
FAMILY HISTORY
Hypertension - ♀
Diabetes - ♂
PERSONAL AND SOCIAL HISTORY
College graduate
Works as a bank employee
She is a non-smoker and non- alcoholic
beverage drinker.
MENSTRUAL HISTORY
Menarche at 11 years old
Regular, lasts for 5-7 days
2-3 fully soaked pads a day with noted
dysmenorrhea
LNMP = November 25-30, 2020
PMP = October 2020
GYNECOLOGICAL HISTORY
Pap smear, last 2020 – Unremarkable
SEXUAL HISTORY
First sexual contact at 27 years of age
Two (2) lifetime sexual partner.
Patient had last sexual contact last December 2020.
Contraceptive History
None
HISTORY OF PRESENT PREGNANCY
5wks PTC 4 weeks PTC 3 weeks PTC 4 days PTC Day of consult
Laboratory
Serum beta – hCG: 120,000 mIU/mL
GYNECOLOGY ULTRASOUND REPORT(TVS)
GYNECOLOGY ULTRASOUND REPORT(TVS)
GYNECOLOGY ULTRASOUND REPORT(TVS)
Diagnosis:
Normal sized anteverted uterus
Consider H. mole complete
Myoma uteri
Consider theca lutein cyst, right
Normal left ovary with corpus luteum
FINAL DIAGNOSIS
38 yo, G1P0, Myoma Uteri FIGO 5, Theca Lutein Cyst R, Complete
Hydatidiform
5wks PTC 4 weeks PTC 3 weeks PTC 4 days PTC Day of consult
• Macroscopically
• transform the chorionic
villi into clusters of
vesicles
MANAGEMENT
DIAGNOSTIC PROCEDURES
Covid 19 RT- PCR
CBC – to assess if blood transfusion is needed due to vaginal
bleeding
Blood typing & cross matching – transfusion PRN
Serum beta-hCG – elevated in pregnancy, highly elevated in H.
moles
DIAGNOSTIC PROCEDURES
Transvaginal ultrasound
Normal size anteverted uterus, with a well circumscribed
hypoechoic mass at the left posterolateral near cervico-
corporeal junction, subserous measuring 4.40 x 4.31 x 3.85 cm.
Within the endometrium an echogenic material with cystic
spaces measuring 7.10 x 5.35 x 4.50 cm (Volume = 88.9 mL)
Within the right ovary a thin-walled, biloculated, anechoic cystic
structure measuring 1.78 x 1.95 x 1.15 cm.
DEFINITIVE TREATMENT
Uterine Evacuation
Suction curettage is the preferred method of evacuation regardless
of the uterine size in patients who wish to remain fertile
Hysterectomy is rarely recommended unless the patient wishes
surgical sterilization or is approaching menopause
DEFINITIVE TREATMENT
Hysterectomy
May be done if patient is not desirous of pregnancy
Definitive and most common surgical treatment for leiomyomas
Eliminates risk of locally invasive disease and the risk of persistent
trophoblastic disease by up to 50% but does not prevent metastases
POST OP MONITORING
Beta-hCG monitoring
Used to confirm if treatment was successful
Goal: progressive decrease in hCG by at least 10% across 4
values during a 3-week period (days 1, 7, 14, and 21) until
hCG is undetectable (< 5 mIU/mL)
Monitoring until 6 months because there is increased
incidence of Hydatidiform Mole into Gestational
Trophoblastic Neoplasia.
Theca Lutein Cyst
resolve spontaneously following removal of the stimulating hormone
source (H mole, beta-hCG)
Thank You!
References
1) Cunningham, G. F., Lenovo, K. J., & Bloom, S. L. (2018). Williams
Obstetrics (25th ed.). New York: McGraw-Hill Education.
2) Lobo, RA, Gershenson DM, Lentz GM, Valea FA. Comprehensive
Gynecology 7th, edition. 2017