Division of Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore
Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore.
BMJ Case Rep. 2021 Jan 18;14(1):e235028. doi: 10.1136/bcr-2020-235028.
A 34-year-old patient had her first trimester Down syndrome scan followed by serial ultrasound scans which showed a single intrauterine pregnancy with multiple cystic areas in the anterior placenta. She presented in preterm labour with a breech presentation at 32 weeks and underwent an emergency caesarean section. She delivered a male infant weighing 1750 g. The placental histopathology showed a complete hyatidiform mole. At 4 weeks postpartum, beta-human chorionic gonadotrophin (Bhcg) levels rose from 460 to 836 mIU/mL over 1 week. Metastatic workup revealed prominent pelvic nodes and pulmonary nodules in both lungs. This was discussed at the Multi-Disciplinary Tumour Board and single-agent intramuscular methotrexate was recommended. After chemotherapy, she achieved Bhcg normalisation after three cycles. This case highlights the importance of clinical vigilance even in low-risk patients. Unexpected findings on ultrasound should involve multidisciplinary input with radiology colleagues. A high index of suspicion for gestational trophoblastic disease and close follow-up is imperative.
一位 34 岁的患者进行了唐氏综合征筛查的孕早期检查，随后进行了系列超声检查，显示单胎妊娠，前胎盘有多个囊状区域。她在孕 32 周时出现早产，臀位，紧急行剖宫产术。她产下一名男婴，体重 1750 克。胎盘组织病理学检查显示完全性葡萄胎。产后 4 周时，β-人绒毛膜促性腺激素（Bhcg）水平在 1 周内从 460 升至 836 mIU/mL。转移灶检查显示骨盆淋巴结和双肺结节明显。多学科肿瘤委员会对此进行了讨论，推荐使用肌肉注射甲氨蝶呤单药治疗。化疗 3 个周期后，她的 Bhcg 恢复正常。本病例强调了即使在低危患者中也要保持临床警惕的重要性。超声检查的意外发现应包括与放射科同事的多学科意见。对妊娠滋养细胞疾病保持高度怀疑并密切随访至关重要。
