Shrestha A, Bastakoti R, Pandey N, Poudel R, Ranjit S, Makaju R
Department of Obstetrics and Gynecology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal.
Department of Radiology, Dhulikhel Hospital, Kathmandu University Hospital, Dhulikhel, Kavre, Nepal.
Kathmandu Univ Med J (KUMJ). 2022 Apr-Jun;20(78):243-245.
Molar pregnancy is a type of abnormal pregnancy that usually presents with amenorrhea, vaginal bleeding and elevated serum ß-hCG levels. We report a rare case of complete hydatidiform mole occurring in a 46-year-old P2L2 lady who presented with a term size uterus and elevated serum ß-hCG level (> 15,00,000 per deciliter, anemia (hemoglobin: 8.1 g/dL), difficulty in breathing and minimal vaginal bleeding. During the course of her evaluation, she had profuse vaginal bleeding, she underwent suction and evacuation, but bleeding was not controlled despite measures to control it. She was given uterotonics and antifibrinolytic agents and uterine artery ligation. But was proceeded with emergency hysterectomy for uncontrolled hemorrhage. The content of suction and evacuation was vesicles with blood clots and histopathology was reported as complete hydatidiform mole. The patient received a total of 4 units of packed red blood cells. She was discharged from hospital on 5th postoperative day and was followed up serial serum ß-hCG level. Therefore, complete mole can present with enlarged uterus, vaginal bleeding and anemia. It is also important to note that intractable bleeding following suction and evacuation not being controlled with uterotonics and antifibrinolytic agents and uterine artery ligation may require hysterectomy to save the patient's life.
葡萄胎是一种异常妊娠类型，通常表现为闭经、阴道出血和血清β - 人绒毛膜促性腺激素（β - hCG）水平升高。我们报告一例罕见的完全性葡萄胎病例，患者为一名46岁、孕2产2的女性，其子宫大小如足月妊娠，血清β - hCG水平升高（>1500000每分升），伴有贫血（血红蛋白：8.1克/分升）、呼吸困难和少量阴道出血。在评估过程中，她出现大量阴道出血，接受了吸宫术，但尽管采取了控制出血的措施，出血仍未得到控制。给予了宫缩剂和抗纤溶药物，并进行了子宫动脉结扎。但由于出血无法控制，遂进行了急诊子宫切除术。吸宫内容物为水泡样物伴血凝块，组织病理学报告为完全性葡萄胎。患者共输注了4单位浓缩红细胞。术后第5天出院，并对其血清β - hCG水平进行了连续随访。因此，完全性葡萄胎可表现为子宫增大、阴道出血和贫血。还需注意的是，吸宫术后难以控制的出血，在使用宫缩剂、抗纤溶药物及子宫动脉结扎后仍无法控制时，可能需要进行子宫切除术以挽救患者生命。
