Near death 18 weeks preeclampsia in molar pregnancy

ABSTRACT

Authors present a case of a molar pregnancy of 18 weeks with preeclampsia complicated with acute pulmonary oedema. A condition carrying a significant risk to mother, therefore, raising an important issue on preeclampsia symptoms on pregnancies before 20 weeks. A 31-year-old woman gravida 2, parity 1 presented with dyspnea at 18 weeks' gestation. Blood pressure was very high (180/110 mmHg) and there was markedly proteinuria (+4). She had severe dyspnea and her oxygen saturation level was 75%. Her chest X-ray graph showed massive acute pulmonary oedema. Ultrasonography shows endometrial cavity containing multiple small cystic spaces, creating a characteristic “snowstorm” and “cluster of grapes” appearance. Markedly elevated quantitative human chorionic gonadotropin (250.000 mIU/mL). The acute pulmonary oedema has been managed by diuretics (Furosemide) and oxygen. There was no cardiac abnormalities in the tranthoracic echocardiogram. Authors administered antihypertensive therapy (intravenous nicardipine and lmethyldopa in per os), and magnesium sulfate in prevention of eclamptic seizures. The pregnancy was terminated by uterine evacuation under oxytocin infusion by manual ultrasound aspiration. She was followed up intensive care unit for two days. Causes of secondary high blood pressure had been eliminated. The patient's blood pressure rapidly normalized two days after delivery. Dyspnea disappeared one day later. Pathologic and cytogenetic analyses revealed a complete hydatiform mole. Two days after delivery; the serum β-hCG level was 99000 mlU/ml. A control ultrasonography shows an empty uterus. Hydatidiform mole is classified into 2 different subtypes, complete hydatidiform mole and partial or incomplete hydatidiform mole development of preeclampsia prior to 20 weeks of gestation should prompt a clinical evaluation to exclude the possibility of an underlying hydatidiform molar pregnancy. Ultrasonography and level of serum BHCG are the initial investigation of choice for the detection of hydatidiform mole. Aspiration is the treatment of reference.