Hydatidiform mole in a 39-year-old woman.

A 39-year-old woman (gravida 4, para 3) presented at 14 weeks' gestation to the emergency department with acute pelvic pain and substantial vaginal bleeding. Her blood pressure was 80/40 mm Hg and heart rate 114 beats/min. She was afebrile. Clinical examination showed mild suprapubic tenderness with distention. Immediate point-of-care ultrasound showed that her uterus contained echogenic structures with a "snowstorm" appearance. There were no visible embryonic or fetal structures. On speculum examination, the patient's vagina was full of blood clots with grapelike vesicles (Figure 1). We resuscitated the patient with intravenous fluids and transfused her with 4 units of packed red blood cells. We performed an urgent operative cervical dilatation and ultrasound-guided aspiration of the uterine contents. She received 20 IU intravenous oxytocin and the vaginal bleeding stopped. Pathologic examination confirmed the clinical diagnosis of molar pregnancy, showing a noninvasive complete hydatidiform mole. Chromosomal study showed a diploid 46 XX karyotype. A metastatic assessment of...