PAINE #PANCE Pearl – Obstetrics


42yo G2P1001, who is 12-weeks gravid, presents to your office with concerns of public pain and a single episode of vaginal bleeding this morning. Physical examination reveals a gravid uterus with fundal height measured at the level of the umbilicus. Serum beta-hCG was found to be 745,223 mIU/mL. Ultrasound is below.

  1. What are the important features of this case?
  2. What is the condition that is present?
  3. What is the next step in management?


  1. The important features of this case are advanced maternal age (>35y), fundal height commensurate with a 20-week gestation, and a profoundly elevated beta hCG

2. The ultrasound video shows the classic “snow storm appearance” or “bunches of grapes” which is pathognomonic for hydatidiform mole, a type of gestational trophoblastic disease (GTD)

3. Initial management for GTD is methotrexate due to effectiveness, patient tolerance, and cost.

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