Original Article

Characteristics of Patients Who Present to the Emergency Department with Molar Pregnancy

Authors: Robert Murphy, BS, Krista Jahnke, MD, Debra Houry, MD, MPH

Abstract

Objective: The purpose of this study was to determine presenting signs/symptoms and risk factors in emergency department (ED) patients ultimately diagnosed with molar pregnancy.


Methods: A retrospective review of ED medical records using a standardized abstraction sheet was conducted over a 10-year period (1995–2005) from three EDs.


Results: Records were available on 44 patients (mean age 25.2 years, 75% African-American) with a diagnosis of molar pregnancy who had been seen in the ED. Almost half presented with abdominal pain, nausea/vomiting, and/or vaginal bleeding. Forty-three percent had a history of sexually transmitted disease; 41% had a history of abdominal or gynecological surgery; and three patients had a documented prior molar pregnancy. Of 22 ultrasounds performed, 68% were noted to have a molar pregnancy. Only five patients had molar pregnancy listed in the differential diagnosis at their initial visit.


Conclusion: Patients who presented with molar pregnancy tended to be young, multiparous, and African-American. The most common presenting complaint was vaginal bleeding, and the ultrasound was not diagnostic of molar pregnancy in almost one-third of the cases.


Key Points


* Patients who presented with molar pregnancy tended to be young, multiparous, and African-American.


* Molar pregnancy was not considered in the differential diagnosis in the majority of these patients.


* hCG levels ranged from 10 to 1,000,000; thus this cannot be used reliably to exclude molar pregnancy.

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