Invasive Mole After Incomplete Miscarriage

Case presentation

A 33-year-old healthy woman with two previous deliveries and a history of spontaneous miscarriage with uterine curettage experienced a new spontaneous incomplete miscarriage in the 14^th week of pregnancy. When admitted to the emergency department, the patient was bleeding heavily from the vagina, with the vital signs being normal. Transvaginal ultrasound and color Doppler imaging detected an inhomogeneous intrauterine mass with an invasive mole in the destroyed posterior uterine wall (mola destruens; [Fig. 1a]). Blood counts indicated mild anemia, and β-hCG was 3220 U/l. Based on these findings, a hysteroscopic resection of the intrauterine mass was performed without extending surgery to the destroyed uterine wall, to avoid the risk of possible uterine perforation ([Fig. 1b]). The operation was performed with the application of an intracavitary hemostatic sponge and 1 g intravenous tranexamic acid, without further bleeding. After uterine evacuation with uterotonics, owing to the slow decline in the concentration of β-hCG, conservative treatment with methotrexate/leucovorin was given. The complete regression of the Doppler signal of myometrial invasive infiltration and the absence of β-hCG secretion were monitored for one month. Pathohistology revealed a molar trophoblastic degeneration.

Fig. 1 a/b Invasive molar pregnancy: The crosses in the Doppler ultrasound image (a) mark the mole to be seen on the left side of the hysteroscopic resection specimen (b), along with parts of the trophoblastic tissue.

Publication History

Article published online:
09 March 2022

• References

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