Question

A previously healthy 27-year-old female $G_1 P_0$ at 16 weeks gestation presents to the ED with a complaint of continued nausea and vomiting and new vaginal bleeding. She has no abdominal pain. Her blood pressure is $160 / 90 \mathrm{mmHg}$ with a heart rate of 110 beats per minute. What is the MOST likely diagnosis? (A) Implantation bleeding. (B) Ectopic pregnancy. (C) Molar pregnancy. (D) Preeclampsia.

   A previously healthy 27-year-old female $G_1 P_0$ at 16 weeks gestation presents to the ED with a complaint of continued nausea and vomiting and new vaginal bleeding. She has no abdominal pain. Her blood pressure is $160 / 90 \mathrm{mmHg}$ with a heart rate of 110 beats per minute. What is the MOST likely diagnosis?
(A) Implantation bleeding.
(B) Ectopic pregnancy.
(C) Molar pregnancy.
(D) Preeclampsia.

Emergency Medicine Examination & Board Review

Susan Promes 3rd Edition

Chapter 10, Problem 9

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The patient is experiencing nausea, vomiting, and vaginal bleeding, with no abdominal pain. Her blood pressure is elevated at 160/90 mmHg and her heart rate is elevated at 110 beats per minute. Show more…

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A previously healthy 27-year-old female $G_1 P_0$ at 16 weeks gestation presents to the ED with a complaint of continued nausea and vomiting and new vaginal bleeding. She has no abdominal pain. Her blood pressure is $160 / 90 \mathrm{mmHg}$ with a heart rate of 110 beats per minute. What is the MOST likely diagnosis? (A) Implantation bleeding. (B) Ectopic pregnancy. (C) Molar pregnancy. (D) Preeclampsia.

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Key Concepts

Gestational Trophoblastic Disease (Molar Pregnancy)

This concept involves abnormal proliferation of trophoblastic tissue resulting in a nonviable pregnancy. Molar pregnancy is characterized by markedly elevated levels of human chorionic gonadotropin (hCG) leading to symptoms such as excessive nausea and vomiting, vaginal bleeding, and early-onset hypertensive signs that can mimic preeclampsia, but typically present before the 20-week threshold for typical preeclampsia.

Hypertensive Disorders of Pregnancy

This concept includes conditions that cause high blood pressure during pregnancy, such as preeclampsia, which usually develop after 20 weeks of gestation. Understanding the typical timing and clinical presentation of hypertensive disorders in pregnancy is crucial for differentiating them from conditions like molar pregnancy, where hypertension may appear unusually early in the gestational period.

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