Snapshot A 21-year-old female presents at 10 weeks of gestation with uterine bleeding, pelvic pressure, and multiple episodes of non-bloody and non-bilious emesis. The patient has tried eating slowly with frequent small snacks, such as soda crackers. She describes the bleeding as "prune juice" like, but denies it being large-volume. On exam, the uterus is larger than gestational age. Appropriate imagine is obtained. Introduction A type of gestational trophoblastic disease (GTD) molar pregnancies are considered premalignant when malignant, are termed gestational trophoblastic neoplasia (GTN) e.g., choriocarcinoma originate in the placenta has the potential to invade the uterus and metastasize Hydatidiform mole (HM) can be divided into two types complete HM (46,XX; 46,XY) empty ovum being fertilized by a single sperm resulting in duplication of paternal genetic material partial HM (69,XXX; 69,XXY; 69,XYY) normal ovum being fertilized by two sperm (usually) Epidemiology risk of malignancy complete HM 15-20% 2% risk of choriocarcinoma partial HM < 5% choriocarcinoma is rare Risk factors extremes of maternal reproductive age prior history of molar pregnancy Presentation Symptoms hyperemesis gravidarum Physical symptoms vaginal bleeding enlarged uterus pelvic discomfort pain or pressure Evaluation ↑ β-hCG complete HM > partial HM Transvaginal ultrasound complete HM transvaginal ultrasound "snow storm," "cluster of grapes," or "honeycomb" pattern in older sonograms partial HM transvaginal ultrasound fetal parts Uterine evacuation both diagnostic and therapeutic Chest radiography should be obtained if patient presents with pulmonary symptoms Differential Normal pregnancy Incomplete abortion Missed abortion Hyperthyroidism Treatment Uterine evacuation dilation and curettage (preferred) leads to pathologic evaluation to confirm the diagnosis Rho(D) immune globulin in mothers who are Rh-negative after surgical evacuation Serial β-hCG levels aids in the evaluation of post-molar hCG Prognosis, Prevention, and Complications Complications hyperthyroidism pregnancy-induced hypertension malignant transformation e.g., gestational choriocarcinoma ovarian theca lutein cysts acute respiratory distress syndrome (ARDS)