MEDizzy - A 23-year-old woman consults an obstetrician because of the

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REPRODUCTIVE SYSTEM

A 23-year-old woman consults an obstetrician because of the onset of vaginal bleeding in what she considers to be the fifth month of pregnancy; however, examination reveals the uterus to be enlarged to the size of a 7 -month pregnancy. Intravaginal ultrasound fails to detect a fetal heartbeat and instead shows a "snowstorm pattern." Human chorionic gonadotropin is markedly elevated. These findings are strongly suggestive of

ExplanationHydatidiform mole should be suspected when the uterus is enlarged beyond the expected size for the time of the pregnancy. Human chorionic gonadotropin is markedly elevated in this gestational trophoblastic disease. Preeclampsia and eclampsia are forms of toxemia of pregnancy marked by severe hypertension, albuminuria, and edema, with the addition of convulsions and disseminated intravascular coagulation in the latter. Placenta accreta occurs when the placenta adheres directly to the myometrium, leading to severe bleeding at the time of delivery.