The Silent Snowstorm: Complete Hydatidiform Mole Presenting as Asymptomatic Pregnancy of Unknown Location

Vollständiger Abstract

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Gestational trophoblastic disease (GTD) encompasses a spectrum of hyperproliferative disorders, including molar pregnancy. While GTD classically presents with hyperemesis or vaginal bleeding, early diagnosis can be challenging when the patient is asymptomatic, presenting instead as a pregnancy of unknown location (PUL). This report details a 17-year-old G1P0 who initially presented to the emergency department at an estimated 7 weeks’ gestation as a fully asymptomatic PUL following a non-diagnostic outpatient ultrasound. Initial workup demonstrated a β-hCG level of 13,179 mIU/mL and stable vital signs. Three days later, she remained asymptomatic; however, her β-hCG rose to 19,977 mIU/mL, representing a sub-optimal 51.6% rise over 72 hours. During this second visit, a formal pelvic ultrasound revealed an 8.1×4.0×5.8 cm uterus with prominent endometrial thickening and cystic lesions, supporting a presumptive diagnosis of trophoblastic disease, while all ancillary labs remained within normal limits. This case highlights the critical importance of structured follow-up in PUL management, where the combination of sub-optimally rising β-hCG and characteristic imaging findings necessitated a rapid shift from surveillance to definitive intervention despite clinical stability and the absence of classic symptoms. The patient subsequently underwent a suction dilation and curettage, and final pathology confirmed a complete hydatidiform mole. Ultimately, early recognition of a molar pregnancy presenting as an asymptomatic PUL relies heavily on correlating serial β-hCG values with targeted ultrasound findings; rapid diagnosis and definitive management, followed by structured post-evacuation surveillance by gynecological oncology, remain essential to prevent progression to gestational trophoblastic neoplasia.