Central hemodynamic monitoring in a woman with acute respiratory insufficiency after evacuation of a complete molar pregnancy: A case report

T. Rosen, K. Sutin, C. A. Carreno, E. Hibbett, E. F. Funai

Research output: Contribution to journalArticlepeer-review

4 Scopus citations

Abstract

BACKGROUND: The incidence of hydatiform moles in the United States is approximately 1 in 1,200 pregnancies. Acute respiratory insufficiency is a known complication of molar pregnancies, occurring in 8-11%. While there have been numerous case reports and retrospective studies describing respiratory complications following evacuation of hydatiform moles, only a limited number of reports provide data from central hemodynamic monitoring in patients with this complication. CASE: A 16-year-old, Hispanic woman, gravida 1, para 0, presented to the emergency room at 13 weeks' gestational age by menstrual dating with complaints of vaginal bleeding for two days. The serum quantitative β-hCG level was 1 × 10 6 mIU/mL, and a bedside sonogram was consistent with hydatiform mole. After informed consent was obtained, the patient underwent dilation and suction curettage. Approximately five minutes after evacuation of the uterus was begun, the patient developed pulmonary edema in the setting of oliguria. A pulmonary artery catheter was inserted to determine the etiology of the edema. The initial pulmonary capillary wedge pressure was > 18 mm Hg, consistent with hydrostatic pulmonary edema. Volume overload in association with a reduced colloid osmotic pressure to wedge pressure gradient was primarily responsible for the pulmonary edema in this patient. CONCLUSION: The majority of case reports of pulmonary complications after evacuation of a hydatidiform mole were either presumed or documented to be due to trophoblastic pulmonary embolism. Thyrotoxicosis, fluid overload with dilutional anemia, preeclampsia, sepsis, hypoalbuminemia or a combination of these factors may be more common than trophoblastic embolization.

Original languageEnglish (US)
Pages (from-to)916-922
Number of pages7
JournalJournal of Reproductive Medicine for the Obstetrician and Gynecologist
Volume46
Issue number10
StatePublished - Nov 15 2001
Externally publishedYes

All Science Journal Classification (ASJC) codes

  • Reproductive Medicine
  • Obstetrics and Gynecology

Keywords

  • Invasive cardiac monitoring
  • Molar pregnancy
  • Pulmonary edema

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