Table 3. Antenatal management and pregnancy outcomes.
| Case no. | Planned management | Complications | GA at delivery | Delivery type | EBL (mL) | Genetics prenatal | hCG trend | Subsequent Dx | Treatment |
|---|---|---|---|---|---|---|---|---|---|
| 1 | Expectant (initially declined termination) Serial growth ultrasounds Termination when HELLP |
SAB of twin B at 14 wk HELLP at 16 wk |
16 wk and 6 d | D&E | 1,000 | 70 XXXY | Plateau at 8 wk PP | Metastatic GTN (FIGO stage 3) lung nodules | IV MTX |
| 2 | Expectant (declined termination) Serial growth ultrasounds |
VB (admission) Anemia Preterm labor |
20 wk and 2 d | SVD | 300 | None | Nadir by 12 wk PP | None | None |
| 3 | Expectant | VB Tachycardia Palpitations |
13 wk and 3 d | D&E | 200 | T22 | Nadir by 13 wk PP | None | None |
| 4 | Expectant (declined termination) | VB Hyperthyroidism (admission) Anemia/transfusion (2 U pRBC) PEC with severe features Hemorrhage with passage of molar tissue Intraoperative transfusion (3 U pRBC) Hysterectomy due to postpartum hemorrhage |
24 wk and 5 d | Emergent classical CD | 2,500 | None | Nadir by 8 wk PP, then increased | Metastatic GTN FIGO stage 4 | IV MTX then IV dactinomycin |
| 5 | Desired termination | Pulmonary edema | 21 wk and 1 d | D&E | 125 | None | Nadir by 7 wk PP | None | None |
| 6 | Expectant Serial laboratories Serial growth ultrasounds |
SAB of twin A VB Superimposed PEC with severe features |
34 wk and 5 d | SVD | 250 | None | Nadir by 4 wk PP | None | None |
| 7 | Expectant Serial laboratories Serial growth ultrasounds |
VB GHTN |
34 wk and 2 d | Classical CD | 1,000 | None | Not available | None | None |
| 8 | Expectant Serial laboratories Serial growth ultrasounds |
VB and anemia PTL Postpartum hemorrhage |
32 wk and 2 d | Urgent classical CD due to funic presentation | 1,500 | None | Nadir by 7 wk PP | None | None |
| 9 | Expectant Serial laboratories Serial growth ultrasounds |
VB PTL HTN Fever and tachycardia (unclear diagnosis) |
28 wk and 3 d | SVD | 350 | None | Nadir by 10 wk PP | None | None |
| 10 | Desired termination | Abnormal TFTs with palpitations (started methimazole) Bilateral ovarian masses (largest 10 × 9 × 8 cm) |
15 wk | D&E | 250 | None | Nadir by 4 wk PP then elevated | Metastatic GTN FIGO stage 3 | IV MTX and leucovorin |
| 11 | Expectant Serial laboratories Serial growth ultrasounds |
VB PTL |
34 wk and 2 d | SVD | 300 | None | Nadir by 6 wk PP | None | None |
| 12 | Desired termination | VB | 16 wk and 6 d | D&E | 250 | None | Nadir by 12 wk PP | None | None |
| 13 | Desired termination | None | 15 wk | D&C | 50 | None | Plateau at 2 wk PP | GTN FIGO stage 1 |
IV MTX |
| 14 | Expectant | Chorioamnionitis Postpartum hemorrhage |
17 wk and 5 d | SVD | 500 | 46 XX | Nadir by 12 wk PP | None | None |
Abbreviations: CD, cesarean delivery; D&C, dilation and curettage; D&E, dilation and evacuation; FIGO, International Federation of Gynecology and Obstetrics; GA, gestational age; GTD, gestational trophoblastic disease; GTN, gestational hypertension; HELLP, hemolysis, elevated liver enzymes, low platelets; HTN, hypertension; IV, intravenous; MTX, methotrexate; PTL, preterm labor; PP, postpartum; SAB, spontaneous abortion; SVD, spontaneous vaginal delivery; VB, vaginal bleeding; PRBC, packed red blood cells.