A 29-year-old woman, gravida 3 para 2, at 36 weeks gestation presented to the emergency department with complaints of sudden-onset severe abdominal pain, heavy vaginal bleeding, and decreased fetal movements. Her pregnancy had been uneventful until this episode. She had been exposed to extreme temperatures due to outdoor living during the last ten days. Three days ago, she went to an urgent care center for a severe cough and was prescribed azithromycin for ‘possible bronchitis’. On arrival, she appeared pale, diaphoretic, and visibly distressed. Her temperature is 102 °F , heart rate is 122 beats/min, blood pressure is 90/60 mm Hg, respirations are 34 breaths/min, and oxygen saturation is 89% on room air. On examination, the abdomen was firm and tender to palpation, with a rigid uterus. A bedside ultrasound revealed a retroplacental clot and partial detachment of the placenta. Fetal heart monitoring showed late decelerations and minimal variability. Laboratory results Platelet count: 53,000/μL (normal range: 150,000–450,000/μL) Prothrombin time (PT): 18 seconds (normal range: 10–13 seconds) Activated partial thromboplastin time (aPTT): 40 seconds (normal range: 25–35 seconds) Fibrinogen: 100 mg/dL (normal range: 200–400 mg/dL) D-dimer: >10,000 ng/mL (normal range: <500 ng/mL) Fibrin degradation products (FDPs): 40 µg/mL (normal range: <5 µg/mL) Hemoglobin: 8.5 g/dL ( normal range: 12–16 g/dL for women) Peripheral blood smear: Schistocytes Which of the following could have triggered this condition in this patient?

A 26-year-old woman presents to her gynecologist with complaints of intermittent vaginal bleeding, persistent fatigue, and mild pelvic pain. She also mentions recent shortness of breath and a mild cough over the past two weeks. She denies fever, abdominal swelling, or recent pregnancies. On physical examination, she appears pale but stable. Speculum examination reveals dark blood in the vaginal canal with no visible lesions. Her uterus is mildly tender on bimanual examination and appears slightly enlarged. The gynecologist orders a serum beta-hCG test, which returns markedly elevated at 125,000 IU/L. An ultrasound of the pelvis reveals a heterogeneous, highly vascular mass in the uterine cavity. A chest X-ray reveals multiple nodular lesions in both lungs. Biopsy reveals dimorphic neoplasm characterized by mononucleate cytotrophoblast and intermediate trophoblast, intimately admixed with multinucleate syncytiotrophoblast. The lesion shows prominent hemorrhage due to its extensive pseudovascular network. It also has central necrosis. Which of the following is the primary treatment for this neoplasm?

A 28-year-old woman presents to her gynecologist with complaints of intermittent vaginal bleeding, persistent fatigue, and mild pelvic pain. She also mentions recent shortness of breath and a mild cough over the past two weeks. She denies fever, abdominal swelling, or recent pregnancies. On physical examination, she appears pale but stable. Speculum examination reveals dark blood in the vaginal canal with no visible lesions. Her uterus is mildly tender on bimanual examination and appears slightly enlarged. The gynecologist orders a serum beta-hCG test, which returns markedly elevated at 125,000 IU/L. An ultrasound of the pelvis reveals a heterogeneous, highly vascular mass in the uterine cavity. A chest X-ray reveals multiple nodular lesions in both lungs. Biopsy reveals dimorphic neoplasm characterized by mononucleate cytotrophoblast and intermediate trophoblast, intimately admixed with multinucleate syncytiotrophoblast. The lesion shows prominent hemorrhage due to its extensive pseudovascular network. It also has central necrosis. What is the most common precursor to this neoplasm?

A 24 year-old woman G2P1, with one prior healthy vaginal delivery and no significant medical conditions presents to the emergency department with complaints of abnormal vaginal bleeding and severe nausea and vomiting at 10 weeks of gestation. She describes her bleeding as intermittent but heavy at times and notes that her nausea is much worse than in her first pregnancy. On examination, her uterus is larger than expected for 10 weeks gestation. She denies abdominal pain or fever. There are no signs of hemodynamic instability. Laboratory tests are ordered. Beta-hCG is markedly elevated at 150,000 IU/L, significantly higher than expected for her gestational age. The ultrasound reveals a “snowstorm” pattern consistent with a complete molar pregnancy. She is diagnosed with a complete molar pregnancy. Which of the following statements about p57KIP2 staining is correct in the context of hydatidiform moles?

A 24 year-old woman G2P1, with one prior healthy vaginal delivery and no significant medical conditions presents to the emergency department with complaints of abnormal vaginal bleeding and severe nausea and vomiting at 10 weeks of gestation. She describes her bleeding as intermittent but heavy at times and notes that her nausea is much worse than in her first pregnancy. On examination, her uterus is larger than expected for 10 weeks gestation. She denies abdominal pain or fever. There are no signs of hemodynamic instability. Laboratory tests are ordered. Beta-hCG is markedly elevated at 150,000 IU/L, significantly higher than expected for her gestational age. The ultrasound reveals a “snowstorm” pattern consistent with a complete molar pregnancy. She is diagnosed with a complete molar pregnancy. What is the most common karyotype associated with a complete hydatidiform mole?

A 24 year-old woman G2P1, with one prior healthy vaginal delivery and no significant medical conditions presents to the emergency department with complaints of abnormal vaginal bleeding and severe nausea and vomiting at 10 weeks of gestation. She describes her bleeding as intermittent but heavy at times and notes that her nausea is much worse than in her first pregnancy. On examination, her uterus is larger than expected for 10 weeks gestation. She denies abdominal pain or fever. There are no signs of hemodynamic instability. Laboratory tests are ordered. Beta-hCG is markedly elevated at 150,000 IU/L, significantly higher than expected for her gestational age. The ultrasound reveals a “snowstorm” pattern consistent with a complete molar pregnancy. She is diagnosed with a complete molar pregnancy. After counseling, she undergoes suction curettage to evacuate the uterus. What is the most important follow-up measure after evacuation of a complete molar pregnancy?

A 25-year-old woman presents to the clinic complaining of vaginal bleeding and abdominal pain. She reports missing her last menstrual period and experiencing nausea and vomiting. On physical examination, the uterus is enlarged for gestational age. A pelvic ultrasound is performed, revealing a heterogeneous, complex mass within the uterine cavity. It reveals no fetal parts. Laboratory tests confirm elevated levels of human chorionic gonadotropin (hCG). You suspect a complete molar pregnancy. Which of the following is NOT a typical feature of a complete molar pregnancy?

A 24 year-old woman G2P1, with one prior healthy vaginal delivery and no significant medical conditions presents to the emergency department with complaints of abnormal vaginal bleeding and severe nausea and vomiting at 10 weeks of gestation. She describes her bleeding as intermittent but heavy at times and notes that her nausea is much worse than in her first pregnancy. On examination, her uterus is larger than expected for 10 weeks gestation. She denies abdominal pain or fever. There are no signs of hemodynamic instability. Laboratory tests are ordered. Beta-hCG is markedly elevated at 150,000 IU/L, significantly higher than expected for her gestational age. You suspect a complete molar pregnancy. What is the hallmark ultrasound finding in a complete molar pregnancy?

A 32-year-old woman presents to the emergency department with a sudden onset of dizziness and lower abdominal pain, specifically on the right side, which started 12 hours prior to her visit. The pain has progressively worsened, radiating to her shoulder, and is accompanied by light vaginal bleeding. She notes that her last menstrual period was 7 weeks before this episode. Her medical history included a treated case of pelvic inflammatory disease and mild endometriosis, with one previous normal vaginal delivery three years ago. Upon examination, her vital signs showed a blood pressure of 90/60 mmHg, a heart rate of 104 bpm, respiratory rate of 18 breaths per minute, and a temperature of 37.2°C. The abdominal examination reveals tenderness in the right lower quadrant with rebound tenderness and guarding. A pelvic exam confirms right adnexal tenderness with minimal blood in the vaginal vault. What is the next step in the management of this patient?