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 34-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, a prior tubal surgery, a prior ectopic pregnancy, and prior IUD use. She smokes more than 20 cigarettes per day and drinks 2 or 3 alcoholic beverages. 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. In this visit, which of the following is the most significant risk factor for ectopic pregnancy in this patient?

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?

A 24-year-old woman presents to the emergency department with complaints of lower abdominal pain and vaginal spotting for the past three days. She describes the pain as sharp and intermittent, primarily on the right side, and denies any fever or chills. She reports a positive home pregnancy test taken two weeks ago but has not yet seen a healthcare provider. Her last menstrual period was six weeks ago. She denies significant medical history, prior surgeries, or sexually transmitted infections but mentions occasional irregular menstrual cycles. On physical examination, the patient appears mildly distressed due to pain. Her vital signs reveal a blood pressure of 110/70 mmHg, a pulse of 95 beats per minute, and no fever. Abdominal examination shows tenderness in the right lower quadrant without guarding or rebound tenderness. Pelvic examination reveals mild cervical motion tenderness and tenderness in the right adnexa, with no palpable masses. Speculum examination shows a small amount of dark blood in the vaginal vault. A urine pregnancy test performed in the emergency department is positive.You suspect ectopic pregnancy. Which of the following is a contraindication for methotrexate treatment in ectopic pregnancy?

A 28-year-old woman presents to the emergency department with complaints of lower abdominal pain and vaginal spotting for the past three days. She describes the pain as sharp and intermittent, primarily on the right side, and denies any fever or chills. She reports a positive home pregnancy test taken two weeks ago but has not yet seen a healthcare provider. Her last menstrual period was six weeks ago. She denies significant medical history, prior surgeries, or sexually transmitted infections but mentions occasional irregular menstrual cycles. On physical examination, the patient appears mildly distressed due to pain. Her vital signs reveal a blood pressure of 110/70 mmHg, a pulse of 95 beats per minute, and no fever. Abdominal examination shows tenderness in the right lower quadrant without guarding or rebound tenderness. Pelvic examination reveals mild cervical motion tenderness and tenderness in the right adnexa, with no palpable masses. Speculum examination shows a small amount of dark blood in the vaginal vault. A urine pregnancy test performed in the emergency department is positive.You suspect ectopic pregnancy. Which of the following is the best initial diagnostic step for suspected ectopic pregnancy?