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

BACKGROUND: The incidence of hydatiform, moles in the United States is appr oximately 1 in 1,200 pregnancies. Acute respiratory insufficiency is a know n 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 num ber of reports provide data from, central hemodynamic monitoring in patient s with this complication. CASE: A 16-year-old, Hispanic woman, gravida 1, p ara 0, presented to the emergency room at 13 weeks' gestational age by mens trual dating with complaints of vaginal bleeding for two days. The serum qu antitative beta -hCG level was 1 x 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 minute s 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 we dge pressure was > 18 mm Hg, consistent with hydrostatic pulmonary edema. V olume overload in association with a reduced colloid osmotic pressure to we dge pressure gradient was primarily responsible for the pulmonary edema in this patient. CONCLUSION: The majority of case reports of pulmonary complications after e vacuation of a hydatid form mole were either presumed or documented to be d ue 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.