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Case Reports in Obstetrics and Gynecology
Volume 2018, Article ID 8201949, 3 pages
https://doi.org/10.1155/2018/8201949
Case Report

A 34-Week Size Uterus with a Complete Hydatidiform Mole: Hook Effect and Severe Anemia with No Vaginal Bleeding

1Department of Obstetrics and Gynecology, Maimonides Medical Center, Brooklyn, NY 11219, USA
2Ronald O. Perelman and Claudia Cohen Center for Reproductive Medicine, Weill Cornell Medical Center, New York, NY 10021, USA

Correspondence should be addressed to Mohamad Irani; moc.liamtoh@inari.damahom

Received 17 September 2017; Accepted 22 January 2018; Published 13 February 2018

Academic Editor: Giampiero Capobianco

Copyright © 2018 Rodney McLaren et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Complete hydatidiform mole is an abnormal pregnancy that usually presents with vaginal bleeding and markedly elevated serum ß-hCG levels. We report a rare case of complete hydatidiform mole occurring in a 16-year-old nulligravid who presented with a 34-week size uterus and a relatively low serum ß-hCG level (722 IU/L)—likely related to the “hook effect”—and severe anemia (hemoglobin: 6.1 g/dL) despite the absence of vaginal bleeding. She also reported right flank pain and was diagnosed with moderate right hydronephrosis owing to the compression exerted by the enlarged uterus on the right ureter. The patient received a total of 6 units of packed red blood cells and was managed by dilation and evacuation followed by serial monitoring of serum ß-hCG levels. Therefore, complete mole can present with symptoms related to an enlarged uterus and severe anemia before the occurrence of vaginal bleeding. It is also important to note that a negative urine pregnancy test or relatively low serum ß-hCG level should prompt repeating the measurement on diluted sample to prevent the “hook effect.”