Delayed Diagnosis of Molar Pregnancy Leads to Uterine Cancer

Case Overview

Questions to the Gynecology expert and their responses

What is the standard of care in identifying and treating molar pregnancy?

The ED doctor's management was inadequate, most notably with respect to poor follow-up. A Quantitative Beta Human Chorionic Gonadotropin level (QBHCG) should have been obtained on the first visit, and compared to a repeat level two days later. Likewise serial ultrasounds should have been ordered. This sequence of tests is important to discriminate a viable pregnancy from a miscarriage, from an ectopic pregnancy, from a molar pregnancy.

Should this cancer have been identified earlier?

It is likely that such testing would have strongly suggested the diagnosis of molar pregnancy right at the outset. The failure to obtain Ob/Gyn consultation was below the standard of care. A D & C is the final common pathway of diagnosis and management, and should have been performed much earlier in this patient. It would have stopped the bleeding and confirmed the diagnosis of molar pregnancy.

About the expert

This qualified, board-certified expert has been in clinical OB/GYN practice for 20+ years and is currently a practicing OB/GYN dealing frequently with high risk pregnancy. His hospital affiliations include several major hospital centers in NY, and he has published several times in his field. Furthermore, he has also assumed several high ranking administrative positions in the OB/GYN department at a prior institution.