A 36-year-old G1P0 woman presents for her first prenatal visit late in her first trimester of pregnancy; she complains of persistent vaginal bleeding, nausea, and pelvic pain. Physical examination is notable for a gravid uterus larger than expected for gestational age. Fetal heart tones are absent.Which of the following is most likely to be true?

Ans. is a, i.e b-hCG levels will be higher than normalIn the given question patient is presenting late in her first trimester of pregnancy with complains of persistent vaginal bleeding, nausea, and pelvic pain. Physical examination is notable for a gravid uterus larger than expected for gestational age. Fetal heart tones are absent.D/D of height of uterus larger than the period of gestation:Wrong datesTwin pregnancyMolar pregnancyConcealed variety of Abruptio placentaPolyhydramnios.Twin pregnancy can be ruled out because it does not explain persistent vaginal bleeding and moreover in twin/multiple pregnancy fetal heart tones are not absent...2 or more FHS are heard depending on the number of fetuses.Concealed variety of APH does not occur in late first trimester. APH by definition means any bleeding which occurs after 28 weeks of pregnancy and uptil the birth of the child and hence it can be ruled out although absent fetal tones and Fundal height more than the gestational age are seen.Polyhydramnios again can be ruled out since bleeding cannot be explained by it ...so we are left with molar pregnancy which explainds all the findings.Always remember: Patient complaining of extremes of nausea, vomiting + bleeding in first trimester + size of uterus more than the period of amenorrhea-think of Molar pregnancy.The USG shown in the plate is typical snow storm appearance. Hence diagnosis is confirmed.