A 19-year-old primigravida has vaginal bleeding and an enlarged-for-dates uterus. In addition, no fetal heart sounds are heard. The ultrasound is seen in the Illustration. The most likely diagnosis of this woman's condition is

Ans. D. Hydatidiform moleThe history, clinical picture, and ultrasound of the woman in the question are characteristic of hydatidiform mole. The most common initial symptoms include an enlarged-for-dates uterus and continuous or intermittent bleeding in the first two trimesters. Other symptoms include hypertension, proteinuria, and hyperthyroidism. Hydatidiform mole is 10 times as common in the Far East as in North America, and it occurs more frequently in women over 45 years of age. A tissue sample would show a villus with hydropic changes and no vessels. Grossly, these lesions appear as small, clear clusters of grapelike vesicles, the passage of which confirms the diagnosis.