A 19-year-old primigravida at 17 weeks of gestation presents with blood pressure of 172/114 mmHg, 3+ proteinuria, and persistent headache. Her uterus measures 22 weeks size. Ultrasound shows a heterogeneous echogenic mass filling the uterine cavity with a classical snowstorm appearance and no fetus. What is the underlying cause of her hypertension?
- A Chronic essential hypertension unmasked by pregnancy
- B Hydatidiform mole with very early onset pre-eclampsia ✓
- C Pre-eclampsia arising from multiple gestation
- D Renal artery stenosis
Correct answer: B. Hydatidiform mole with very early onset pre-eclampsia
Explanation
Pre-eclampsia developing before 20 weeks is unusual and should prompt a search for a predisposing cause, and complete hydatidiform mole is the classic association. The exaggerated placental mass and trophoblastic proliferation release antiangiogenic factors, producing full blown pre-eclampsia in the second trimester. The snowstorm appearance, absent fetus, and uterus large for dates confirm the mole. Multiple gestation raises pre-eclampsia risk but not typically before 20 weeks, and neither chronic hypertension nor renal artery stenosis explains the ultrasound findings.
Reference: Williams Obstetrics, 26th ed.
High-yield for: NEET PGINI-CETNExTFMGEUSMLEPLABMRCP
Written and medically reviewed by the StethoPrep medical team.