A woman was admitted with a diagnosis of molar pregnancy in her third pregnancy. She presented in her 4th month of pregnancy due to spotting from the vagina. At admission, she was mildly anaemic. Abdomen revealed a uterine size of 32 weeks with no foetal parts. Sonography confirmed a complete mole. She was planned for elective evacuation after all the preoperative investigations were done. A consultant uneventfully completed the suction evacuation. 2 h after the procedure, she was found to be tachypneic and pale. Her pulse was 120/min, and blood pressure was 90 mm of Hg systolic. She had tachypnea and dyspnea. Abdomen appeared distended. Initially, I thought that she has gone in for adult respiratory distress syndrome due to metastases of the mole, but the abdominal distension was not fitting into the diagnosis. I decided to do a scan, and to my surprise, I found that the uterus which was found to be 12 weeks size showed a possible invasion by the molar tissue on the anterior wall. We took her up for laparotomy as in spite of resuscitation her condition did not stabilize.

There was a 3 × 4 cm irregular perforated area on the anterior wall through which molar tissue was protruding (Fig. 7.1), and there was brisk bleeding from the partially ruptured myometrium.

We proceeded with hysterectomy. I presume that it was not perforation at the procedure of evacuation, but the invasion of the myometrium by the molar tissue (confirmed so by histopathology) which caused the weakening, and the brisk bleed got precipitated following the handling during the evacuation procedure. She later required chemotherapy due to persistent trophoblastic disease.

The following case once again makes me wonder why a few women are not fated to have their children. She was a case of the recurrent mole. In the first pregnancy, the mole was evacuated uneventfully, and the follow-up was uneventful. In the second conception after 2 years, she was diagnosed with repeat molar pregnancy. The same was evacuated, but she developed the persistent gestational trophoblastic disease and feature suggestive of an invasive mole in the uterus. She underwent chemotherapy. There was complete clearance with undetectable βhCG levels for nearly 2 years. She attempted pregnancy again. This time, she presented at 10 weeks of pregnancy in shock with haemoperitoneum. Urgent laparotomy confirmed rupture of the uterus with invasive molar tissue. Hysterectomy was carried out. She underwent multidrug chemotherapy (EMA-CO regimen). It has been now two years, and her βhCG levels have been undetectable for the last 6 months.