Volumineux œdème vulvaire comme mode de révélation d'une grossesse môlaire: à propos d'un cas

Molar pregnancy is a benign trophoblastic disease usually discovered in patients with metrorrhagia and early miscarriage. We here report a case of molar pregnancy associated with severe preeclampsia in a 18-year-old primiparous woman presenting with early onset of vulvar swelling occurring in a three-day period. The patient reported metrorrhagias, headaches, vulvar pruritus lasting for a week. Physical examination on admission showed severe hypertension 150/110 mmHg with positive dipstick proteinuria +2 and discreet edema on the lower limbs. Fundal height was 20cm. Gynecological examination showed voluminous vulvar swelling with positive Godet sign sensitive to palpation (A, B). Blood test showed Rh positive blood type A, haemoglobin level 8.2 g/dl and positive qualitative HCG. Ultrasound revealed the absence of an embryo, “honeycomb-like multiple cysts and bilateral ovarian lutein cysts. No differential diagnosys, such as allergic reaction or vulvar infectious due to herpes, was suspected. Electric vacuum aspiration was performed and trophoblastic vescicular debris were collected. Anatomopathological examination helped to confirm the diagnosis of molar pregnancy. Immediately after, the patient was transfused with a unit of blood and received antihypertensive treatment. Clinical monitoring, laboratory tests and routine ultrasound were performed with favorable outcome and regression of the vulvar edema.