DISCUSSION
The Complications in the third trimester of pregnancy, although well described, can be fatal, and any abnormality requires an integral assessment, especially with the first appearance of hypertension, associated or not with proteinuria1.The ultrasonographic exam of the uterus in the 1st trimester and in particular the colour Doppler vaginal echography has made it possible to detect anomalies in the early pregnancy like the hydatidiform mole, that even when the diagnosis is made mostly by this technique, the histologic exam of the evacuated material (fig. 4) is vital to confirm the diagnosis11. This disease has to be considered as pre-malignant, because it has been described that 15-20% of complete mole and 1% of incomplete moles can generate malignant degradation of the invasive mole type, choriocarcinoma, and in rare cases, trophoblastic tumors of the placental vessels.  After the evacuation of the mole, the patients should be closely monitored with quantification of the B-hCG at least every 2 weeks until non-detectable measures are obtained. Subsequently, normal values should persist and be evaluated monthly for a minimum of 6 months12. In 10-20% of patients in whom the B-hCG levels remain high, various courses of chemotherapy may be required, depending on the FIGO and WHO stratification for gestational trophoblastic neoplasia13. In general, patients are no longer required to receive prophylactic chemotherapy in the diagnosis of mole; this produces an unnecessary exposure in 80% of the cases and should only be offered in patients who would not receive the appropriate follow-up12.The complications of molar pregnancy are another topic that should be considered in addition to the risk of neoplasia evolution. First, one of the most relevant is hyperthyroidism (because of the similarities between the α subunits of HCG and TSH), in which a beta-adrenergic blockade could be required to prevent and revert metabolic and cardiovascular complications of a thyroid storm14. Second, the thecal-lutein ovarian cysts, secondary to the ovarian hyperstimulation, could be twisted or spontaneously broken (this might have been the cause of the abdominal syndrome that the patient presented posterior to the evacuation of the mole; however, this was not evidenced in the moment of rupture with laparotomy). Finally, cardiopulmonary symptoms are associated with trophoblastic emboly13.All the afore mentioned studies showed a general trend of resolution according to the decrease in B-hCG levels. Patients with hyperemesis related to pregnancy in 8-28% generally in earlier stages of gestation and with more severity because of the high levels of these hormones related to different isoforms or mutations in the receptors of this hormone7.The total level of hCG is crucial for the follow-up of patients with gestational trophoblastic disorders. The chemical exams should measure all the portions of the molecule in particular the free- beta subunit, the hCG hyperglycosylated, hCG “nicked” and the hCG without the terminal carboxyl segment, because these segments in particular are higher in neoplasia than the total hCG.Other clinical entity, although not very frequent that clinicians should also considered is the ghost hCG where the patients contain heterophilic antibodies that react with antibodies of certain analysis kits which generates a false positive result of hCG15,In general, the patients with history of molar pregnancy either partial or complete can have other reproductive successful attempts, they only posses a higher risk of recurrence between 1-1.9% and after 2 or more molar pregnancies it increases to 15-17.5%16. Lastly, it can result fatal not to maintain a suspicious of preeclampsia in an early pregnancy before 20 weeks in a clinical context that results relevant, although the prevalence is low, like it could have been in the case of this patients that coursed with severity criteria preeclampsia.