A client asks about sterilization. Which statement is correct?

Hydatidiform mole, a type of gestational trophoblastic disease, arises from abnormal fertilization resulting in a non-viable pregnancy with overproliferating trophoblasts. This condition leads to hydropic vesicles that fill the uterus, causing rapid expansion beyond normal dates. High serum hCG levels often exceed 100,000 mIU/mL, causing severe hyperemesis.

A. Cervical insufficiency: This condition involves painless cervical dilation during the second trimester, often leading to preterm birth or pregnancy loss. It does not cause an increase in uterine size; rather, the uterus remains appropriate for gestational age until the fetus is expelled. Uterine enlargement is primarily driven by the internal products of conception.

B. Molar pregnancy: Pathological proliferation of placental tissue creates a "snowstorm" appearance on ultrasound, where the uterus is consistently larger than the calculated gestational age. The excessive trophoblastic growth and fluid-filled cysts expand the uterine cavity rapidly. This classic sign helps distinguish it from normal singleton or even multifetal pregnancies.

C. Spontaneous abortion: During a miscarriage, uterine size may actually be smaller than expected due to the loss of amniotic fluid or the partial expulsion of the gestational sac. It typically presents with vaginal bleeding and pelvic cramping. Uterine growth ceases once the pregnancy is no longer viable or the fetus is lost.

D. Ectopic pregnancy: Implantation occurs outside the uterine cavity, most commonly in the fallopian tubes, meaning the uterus does not enlarge significantly. While the uterus might thicken slightly due to hormonal changes, it will not measure larger than expected dates. An empty uterus on ultrasound with a positive pregnancy test is diagnostic.

Gestational diabetes results from placental hormones like human placental lactogen inducing maternal insulin resistance. Management aims to maintain euglycemia to prevent fetal macrosomia and neonatal hypoglycemia. The initial approach focuses on stabilizing postprandial glucose levels through lifestyle and behavioral modifications.

A. Diet modification: Controlling the intake of complex carbohydrates and spreading caloric consumption throughout the day often successfully manages blood sugar levels. Most women can achieve glycemic targets without pharmacological assistance. It is the established standard of care for initial GDM management.

B. Insulin: Pharmacological intervention with insulin is only initiated if nutritional therapy and exercise fail to meet glycemic goals. While highly effective, it requires intensive training and carries a risk of hypoglycemia. It is a second-line treatment rather than the primary starting point.

C. Steroids: Corticosteroids are used to promote fetal lung maturity in cases of threatened preterm labor but actually worsen hyperglycemia by increasing insulin resistance. They are contraindicated as a treatment for GDM. Administering steroids would cause a dangerous rise in maternal glucose levels.

D. Surgery: There is no surgical procedure used to treat or manage the metabolic dysfunction of gestational diabetes. Management is strictly medical and nutritional during the pregnancy. Postpartum, the condition usually resolves spontaneously after the delivery of the placenta.