Expectant Management of a Twin Pregnancy with Complete Hydatidiform Mole and Coexistent Normal Fetus

Abstract

Twin pregnancies complicated by complete hydatidiform mole coexisting with a viable fetus are rare and may result in significant complications. We describe the expectant management and our surgical approach in a 27-year-old Rh-negative woman presenting with recurrent episodes of vaginal bleeding and a twin pregnancy consisting of a molar pregnancy coexisting with a normal fetus. Inpatient management was undertaken with close maternal and fetal monitoring until cesarean delivery of a healthy female infant and histopathologically confirmed complete hydatidiform molar pregnancy (karyotype 46XX) at 34 weeks with no evidence of malignancy.

Twin pregnancy with a coexisting mole: case report

“…Increased incidence is due to greater use of assisted reproductive technologies. 1,2 Risk factors include previous history of molar pregnancy, extremes of age, and consanguineous marriage. Symptoms like hyperemesis gravidarum, heavy bleeding from the vagina, excessive uterine enlargement, and early failed pregnancy.…”

“…Women must be counseled regarding maternal and fetal complications like lateabortion, malpresentation, preterm labor, vaginal bleeding, persistent GTN, severe anemia in the fetus, hyperthyroidism, hypertensive disorder of pregnancy, pulmonary edema, and thromboembolic phenomena. 1,2 Therefore, a pregnancy needs to be followed with an ultrasound assessment of fetal growth and anatomy. The use of ultrasound in early pregnancy has led to the earlier diagnosis of molar pregnancy.…”

“…Ultrasound diagnosis of partial molar pregnancy is more cystic spaces in the placenta, and a ratio of transverse to an anteroposterior dimension of gestation sac of greater than 1.5 is required for the reliable diagnosis of partial molar pregnancy. [1][2][3] Estimation of HCG levels may be of value in diagnosing molar pregnancies, HCG levels more significant than two multiples of the median. Suction and curettage are the method of choice for evacuation of complete molar pregnancies.…”

“…Other types of GTD include invasive mole, choriocarcinoma, placental site trophoblastic tumor, twin gestation with a molar pregnancy. 1,2 Twin gestation with a molar pregnancy is one of the rarest forms of presentation seen, and its management is complex because of the possibility of fetal survival should be weighed against the risk and its outcome. 3…”

Mola invasiva coexistente con feto vivo normal. Reporte de caso

“…La Organización Mundial de la Salud (OMS) clasifica la enfermedad trofoblástica gestacional (ETG) en trastornos del desarrollo placentario (mola completa, parcial y mola invasiva) y neoplasias del trofoblasto (coriocarcinoma, tumor trofoblástico del sitio placentario y tumor trofoblástico epitelioide), entre otros. (1) La presentación de una mola completa con un gemelo sano es un evento muy raro, con prevalencia de 1 por 20 000 a 100 000 (2) ; y la posibilidad de lograr un nacido vivo varía entre 7 y 40% (3,4) . Este bajo porcentaje se debe a la ocurrencia de complicaciones materno-fetales como aborto espontáneo, parto prematuro, muerte fetal intrauterina, sangrado, preeclampsia, enfermedad trofoblástica persistente, tirotoxicosis, entre otros (5) Comunicamos un caso referido a nuestro hospital y la estrategia de manejo realizado para lograr la viabilidad neonatal.…”