Successful delivery of a twin pregnancy with complete hydatidiform mole and coexistent live fetus: a case report and review of literature

Abstract

Background: A twin pregnancy consisting of either a complete or partial hydatidiform mole and a fetus is rare. The reported incidence ranges from 1:22,000-100,000 pregnancies, and complete hydatidiform mole with a coexistent fetus (CHMCF) comprises the majority of these cases. The management of CHMCF is controversial, as maternal risk with continuation of the pregnancy should be weighed against fetal survival. Women with CHMCF are at risk of developing preeclampsia, gestational diabetes, hyperthyroidism, antepartum hemorrhage, and gestational trophoblastic neoplasia. Case: We report a case of a healthy 32-year-old woman in her third pregnancy. She presented at 18 weeks gestation with vaginal bleeding and a significantly large uterus relative to the gestational age. Ultrasound showed CHMCF with a beta-hCG value of 398,800 IU/L. After careful discussion with the patient and after considering her options, she elected to continue the pregnancy. She was closely monitored for complications and had no maternal or fetal concerns. An elective cesarean delivery was performed at 32 weeks. A live female infant was delivered together with a normal placenta and a complete mole. The mother and baby were discharged in good condition after 2 days. A histopathological examination of the molar tissue confirmed the CHMCF diagnosis. No finding of gestational trophoblastic neoplasia (GTN) was discovered throughout one-year follow-up. Conclusion: Successful pregnancy outcomes can be achieved in cases of CHMCF. Comprehensive counseling with the patient regarding possible complications is important. Closely monitoring the mother for any complications and performing ongoing fetal surveillance are essential. Delivery should be planned at a tertiary center with good facilities and neonatal support.