A twin pregnancy with a hydatidiform mole and a coexisting live fetus: prenatal diagnosis, treatment, and follow-up

Abstract

Twin molar pregnancy with a hydatidiform mole and a coexisting live fetus is a rare form of gestational trophoblastic disease associated with an increased risk of obstetric complications and poor perinatal outcome. Prenatal diagnosis is essential for couple counseling and follow-up in Tertiary Reference Centers. Magnetic resonance imaging is important for the diagnostic differentiation of placental mesenchymal dysplasia and exclusion of myometrial invasion. Here we present a case of twin molar pregnancy with a hydatidiform mole and a coexisting live fetus diagnosed at gestational week 14 using two-dimensional (2D) and three-dimensional (3D) ultrasound and magnetic resonance imaging. We also describe the obstetric management and postmolar follow-up.

Twin pregnancy with a partial hydatidiform mole and a coexistent live fetus. Diagnostic and therapeutic dilemmas. A case report and the review of literature

“…When the normal appearance of the placenta is not visualized, a complete hydatidiform mole with a coexistent live fetus (CHMCF) may be misdiagnosed as a singleton pregnancy with a partial mole and a live fetus in one amniotic sac. Since the prognosis for pregnancy outcome is different in each case, visualization of a normal placenta often adjacent to a large molar placenta is of key importance for the correct diagnosis [7,8]. PHM is more difficult to diagnose than CHM even in a singleton pregnancy due to the absence of the characteristic ultrasound features.…”

“…The most common maternal complications include severe haemorrhage leading to anaemia, severe preeclampsia, hyperthyroidism and thromboembolic disorders [1,[4][5][6]8]. Also common are such events as fetal growth retardation, intrauterine death, miscarriage or premature birth [1,4,7,10]. Most of the cases reported in the literature are those of a multiple pregnancy with CHM and a coexistent live fetus.…”

“…Vaisbuch et al used a similar procedure at 16 weeks gestation in a patient with early onset severe preeclampsia and thyreotoxicosis [8]. Braga et al reported termination by hysterotomy of a pregnancy with CHMCF at 15 weeks gestation, due to the worsening of the mother's clinical condition with hCG levels of 1 881 508 mIU/mL [7]. Braga commented that uterine evacuation by aspiration is not possible after the 12 th week of gestation due to the presence of a fetal skeleton.…”

“…Also, the use of misoprostol is contraindicated as it may increase the likelihood of massive pulmonary thromboplastic embolization. After the first trimester, laparotomy and uterine evacuation by hysterotomy may be considered, especially when there are risk factors for adverse outcomes [7]. Close monitoring of hCG levels is mandatory after uterine evacuation of a molar pregnancy with a coexistent live fetus as it is after termination of a singleton pregnancy.…”

A case report of twin pregnancy with hydatidiform mole and co-existing live fetus

“…Diagnosis by ultrasonography is usually between 12 and 14 weeks, with a detection rate of 68%. [ 11 12 ] When detected early in pregnancy, most women are either advised or opt for termination of pregnancy. However, as many of these pregnancies arise due to infertility treatment, some women may wish to continue pregnancy with added risk.…”