Singleton Partial Molar Pregnancy Delivered in Third Trimester: A Case Report

Abstract

Background: A partial mole is the result of fertilization of a haploid ovum by two sperms or duplication of one sperm, resulting in a triploid karyotype (69 XXY, 69 XXX, 69 XYY). To date, there are very few cases of histo-pathologically confirmed partial moles with diploid karyotypes which survived. This case is reported to highlight the rarest variant of partial molar pregnancy. Case presentation: Here we present a case of singleton partial molar pregnancy co-existing with a live fetus delivered to an 18 years old primigravida lady at Jimma university medical center (JUMC) after amenorrhea of 8 months. She presented with eclamptic seizure for which she was admitted with a diagnosis of Eclampsia in 3 rd trimester pregnancy. Malpresentation (breech) with? Abruptio placenta to rule out partial mole was considered initially. Cesarean section (C/S) was done to effect delivery of an alive female neonate weighing 1100 gm with an APGAR score of 4, 6 & 7 at 1st, 5 th & the 10 th minute of life. The neonate is admitted to neonatal intensive care unit (NICU) where she is complicated by early neonatal death after 65 hours of stay despite many efforts, the possible cause of death being respiratory failure secondary to underlying prematurity. Grossly placenta was single, weighing 1200 gm and invaded by vesicles except its membrane. Histo-pathological finding of placenta was consistent with partial mole. Conclusion: The optimal management of hydatidiform mole with coexistent live fetus is currently uncertain. Clinicians are recommended to present their individual cases for the establishment of guidelines for the management and prenatal counseling for pregnancies with partial mole with coexistent fetuses.

Molar Changes with a Normal Viable Fetus: A Case Report

“…Herein, we presented the case of woman with partial mole that was recognized at 13 weeks gestation, who gave birth to a normal female neonate. This is a rare condition with a prevalence of 0.005 to 0.01% ( 4 ). Mitotic abnormalities in the early post-fertilization period and placental mosaicism can be a potential cause for this event ( 4 ).…”

“…Another case reported by Tesemma et al was an 18-year-old primigravida mother with a singleton term pregnancy coincident with a partial mole who presented with signs and symptoms of eclampsia including generalized tonic-colonic seizures and a blood pressure of 170/100 mmHg. The patient underwent emergency Cesarean section and gave birth to a female neonate weighting 1100 g. The neonate was admitted to neonatal intensive care unit (NICU) and deceased after 65 hours due to respiratory failure, possibly because of prematurity ( 4 ).…”

“…The coincidence of molar changes with a normal fetus is extremely rare, with a reported incidence rate of 0.005-0.01 % in all pregnancies ( 4 ). This condition poses several risks to the mother and the fetus.…”

Partial molar pregnancy with live fetus in first trimester: what should we do next

“…6 It usually derives from dispermic fertilization of the normal haploid oocyte and produces a triploid set of chromosomes. 4 Ultrasonography has made it possible to diagnose a hydatidiform mole and coexistent fetus in the first trimester. 6 Hydatidiform mole with coexistent normal fetus is not necessarily considered a partial mole.…”

“…3 It usually derives from dispermic fertilization of a normal haploid oocyte and produces a triploid set of chromosomes (69 XXX, 69 XXY, or 69 XYY) most commonly associated with the presence of a malformed fetus. 4 Survival of a fetus to term in the presence of partial mole remains an extremely uncommon occurrence, and such cases represent an extremely rare outcome of molar pregnancy. 5 we report one of the rarest presentations of partial molar pregnancy with the live fetus in the first trimester and then what should we do next.…”