Term delivery of a complete hydatidiform mole with a coexisting living fetus followed by successful treatment of maternal metastatic gestational trophoblastic disease

Abstract

A pregnancy with a complete hydatidiform mole and a living cotwin can be a serious threat to the health of both the mother and the fetus. Early diagnosis depends on a combination of detecting an unusually high level of serum beta-HCG and ultrasound examination. We suggest that continuation of the pregnancy may be an acceptable option and that the pregnancy may continue until term if a normal fetal anatomy is assured and maternal complications are under control. Patients require careful postpartum follow up and any recurrent disease should be managed aggressively.

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

“…The coexistence of a molar pregnancy and a live normal fetus carries a risk of severe fetal and maternal complications. 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].…”

“…The reported patient had severe hyperthyroidism and features of liver injury which were indications for pregnancy termination. In the past, the diagnosis of a molar pregnancy with a coexistent live fetus was an indication for an immediate therapeutic termination [4,8]. Now, when a normal fetal development is confirmed by ultrasound and there are no maternal complications, analysis of the fetal karyotype is recommended.…”

“…Women who decide to proceed with their pregnancy should be aware that the chances of a successful outcome are approximately 40% [1,2,6]. A conservative approach is possible under close monitoring and when there are no maternal complications [3,4,6]. Decreasing hCG levels and absence of maternal complications are good predictors of a successful pregnancy outcome [12].…”

“…The coexistence of a hydatidiform mole with a normal fetus is extremely rare with an incidence of 1/20 000 to 1/100,000 pregnancies [1][2][3][4]. In most cases, this is a complete hydatidiform mole (CHM).…”

Management of twin pregnancy with a hydatidiform mole and surviving healthy co-existent fetus

“…Complete molar pregnancies are diploid, partial molar pregnancies are triploid. 3 Multiple pregnancies can also be complicated with complete or partial hydatidiform molar pregnancy and a live fetus. Twin pregnancies with complete mole and a coexisting live fetus are rare obstetric conditions seen in 1 case of 22000 to 100000 pregnancies.…”