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Garcia JB, Seasely AR, Roland D, Guo H, Boozer M, Cozzi G, Toboni MD. Management of a complete mole and coexisting fetus in post-dobbs world. Gynecol Oncol Rep 2024; 52:101375. [PMID: 38571565 PMCID: PMC10987889 DOI: 10.1016/j.gore.2024.101375] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 03/21/2024] [Accepted: 03/22/2024] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND Twin pregnancies consisting of a complete hydatidiform mole and a coexistent fetus (CMCF) are rare and associated with a high rate of maternal-fetal morbidity and mortality. Management of these pregnancies remains controversial and increasingly challenging following the Dobbs versus Jackson Women's Health decision given the viability of the coexisting twin fetus. CASE This case looks at the diagnosis, management, and maternal-fetal outcomes of a viable fetus coexisting molar pregnancy at a large academic center in an abortion-restricted state. CONCLUSION CMCF pregnancies are associated with a high risk of morbidity and mortality and are increasingly difficult to manage following the Dobbs decision. Testing platforms, which identify genetic abnormalities in the first trimester, are increasingly important as access to abortion care in the United States is restricted.
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Affiliation(s)
- Jordan Barton Garcia
- University of Alabama at Birmingham Department of Obstetrics and Gynecology, United States
| | - Angela R. Seasely
- University of Alabama at Birmingham Division of Maternal Fetal Medicine, United States
| | - Damien Roland
- University of Alabama at Birmingham Department of Pathology, United States
| | - Hua Guo
- University of Alabama at Birmingham Department of Pathology, United States
| | - Margaret Boozer
- University of Alabama at Birmingham Division of Women’s Reproductive Healthcare, United States
| | - Gabriella Cozzi
- University of Alabama at Birmingham Division of Maternal Fetal Medicine, United States
| | - Michael D. Toboni
- University of Alabama at Birmingham Division of Gynecology Oncology, United States
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2
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Hajri T, Massoud M, Vergne M, Descargues P, Allias F, You B, Lotz JP, Haesebaert J, Bolze PA, Golfier F, Massardier J. Multiple pregnancy with complete hydatidiform mole and coexisting normal fetus in a retrospective cohort of 141 patients. Am J Obstet Gynecol 2024; 230:362.e1-362.e8. [PMID: 37722570 DOI: 10.1016/j.ajog.2023.09.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2023] [Revised: 08/18/2023] [Accepted: 09/08/2023] [Indexed: 09/20/2023]
Abstract
BACKGROUND Multiple pregnancy with a complete hydatidiform mole and a normal fetus is prone to severe obstetrical complications and malignant transformation after birth. Prognostic information is limited for this rare form of gestational trophoblastic disease. OBJECTIVE This study aimed to determine obstetrical outcomes and the risk of gestational trophoblastic neoplasia in women with multiple pregnancy with complete hydatidiform mole and coexisting normal fetus, and to identify risk factors for poor obstetrical and oncological outcomes to improve patient information and management. STUDY DESIGN This was a retrospective national cohort study of 11,411 records from the French National Center for Trophoblastic Disease registered between January 2001 and January 2022. RESULTS Among 11,411 molar pregnancies, 141 involved histologically confirmed multiple pregnancy with complete hydatidiform mole and coexisting normal fetus. Roughly a quarter of women (23%; 33/141) decided to terminate pregnancy because of presumed poor prognosis or by choice. Among the 77% of women (108/141) who continued their pregnancy, 16% of pregnancies (17/108) were terminated because of maternal complications, and 37% (40/108) ended in spontaneous miscarriage before 24 weeks' gestation. The median gestational age at delivery in the remaining 47% of pregnancies (51/108) was 32 weeks. The overall neonatal survival rate at day 8 was 36% (39/108; 95% confidence interval, 27-46) after excluding elective pregnancy terminations. Patients with free beta human chorionic gonadotropin levels <10 multiples of the median were significantly more likely to reach 24 weeks' gestation compared with those with free beta human chorionic gonadotropin levels >10 multiples of the median (odds ratio, 7.0; 95% confidence interval, 1.3-36.5; P=.022). A lower free beta human chorionic gonadotropin level was also associated with better early neonatal survival (the median free beta human chorionic gonadotropin level was 9.4 multiples of the median in patients whose child was alive at day 8 vs 20.0 multiples of the median in those whose child was deceased; P=.02). The overall rate of gestational trophoblastic neoplasia after a multiple pregnancy with complete hydatidiform mole and a normal fetus was 26% (35/136; 95% confidence interval, 19-34). All 35 patients had low-risk International Federation of Gynecology and Obstetrics scores, and the cure rate was 100%. Termination of pregnancy on patient request was not associated with lower risk of gestational trophoblastic neoplasia. Maternal complications such as preeclampsia and postpartum hemorrhage were not associated with higher risk of gestational trophoblastic neoplasia, and neither were high human chorionic gonadotropin levels or newborn survival at day 8. CONCLUSION Multiple pregnancy with complete hydatidiform mole and coexisting fetus carries a high risk of obstetrical complications. In patients who continued their pregnancy, approximately one-third of neonates were alive at day 8, and roughly 1 in 4 patients developed gestational trophoblastic neoplasia. Therefore, the risk of malignant transformation appears to be higher compared with singleton complete moles. Low levels of free beta human chorionic gonadotropin may be indicative of better early neonatal survival, and this relationship warrants further study.
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Affiliation(s)
- Touria Hajri
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France
| | - Mona Massoud
- Department of Obstetrics and Gynecology, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon, France
| | - Margot Vergne
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France
| | - Pierre Descargues
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France; Department of Obstetrics and Gynecology, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon, France
| | - Fabienne Allias
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France; Department of Pathology, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon, France
| | - Benoit You
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France; Department of Medical Oncology, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon Sud University Hospital, Investigation Center for Treatments in Oncology and Hematology of Lyon (CITOHL), Lyon, France
| | - Jean-Pierre Lotz
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France; Department of Medical Oncology and Cellular Therapy, Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Tenon University Hospital, Alliance for Cancer Research (APREC), Paris, France
| | - Julie Haesebaert
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France; Research on Healthcare Performance (RESHAPE), Inserm U1290, Université Claude Bernard Lyon 1, France
| | - Pierre-Adrien Bolze
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France; Department of Obstetrics and Gynecology, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon, France
| | - François Golfier
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France; Department of Obstetrics and Gynecology, Université Claude Bernard Lyon 1, Hospices Civils de Lyon, Lyon Sud University Hospital, Lyon, France
| | - Jerome Massardier
- Hospices Civils de Lyon, French Trophoblastic Disease Reference Center, Lyon Sud University Hospital, Lyon, France; Department of Obstetrics and Gynecology, Hospices Civils de Lyon, Femme Mere Enfant University Hospital, Lyon, France.
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Yang J, Shi Z, Jia S, Liu J, Jiang L, Zhu Y. Systematic Evaluation and Nursing Outlook of Clinical Characteristics of 60 Twin Pregnancies with Complete Hydatidiform Mole and a Coexistent Viable Foetus. Patient Prefer Adherence 2023; 17:2631-2640. [PMID: 37920745 PMCID: PMC10618561 DOI: 10.2147/ppa.s428330] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 10/14/2023] [Indexed: 11/04/2023] Open
Abstract
Objective To analyse the clinical data of and provide a reference for the care and perinatal health care of twin pregnancy patients with complete hydatidiform mole and a coexistent foetus (CHM & CF). Methods We searched the China National Knowledge Infrastructure (CNKI) and Wanfang and VIP databases to comprehensively collect clinical studies on the "clinical characteristics of complete hydatidiform mole and coexisting foetal twin pregnancy". Patients' data were extracted from the literature, and 60 patients were divided into Group A (live newborns not delivered, 47) and Group B (live newborns delivered, 13). The clinical characteristics of the two groups were compared to explore the pregnancy outcomes and influencing factors of persistent gestational trophoblastic disease (pGTD) in patients with CHM & CF. Results The gestational week of diagnosis (Odd Ratio (OR)=0.203, 95% Confidence Interval (CI)=0.055-0.753) and number of complications (OR=0.328, 95% CI=0.135-0.793) were found to be independent influencing factors of pregnancy outcomes in patients with CHM & CF (p < 0.05). Ovulation induction therapy (OR=2.333, 95% CI=0.561-9.708), preeclampsia (OR=75.000, 95% CI=11.041-509.486) and the number of complications (OR=4.768, 95% CI=1.914-11.875) were the independent influencing factors of developing pGTD (p < 0.05). Conclusion Pregnancy should not be terminated immediately after the early detection of CHM & CF, and multiple factors should be considered. Preeclampsia may indicate a poor prognosis, and ovulation induction may increase the incidence of pGTD. Targeted nursing and psychological nursing should be carried out according to the clinical symptoms of the patients.
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Affiliation(s)
- Jing Yang
- Department of Obstetrics, Suzhou Municipal Hospital, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, People’s Republic of China
| | - Zhan Shi
- Department of Obstetrics, Suzhou Municipal Hospital, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, People’s Republic of China
| | - Shafeng Jia
- Department of Obstetrics, Suzhou Municipal Hospital, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, People’s Republic of China
| | - Jia Liu
- Department of Nursing Department, Gusu School, Nanjing Medical University, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, People’s Republic of China
| | - Ling Jiang
- Department of Nursing Department, Gusu School, Nanjing Medical University, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, People’s Republic of China
| | - Yueqin Zhu
- Department of Nursing Department, Gusu School, Nanjing Medical University, the Affiliated Suzhou Hospital of Nanjing Medical University, Suzhou, People’s Republic of China
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4
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Ulrikh E, Dikareva E, Govorov I, Komlichenko E, Pervunina T, Li O, Zhamborova O, Dzharbaeva A, Deynega V, Artemenko V, Urmancheeva A. Gestational Trophoblastic Disease with Coexisting Progressing Pregnancy: Personalised Treatment Modalities. Int J Clin Pract 2023; 2023:5502317. [PMID: 37927849 PMCID: PMC10622598 DOI: 10.1155/2023/5502317] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Revised: 09/09/2023] [Accepted: 10/09/2023] [Indexed: 11/07/2023] Open
Abstract
Purpose Gestational trophoblastic disease (GTD) coexisting with a steadily progressing pregnancy is an extremely rare condition presented in the literature as a single case or case series of successful delivery. The purpose of this study was to describe five cases of GTD and present possible management strategies for such patients. Methods Clinical data of five pregnancies with coexisting GTD were identified within the Almazov National Medical Research Centre from 2018 to 2021. Results Three cases of multiple pregnancies with complete hydatidiform moles and two cases of singleton pregnancies with intraplacental choriocarcinoma and invasive hydatidiform moles were identified. Three pregnancies were prolonged and ended with preterm deliveries. Malignant transformation of the GTD accounted for 60% of the cases. The condition of newborns was based on the level of prematurity and functional immaturity, and in all cases, it was aggravated by anemia. Conclusion GTD coexisting with progressing pregnancy is threatened by the risks of preterm delivery, miscarriage, hemorrhage, and disease progression and requires monitoring in a multidisciplinary clinic experienced in the management of patients with malignant tumors during pregnancy. In cases of prolonged pregnancy against the background of GTD, we suggest the following monitoring during pregnancy: pelvic, abdominal ultrasound/MRI (without contrast), prenatal invasive fetal karyotype testing in cases of singleton pregnancy, lung X-ray/CT with uterine shielding, weekly assessment of β-hCG levels, and dynamic monitoring of the fetus. The following postnatal monitoring should be performed: morphological examination of the placenta, weekly assessment of β-hCG levels up to normalization, then monthly assessment up to six months, and control of β-hCG level of the newborn.
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Affiliation(s)
- Elena Ulrikh
- Personalized Medicine Center, Almazov National Medical Research Centre, Saint-Petersburg 197341, Russia
| | - Elena Dikareva
- Personalized Medicine Center, Almazov National Medical Research Centre, Saint-Petersburg 197341, Russia
| | - Igor Govorov
- Personalized Medicine Center, Almazov National Medical Research Centre, Saint-Petersburg 197341, Russia
| | - Eduard Komlichenko
- Personalized Medicine Center, Almazov National Medical Research Centre, Saint-Petersburg 197341, Russia
| | - Tatiana Pervunina
- Personalized Medicine Center, Almazov National Medical Research Centre, Saint-Petersburg 197341, Russia
| | - Olga Li
- Personalized Medicine Center, Almazov National Medical Research Centre, Saint-Petersburg 197341, Russia
| | - Oksana Zhamborova
- Personalized Medicine Center, Almazov National Medical Research Centre, Saint-Petersburg 197341, Russia
| | - Aminat Dzharbaeva
- Personalized Medicine Center, Almazov National Medical Research Centre, Saint-Petersburg 197341, Russia
| | - Viktor Deynega
- Personalized Medicine Center, Almazov National Medical Research Centre, Saint-Petersburg 197341, Russia
| | - Veronika Artemenko
- Personalized Medicine Center, Almazov National Medical Research Centre, Saint-Petersburg 197341, Russia
| | - Adel Urmancheeva
- Personalized Medicine Center, Almazov National Medical Research Centre, Saint-Petersburg 197341, Russia
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Libretti A, Longo D, Faiola S, De Pedrini A, Troìa L, Remorgida V. A twin pregnancy with partial hydatidiform mole and a coexisting normal fetus delivered at term: A case report and literature review. Case Rep Womens Health 2023; 39:e00544. [PMID: 37753223 PMCID: PMC10518573 DOI: 10.1016/j.crwh.2023.e00544] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2023] [Revised: 09/13/2023] [Accepted: 09/15/2023] [Indexed: 09/28/2023] Open
Abstract
Hydatiform mole occurs in 1/1000 singleton and 1/20000-100,000 twin pregnancies. Although the pregnancy often ends in a miscarriage or presents with many obstetric complications such as preeclampsia, vaginal bleeding, hyperthyroidism, prematurity, or fetal malformations, in some cases of twin pregnancy, one of the fetuses can develop normally. Coexistence of a viable fetus in a twin molar pregnancy is more commonly described for cases of complete hydatiform moles than partial hydatiform moles. A partial hydatiform mole coexisting with a normal fetus was suspected in a 40-year-old woman, G2P1, at twelve weeks of gestation of a twin dichorionic diamniotic pregnancy. Serial antenatal ultrasound scans and serial evaluations of human chorionic gonadotropin were performed, and a healthy baby was delivered at term without any obstetric or neonatal complications. A twin pregnancy with partial hydatidiform mole and a coexisting normal fetus is a rare obstetric condition that can result, under proper management, in the delivery of a healthy baby without any sequelae for the mother or child.
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Affiliation(s)
- Alessandro Libretti
- Unit of High-Risk Pregnancy, department of Gynaecology and Obstetrics, University Hospital Maggiore della Carità, 20090 Novara, Italy
- School of Gynaecology and Obstetrics, University of Eastern Piedmont, 20090 Novara, Italy
| | - Daniela Longo
- Unit of High-Risk Pregnancy, department of Gynaecology and Obstetrics, University Hospital Maggiore della Carità, 20090 Novara, Italy
| | - Stefano Faiola
- Fetal Therapy Unit 'Umberto Nicolini', Buzzi Children's Hospital, 20134 Milan, Italy
- Department of Woman, Mother and Neonate, Buzzi Children's Hospital, 20134 Milan, Italy
| | - Alberto De Pedrini
- Unit of High-Risk Pregnancy, department of Gynaecology and Obstetrics, University Hospital Maggiore della Carità, 20090 Novara, Italy
| | - Libera Troìa
- Unit of High-Risk Pregnancy, department of Gynaecology and Obstetrics, University Hospital Maggiore della Carità, 20090 Novara, Italy
- School of Gynaecology and Obstetrics, University of Eastern Piedmont, 20090 Novara, Italy
| | - Valentino Remorgida
- Unit of High-Risk Pregnancy, department of Gynaecology and Obstetrics, University Hospital Maggiore della Carità, 20090 Novara, Italy
- School of Gynaecology and Obstetrics, University of Eastern Piedmont, 20090 Novara, Italy
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6
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Yayna AA, Ayza A, Dana WW, Yemaneh A, Worana B, Tesfaye A, Desalegn A, Kassaye G, Adamu E, Leka YA, Tadesse M, Gure T. Complete molar pregnancy with coexisting normal twin complicated by hyperthyroidism that resulted in normal alive delivery: A case report from Wolaita Sodo, Ethiopia. SAGE Open Med Case Rep 2023; 11:2050313X231189404. [PMID: 37533490 PMCID: PMC10392214 DOI: 10.1177/2050313x231189404] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Accepted: 07/05/2023] [Indexed: 08/04/2023] Open
Abstract
It is a rare condition in twin pregnancies for a fetus to coexist with a complete hydatidiform mole, present with complications, and result in a healthy neonate. Only a few cases have been reported upon review of the literature. Early diagnosis is essential because this type of pregnancy is associated with serious complications and management challenges. The complications associated with these pregnancies include antepartum hemorrhage, hyperthyroidism, preeclampsia, prematurity, fetal death, and gestational trophoblastic neoplasia. Here, we describe a case of dizygotic twin pregnancy in which a complete mole coexists with a normal fetus, complicated by hyperthyroidism, that resulted in the birth of a 1700-g female alive neonate who is euthyroid to a 25-year-old primigravida at a gestational age of 33 weeks by emergency cesarean section for an indication of a twin pregnancy molar coexisting with an alive fetus in labor. The mother had been on conservative management and treated as an inpatient for hyperthyroidism. In our country, there have been three case reports of partial moles with coexisting alive fetuses, but this is the first case report of a complete mole with a coexisting alive fetus.
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Affiliation(s)
- Amanuel Admasu Yayna
- Department of Gynecology and Obstetrics, Wolaita Sodo University Comprehensive and Specialized Hospital, Sodo, Ethiopia
| | - Adane Ayza
- Department of Gynecology and Obstetrics, Wolaita Sodo University Comprehensive and Specialized Hospital, Sodo, Ethiopia
| | - Wokil Wolde Dana
- Department of Gynecology and Obstetrics, Wolaita Sodo University Comprehensive and Specialized Hospital, Sodo, Ethiopia
| | - Amdetsiyon Yemaneh
- Department of Gynecology and Obstetrics, Wolaita Sodo University Comprehensive and Specialized Hospital, Sodo, Ethiopia
| | - Bereket Worana
- Department of Gynecology and Obstetrics, Wolaita Sodo University Comprehensive and Specialized Hospital, Sodo, Ethiopia
| | - Ashebir Tesfaye
- Department of Gynecology and Obstetrics, Wolaita Sodo University Comprehensive and Specialized Hospital, Sodo, Ethiopia
| | - Abinet Desalegn
- Department of Gynecology and Obstetrics, Wolaita Sodo University Comprehensive and Specialized Hospital, Sodo, Ethiopia
| | - Getu Kassaye
- Department of Gynecology and Obstetrics, Wolaita Sodo University Comprehensive and Specialized Hospital, Sodo, Ethiopia
| | - Ermias Adamu
- Department of Gynecology and Obstetrics, Wolaita Sodo University Comprehensive and Specialized Hospital, Sodo, Ethiopia
| | - Yohannes Abraham Leka
- Department of Pathology, Wolaita Sodo University Comprehensive and Specialized Hospital, Sodo, Ethiopia
| | - Mulugeta Tadesse
- Department of Gynecology and Obstetrics, Wolaita Sodo University Comprehensive and Specialized Hospital, Sodo, Ethiopia
| | - Tadesse Gure
- Department of Gynecology and Obstetrics, Haramaya University Comprehensive and Specialized Hospital, Dire Dawa, Ethiopia
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Khalloufi C, Joudar I, El Abbassi I, Jalal M, Lamrissi A, Bouhya S. Twin pregnancy combining complete hydatidiform mole and healthy fetus: Case report and review of the literature. Int J Surg Case Rep 2023; 105:107959. [PMID: 36924602 PMCID: PMC10112189 DOI: 10.1016/j.ijscr.2023.107959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2022] [Revised: 01/24/2023] [Accepted: 03/02/2023] [Indexed: 03/06/2023] Open
Abstract
INTRODUCTION AND IMPORTANCE Twin pregnancy combining a complete mole and a normal fetal pregnancy with its own healthy trophoblast is a rare entity. A partial molar pregnancy almost always ends in miscarriage due to a triploid fetus. CASE PRESENTATION We report the case of a 43-year-old female patient admitted for bleeding during the 20th week of pregnancy. Pelvic ultrasound showed the combination of a complete hydatidiform mole and a normal fetal pregnancy. The decision to medically terminate the pregnancy was taken after consultation with the family. Examination of the placenta and histological study confirmed the diagnosis of complete hydatidiform mole associated with a normal fetus. The evolution was uneventful. CLINICAL DISCUSSION Twin pregnancy combining a complete mole and a normal fetal pregnancy with its own healthy trophoblast is a rare entity that should not be misdiagnosed. There is still no consensus in terms of therapeutic attitude, the dilemma remains and the decision should always include the couple after a thorough explanation of all the risks. CONCLUSION Our case reaffirms that to successfully manage this rare yet life-threatening condition, heterotopic pregnancy should be included in the differential diagnosis for any gravid women presenting with persistent abdominal pain, abnormal bleeding and/or extrauterine mass.
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Affiliation(s)
- Chadia Khalloufi
- Maternity, University Hospital Abderrahim Harouchi, Casablanca, Morocco; Faculty of Medicine and Pharmacy, University Hassan II, Ain chock BP 5366, 20000 Casablanca, Morocco.
| | - Imane Joudar
- Maternity, University Hospital Abderrahim Harouchi, Casablanca, Morocco; Faculty of Medicine and Pharmacy, University Hassan II, Ain chock BP 5366, 20000 Casablanca, Morocco
| | - Imane El Abbassi
- Maternity, University Hospital Abderrahim Harouchi, Casablanca, Morocco; Faculty of Medicine and Pharmacy, University Hassan II, Ain chock BP 5366, 20000 Casablanca, Morocco
| | - Mohammed Jalal
- Maternity, University Hospital Abderrahim Harouchi, Casablanca, Morocco; Faculty of Medicine and Pharmacy, University Hassan II, Ain chock BP 5366, 20000 Casablanca, Morocco
| | - Amine Lamrissi
- Maternity, University Hospital Abderrahim Harouchi, Casablanca, Morocco; Faculty of Medicine and Pharmacy, University Hassan II, Ain chock BP 5366, 20000 Casablanca, Morocco
| | - Said Bouhya
- Maternity, University Hospital Abderrahim Harouchi, Casablanca, Morocco; Faculty of Medicine and Pharmacy, University Hassan II, Ain chock BP 5366, 20000 Casablanca, Morocco
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8
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Diagnostic et prise en charge d’une grossesse gémellaire associant une môle complète à un fœtus vivant : à propos d’un cas. IMAGERIE DE LA FEMME 2023. [DOI: 10.1016/j.femme.2023.01.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/19/2023]
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9
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Case Report of a Triplet Pregnancy with Complete Hydatidiform Mole and Coexisting Twins. Case Rep Obstet Gynecol 2022; 2022:2865342. [PMID: 35966886 PMCID: PMC9371886 DOI: 10.1155/2022/2865342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2022] [Accepted: 07/18/2022] [Indexed: 11/22/2022] Open
Abstract
Background Triplet pregnancy with complete hydatidiform mole and coexisting twin fetuses is extremely rare with an unknown incidence. Case Here, we present a case report of a pregnancy with twin fetuses and concurrent hydatidiform mole that resulted in the preterm delivery of one viable baby, the unfortunate intrauterine demise of the other twin, and successful treatment of gestational trophoblastic neoplasia in the postpartum period. Conclusion This case highlights several important questions that arise for women who choose to carry a multiple gestation pregnancy with complete hydatidiform mole and describes complications that can occur. It is imperative to accurately assess risks and counsel individuals who elect to carry these pregnancies to provide the best possible outcomes.
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10
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Mangla M, Kaur H, Khoiwal K. Partial mole with coexistent live fetus: A systematic review of case reports. J Turk Ger Gynecol Assoc 2022; 23:83-94. [PMID: 35642357 PMCID: PMC9160997 DOI: 10.4274/jtgga.galenos.2022.2021-9-11] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2021] [Accepted: 03/20/2022] [Indexed: 12/01/2022] Open
Abstract
Objective Molar pregnancy coexistent with a live fetus can be a diagnostic and therapeutic challenge. With increasing incidence of multiple pregnancies, there has also been an increase in twin pregnancy with one mole in the recent years. The authors discuss the epidemiology, clinical presentation, and prenatal diagnosis and attempt to design a possible management strategy, to help guide the treating physician, in the management of partial mole with live pregnancy, thereby improving maternal and fetal prognosis. Material and Methods Numerous case reports have been published in various journals regarding management of individual cases of partial molar pregnancy coexistent with live fetus (PMCF). Therefore, we conducted a systematic review of all the case reports and short case series in English concerning partial mole with live pregnancy from 1999 to 2019, that is in the last 20 years. Results In total, 44 case reports of PMCF were analyzed. The mean gestational age at diagnosis was 20+6 (range: 10-40) weeks. Less than half (19/44; 43.2%) were asymptomatic at the time of detection and PMCF was detected on routine scan done for fetal well-being or 11-13-week scan. The majority (56.8%) resulted in the birth of a healthy live fetus. Gestational trophoblastic neoplasia developed in 3/44 (6.8%). Conclusion PMCF involves a high risk of bleeding, preterm labour, intrauterine growth restriction and stillbirth. Successful management of such cases needs prenatal diagnosis, antepartum surveillance and post-natal follow-up. An obstetrician, maternal fetal medicine specialist, gynecology oncologist and neonatal intensivist should be involved in the care of such pregnancies.
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Affiliation(s)
- Mishu Mangla
- Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Hyderabad, India
| | - Harpreet Kaur
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bilaspur India
| | - Kavita Khoiwal
- Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Rishikesk, India
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11
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Liang H, Pan NP, Wang YF, Ye CS, Yan ZQ, Wu RJ. Obstetrical and oncological outcomes of twin pregnancies with hydatidiform mole and coexisting fetus. Taiwan J Obstet Gynecol 2022; 61:453-458. [PMID: 35595437 DOI: 10.1016/j.tjog.2022.03.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/02/2021] [Indexed: 11/29/2022] Open
Abstract
OBJECTIVE To evaluate the obstetrical and oncological progression of twin pregnancies with hydatidiform mole coexisting fetus (HMCF). MATERIALS AND METHODS Using a retrospective method based on patients from the Women's Hospital, Zhejiang University School of Medicine database between January 1990 and October 2020, 17 patients were histologically confirmed as having HMCF, and the patients' prenatal diagnosis, outcomes and development of gestational trophoblastic neoplasia (GTN) were reviewed. RESULTS Among these 17 cases, 11 (64.71%) cases were complete hydatidiform mole coexisting fetus (CHMCF), and 6 (35.29%) cases were partial hydatidiform mole coexisting fetus (PHMCF). The gestational age at diagnosis of CHMCF was significantly earlier than that of PHMCF [9 (8-24) vs. 18 (11-32) weeks, respectively, P < 0.05]. The live birth rate of PHMCF was slightly higher than that of CHMCF (33.33%; 18.18%), but this difference was not statistically significant. The overall rate of GTN incidence of HMCF was 47.06% (8/17), and the GTN rates of PHMCF and CHMCF were 33.33% (2/6) and 54.55% (6/11), respectively. There was no significant difference in the GTN rate between patients who chose to continue pregnancy and those who terminated pregnancy before 24 weeks of gestation. The GTN rate of patients with term delivery was not significantly higher than that of preterm delivery. CONCLUSION In HMCF cases, the incidence rate of CHMCF was higher than that of PHMCF, and PHMCF is more difficult to diagnose in the early stage. Continuing pregnancy does not increase the risk of GTN compared to terminating pregnancy. In cases of HMCF, when the fetal karyotype is normal and maternal complications are controlled, it is safe to continue the pregnancy and extend it to term.
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Affiliation(s)
- Hui Liang
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, PR China
| | - Ning-Ping Pan
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, PR China
| | - Yin-Feng Wang
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, PR China
| | - Chao-Shuang Ye
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, PR China
| | - Zhu-Qing Yan
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, PR China
| | - Rui-Jin Wu
- Department of Obstetrics, Women's Hospital, Zhejiang University School of Medicine, Hangzhou, 310006, PR China.
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12
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McHenry A, Magriples U, Hui P, Morotti R. Complete Hydatidiform Mole and Coexisting Fetus With Gastroschisis: A Case Report Highlighting the Importance of Diagnostic Genotyping. Pediatr Dev Pathol 2021; 24:575-580. [PMID: 34134566 DOI: 10.1177/10935266211024823] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Twin pregnancy with a complete hydatidiform mole and a coexisting fetus (CHMCF) is an extremely rare occurrence, described only by a handful of published series and cases reports. The majority of the literature on CHMCF examines prenatal care and follow-up in relation to the increased risk of gestational trophoblastic neoplasia (GTN). At present, few reports elaborate on the diagnostic process and differential diagnosis, especially in the context of recent molecular advances in risk stratification for GTN. Here, we describe the first known case of a CHMCF with gastroschisis with liveborn delivery at 35 weeks gestation. This report aims to review the pre- and postnatal differential diagnosis and discuss recent updates on the importance of ancillary studies in the diagnosis of gestational trophoblastic disease.
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Affiliation(s)
- Austin McHenry
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Urania Magriples
- Department of Obstetrics, Gynecology & Reproductive Sciences, Yale University School of Medicine, New Haven, Connecticut
| | - Pei Hui
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
| | - Raffaella Morotti
- Department of Pathology, Yale University School of Medicine, New Haven, Connecticut
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13
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Tsakiridis I, Giouleka S, Kalogiannidis I, Mamopoulos A, Athanasiadis A, Dagklis T. Diagnosis and Management of Gestational Trophoblastic Disease: A Comparative Review of National and International Guidelines. Obstet Gynecol Surv 2021; 75:747-756. [PMID: 33369685 DOI: 10.1097/ogx.0000000000000848] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Importance Gestational trophoblastic disease (GTD) is associated with increased mortality and morbidity in women of reproductive age, if managed in a suboptimal way, left untreated, or diagnosed after the development of extensive metastases. Objective The aims of this study were to review and compare the recommendations from published guidelines on these tumors of placental origin. Evidence Acquisition A descriptive review of guidelines from the Royal College of Obstetricians and Gynecologists, the International Federation of Gynecology and Obstetrics, the European Society for Medical Oncology, and the Royal Australian and New Zealand College of Obstetricians and Gynecologists on GTD was carried out. Results All the guidelines agree that suction evacuation is the optimal management for hydatidiform molar pregnancy and that chemotherapy, either single-agent (for low risk) or multiagent (for high risk), is the preferred treatment modality for choriocarcinoma. There is also a consensus that a future pregnancy should be avoided during follow-up; therefore, an effective contraception method should be used. All medical societies recommend the registration of such patients to GTD screening centers, endorse the use of International Federation of Gynecology and Obstetrics 2000 scoring system, and mention that the diagnosis of gestational trophoblastic neoplasia (GTN) should be based on the clinical presentation (from the genital tract and the metastatic sites) and the human chorionic gonadotropin evaluation. Additionally, all 4 medical societies recommend the surgical management of placental site trophoblastic tumors or epithelioid trophoblastic tumors, as chemotherapy is less effective in these cases. However, there is controversy regarding the appropriate follow-up after the treatment of hydatidiform mole, the administration of anti-D immunoglobulin, the time of oxytocin infusion, and the salvage regimens that may be used in cases of resistant or recurrent GTN. Conclusions There is need for consistent international practice protocols, which will lead to an earlier diagnosis and eventually to a more effective management of GTD worldwide and decrease in the recurrence rate and in the associated morbidity and mortality.
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Affiliation(s)
| | | | | | - Apostolos Mamopoulos
- Professor, Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Athanasiadis
- Professor, Third Department of Obstetrics and Gynaecology, Faculty of Medicine, Aristotle University of Thessaloniki, Thessaloniki, Greece
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14
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Tsakiridis I, Mamopoulos A, Kalogiannidis I, Dagklis T, Aggelidou S, Athanasiadis A. Coexisting normal pregnancy with complete mole: a rare case report with successful pregnancy outcome. J OBSTET GYNAECOL 2021; 41:1169-1171. [PMID: 33615969 DOI: 10.1080/01443615.2020.1845636] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Affiliation(s)
- Ioannis Tsakiridis
- Third Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Apostolos Mamopoulos
- Third Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Ioannis Kalogiannidis
- Third Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Themistoklis Dagklis
- Third Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
| | - Stamatia Aggelidou
- Department of Histopathology, Hippokratio General Hospital, Thessaloniki, Greece
| | - Apostolos Athanasiadis
- Third Department of Obstetrics and Gynaecology, Aristotle University of Thessaloniki, Thessaloniki, Greece
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15
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Rajasekaran K, Dadhwal V, Jassim M. Incidental diagnosis of sad fetus syndrome in triplets. BMJ Case Rep 2021; 14:14/2/e238977. [PMID: 33541990 PMCID: PMC7868267 DOI: 10.1136/bcr-2020-238977] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
An unusual presentation of gestational trophoblastic disease is twin molar pregnancy, rarest in triplets with differentials being partial/complete mole, placental mesenchymal dysplasia (PMD), placental cysts or chorioangioma each with different complications. Counselling to continue pregnancy depends on diagnosis. A 37-year-old G2P1L1, donor oocyte In vitro fertlisation (IVF) twin pregnancy was referred at 24 weeks with cystic areas in placenta. Probability of twin partial mole or PMD was assessed. The scan of fetuses showed normal growth, no structural anomalies. Biochemical markers showed high maternal beta human chorionic gonadotropin (β-hCG). Amniocentesis of molar fetus revealed normal karyotype. Likely diagnosis made as twin partial mole. The patient delivered by caesarean section at 28+2 weeks due to preterm labour. Twins, a male and a female baby, were delivered with three placentas, two normal and the third with molar changes and no fetal parts. Diagnosis was revised as triplet with partial mole, which was confirmed on histopathology. Serial monitoring of β-hCG became undetectable by eighth week. The male baby died on day 4. The mother and the female baby were discharged.
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Affiliation(s)
- Keerthana Rajasekaran
- Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Vatsla Dadhwal
- Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, Delhi, India
| | - Mohamed Jassim
- Pathology, Kidwai Memorial Institute of Oncology, Bangalore, Karnataka, India
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16
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Mok ZW, Merchant K, Yip SL. Management of a complete hydatidiform mole with a coexisting live fetus followed by successful treatment of maternal metastatic gestational trophoblastic disease: learning points. BMJ Case Rep 2021; 14:14/1/e235028. [PMID: 33461990 PMCID: PMC7813335 DOI: 10.1136/bcr-2020-235028] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
A 34-year-old patient had her first trimester Down syndrome scan followed by serial ultrasound scans which showed a single intrauterine pregnancy with multiple cystic areas in the anterior placenta. She presented in preterm labour with a breech presentation at 32 weeks and underwent an emergency caesarean section. She delivered a male infant weighing 1750 g. The placental histopathology showed a complete hyatidiform mole. At 4 weeks postpartum, beta-human chorionic gonadotrophin (Bhcg) levels rose from 460 to 836 mIU/mL over 1 week. Metastatic workup revealed prominent pelvic nodes and pulmonary nodules in both lungs. This was discussed at the Multi-Disciplinary Tumour Board and single-agent intramuscular methotrexate was recommended. After chemotherapy, she achieved Bhcg normalisation after three cycles. This case highlights the importance of clinical vigilance even in low-risk patients. Unexpected findings on ultrasound should involve multidisciplinary input with radiology colleagues. A high index of suspicion for gestational trophoblastic disease and close follow-up is imperative.
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Affiliation(s)
- Zhun Wei Mok
- Division of Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore
| | - Khurshid Merchant
- Department of Pathology and Laboratory Medicine, KK Women's and Children's Hospital, Singapore
| | - Swee Lin Yip
- Division of Obstetrics and Gynaecology, Department of Obstetrics and Gynaecology, KK Women's and Children's Hospital, Singapore
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17
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Camacho-Montaño AM, Niño-Alba R. Partial molar pregnancy with live fetus complicated by intrauterine growth restriction and severe preeclampsia. Case report and review of the literature. REVISTA COLOMBIANA DE OBSTETRICIA Y GINECOLOGIA 2020; 71:286-296. [PMID: 33247892 DOI: 10.18597/rcog.3461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2019] [Accepted: 06/21/2020] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To report the case of a partial molar pregnancy with live fetus and conduct a review of the literature regarding maternal and fetal complications associated to this condition. METHODS Case report of a partial mole with a 33 weeks live fetus complicated by intrauterine growth restriction, oligohydramnios and severe preeclampsia. We report satisfactory maternal and neonatal outcomes and 1-year follow-up. A search was conducted in the Medline via Pubmed, Lilacs, Ovid, Uptodate and Google Scholar databases using the following MESH terms: hiditadiform mole, partial mole, live fetus, coexisting live fetus. Case series and case reports of pregnant women with coexisting partial mole and live fetus at the time of diagnosis were selected and information regarding maternal and fetal prognosis was extracted. RESULTS Initially, 129 related titles were identified. Of these, 29 met the inclusion criteria, and 4 articles were excluded due to failed access to the full text. Overall, 31 reported cases were included; 9 ended in miscarriage, 8 in fetal demise or perinatal death, and 14 (45 %) resulted in a live neonate. The most frequent maternal complication was preeclampsia in 6 (19.35 %) cases. CONCLUSIONS The coexistence of a partial mole with a live fetus poses a high risk of adverse perinatal outcomes and preeclampsia. The volume of information regarding this rare condition must be increased in order to better determine potential interventions in cases of euploid fetuses and to provide adequate counseling in clinical practice. Therefore, reporting these cases is important to build sufficient evidence about the natural course of this condition.
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Affiliation(s)
| | - Reinaldo Niño-Alba
- Médico cirujano, especialista ginecología y obstetricia, Universidad Nacional de Colombia, Bogotá(Colombia)
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18
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Zilberman Sharon N, Maymon R, Melcer Y, Jauniaux E. Obstetric outcomes of twin pregnancies presenting with a complete hydatidiform mole and coexistent normal fetus: a systematic review and meta-analysis. BJOG 2020; 127:1450-1457. [PMID: 32339446 DOI: 10.1111/1471-0528.16283] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/16/2020] [Indexed: 11/28/2022]
Abstract
BACKGROUND Epidemiological data on obstetric and oncologic complications in twin pregnancies combining a complete hydatidiform mole (CHM) coexisting with a normal fetus and placenta are limited. OBJECTIVES To evaluate perinatal and obstetric outcomes for mother and fetus and risk of gestational trophoblastic neoplasia (GTN) in twin pregnancies including a CHM. SEARCH STRATEGY PubMed, MEDLINE and EMBASE and the grey literature were searched for articles published between May 1980 and May 2019 using a protocol designed a priori and registered on PROSPERO (CRD42018112524). SELECTION CRITERIA Observational cohort studies of four or more cases confirmed by histopathology and providing data on pregnancy outcomes and GTN. DATA COLLECTION AND ANALYSIS Two reviewers independently reviewed abstracts and full-text articles. The quality of the studies was assessed with the Newcastle-Ottawa scale and a meta-analysis was performed. MAIN RESULTS Of the 344 abstracts identified, 14 studies (244 cases) met the eligibility criteria. The incidence of maternal complication in ongoing pregnancies was 80.8% and included vaginal bleeding, hyperthyroidism and pre-eclampsia. There were overall 91 (50%) live births in ongoing pregnancies and 83 (34%) of the total cases were subsequently diagnosed with GTN. Substantial and significant (P < 0.001) heterogeneity was found for the incidence of preeclampsia indicating variability in reporting the incidence of some obstetric complications between studies. CONCLUSIONS Patients diagnosed with a twin pregnancy combining a CHM and an apparently normal fetus have a high risk of perinatal complications, low live-birth rates and around a third of them will develop a GTN and should be managed by specialised multidisciplinary teams. TWEETABLE ABSTRACT Our study indicates a high rate of obstetric and oncologic complications in patients presenting with a complete hydatidiform mole and coexistent normal fetus.
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Affiliation(s)
- N Zilberman Sharon
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel.,Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - R Maymon
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel.,Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Y Melcer
- Department of Obstetrics and Gynecology, The Yitzhak Shamir Medical Center (formerly Assaf Harofeh Medical Center), Zerifin, Israel.,Affiliated with the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - E Jauniaux
- Faculty of Population Health Sciences, EGA Institute for Women's Health, University College London, London, UK
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19
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Gabra MG, Gonzalez MG, Bullock HN, Hill MG. Cell-Free DNA as an Addition to Ultrasound for Screening of a Complete Hydatidiform Mole and Coexisting Normal Fetus Pregnancy: A Case Report. AJP Rep 2020; 10:e176-e178. [PMID: 32566367 PMCID: PMC7302929 DOI: 10.1055/s-0040-1709981] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Accepted: 02/20/2020] [Indexed: 11/18/2022] Open
Abstract
Background Complete hydatidiform mole and coexisting normal fetus pregnancies (CHMCF) are rare and can be life-threatening to the mother. Definitive diagnosis can be made with chorionic villus sampling or amniocentesis. However invasive procedures carry a risk of bleeding. We present the case of a twin molar pregnancy where a cell-free DNA screening test was utilized to evaluate for CHMCF pregnancy. Case A patient presented at 15-week gestational age with suspected CHMCF pregnancy. Ultrasound revealed a normal-appearing pregnancy abutting a multicystic lesion concerning for a complete mole. Cell-free DNA was obtained and was suggestive of complete paternal uniparental disomy. Pathological evaluation of the products of conception confirmed the diagnosis of CHMCF. Conclusion In atypical cases, cell-free DNA may be useful in evaluation of molar pregnancy.
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Affiliation(s)
- Martina G Gabra
- Department of Obstetrics and Gynecology, Banner-University Medical Center, University of Arizona, Tucson, Arizona
| | - Maritza G Gonzalez
- Department of Obstetrics and Gynecology, Banner-University Medical Center, University of Arizona, Tucson, Arizona
| | - Holly N Bullock
- Department of Obstetrics and Gynecology, Banner-University Medical Center, University of Arizona, Tucson, Arizona
| | - Meghan G Hill
- Department of Obstetrics and Gynecology, Banner-University Medical Center, University of Arizona, Tucson, Arizona
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20
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Odedra D, MacEachern K, Elit L, Mohamed S, McCready E, DeFrance B, Wang Y. Twin pregnancy with metastatic complete molar pregnancy and coexisting live fetus. Radiol Case Rep 2019; 15:195-200. [PMID: 31890067 PMCID: PMC6928291 DOI: 10.1016/j.radcr.2019.11.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2019] [Revised: 11/24/2019] [Accepted: 11/24/2019] [Indexed: 11/26/2022] Open
Abstract
We present a case of a 34-year old G1P0 female with twin-gestation and positive prenatal screening. Initial ultrasounds demonstrated a normal live fetus with an indeterminate but persistent placental lesion. The patient presented at 23 weeks of gestational age with vaginal bleeding. On examination, a 2 cm vaginal lesion was identified. Further cross-sectional imaging demonstrated a normal appearing fetus with a mixed solid and cystic placental lesion as well as an additional lesion in the vagina. Metastatic workup revealed diffuse pulmonary metastases. Intravascular embolization was carried out to minimize the bleeding from the vaginal lesion, followed by the delivery of the fetus with an urgent Caesarean section and treatment with chemotherapy. Pathology and genetics testing confirmed diagnosis of a complete molar pregnancy with a coexisting live fetus. This case highlights the importance of any unexpected findings within the placenta or the uterus in a pregnant patient. The radiologist should maintain a high index of suspicion for gestational trophoblastic disease in such cases, communicate clearly with the clinical team and suggest appropriate additional imaging.
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Affiliation(s)
- Devang Odedra
- Department of Radiology, McMaster University, Room 2S23-1, 1200 Main Street West, Hamilton, ON L8N 3Z5, USA
| | - Kelsey MacEachern
- Michael DeGroote School of Medicine, McMaster University, Hamilton, ON, USA
| | - Lorraine Elit
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, USA.,Department of Oncology, McMaster University, Hamilton, ON, USA
| | - Sarab Mohamed
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, USA
| | - Elizabeth McCready
- Department of Pathology and Molecular Medicine, McMaster University, Hamilton, ON, USA.,Department of Genetics, McMaster University, Hamilton, ON, USA
| | - Bryon DeFrance
- Department of Obstetrics and Gynecology, McMaster University, Hamilton, ON, USA
| | - Yongdong Wang
- Department of Radiology, McMaster University, Room 2S23-1, 1200 Main Street West, Hamilton, ON L8N 3Z5, USA
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21
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Liu Y, Zheng X, Wang Y, Li Y, Liu C. Identification of a hydatidiform mole in twin pregnancy following assisted reproduction. J Assist Reprod Genet 2019; 37:603-610. [PMID: 31833013 DOI: 10.1007/s10815-019-01650-3] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 12/03/2019] [Indexed: 10/25/2022] Open
Abstract
PURPOSE The aim of this study was to identify a co-existing hydatidiform mole (HM) in twin pregnancy from the abnormal mixed-genomic products of conception (POC) after assisted reproduction by histopathological review, evaluation of p57kip2 immunostaining and short tandem repeat genotyping. METHODS Thirty-seven patients were collected with suspicion for HM by pathological morphology. They had two embryos individually transferred to their uterus after in vitro fertilization and presented two gestational sacs with undeveloped embryos or one sac with an abnormal area by ultrasonography. RESULTS Thirty patients were diagnosed as singleton pregnancy, including twenty-two non-molar gestations, six trisomy gestations, one homozygous complete mole and one heterozygous partial mole. Although six patients had ultrasonic imaging of two gestational sacs, the embryonic components in the vacant sac might fade away after transferring. Other seven patients were considered as twin pregnancy by the allelic genotype from two individual conceptions. For the patients with uniform p57kip2 positivity, excessive paternal alleles indicated the potential partial HM in the twin pregnancy. For the patients demonstrated divergent and/or discordant p57kip2 immunostaining, twin pregnancy with co-existing complete HM or mosaic conception were confirmed by genotyping of different villi population respectively. These patients were monitored by serum β-HCG, while one twin pregnancy with complete mole suffered invasive mole and received chemotherapy. CONCLUSIONS A strategy composed of selective clinicopathological screening, immunohistochemical interpretation and accurate genotyping is recommended for diagnostically challenging mixed-genomic POC of potential twin pregnancy with HM, especially to differentiate a non-molar mosaic conception from a partial mole.
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Affiliation(s)
- Yan Liu
- Department of Pathology, School of Basic Medical Sciences, Third Hospital, Peking University Health Science Center, Beijing, 100191, China.
| | - Xingzheng Zheng
- Department of Pathology, Capital Medical University Beijing Obstetrics and Gynecology Hospital, Beijing, 100123, China
| | - Yuxiang Wang
- Department of Pathology, School of Basic Medical Sciences, Third Hospital, Peking University Health Science Center, Beijing, 100191, China
| | - Yan Li
- Department of Pathology, School of Basic Medical Sciences, Third Hospital, Peking University Health Science Center, Beijing, 100191, China
| | - Congrong Liu
- Department of Pathology, School of Basic Medical Sciences, Third Hospital, Peking University Health Science Center, Beijing, 100191, China.
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22
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Lipi LB, Philp L, Goodman AK. A challenging case of twin pregnancy with complete hydatidiform mole and co-existing normal live fetus - A case report and review of the literature. Gynecol Oncol Rep 2019; 31:100519. [PMID: 31890831 PMCID: PMC6926326 DOI: 10.1016/j.gore.2019.100519] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/22/2019] [Accepted: 11/12/2019] [Indexed: 12/03/2022] Open
Abstract
Twin pregnancy with complete hydatidiform mole and co-existing normal live fetus is rare. Antenatal and postpartum complications such as gestational trophoblastic neoplasia are common. Patients require close clinical monitoring and urgent delivery in the setting of complications. Follow-up with serum β-HCG is important for the diagnosis of persistent trophoblastic disease.
Hydatidiform mole coexisting with a normal live fetus in a twin pregnancy is extremely rare. Management of these cases is challenging due to the risk of severe antepartum and post-partum complications. Herein, we report the case of a 24-year-old gravida 2 para 1 who presented at 28 weeks gestation with severe preeclampsia, vulvar edema and a serum β-HCG of 285,000 IU/mL. Ultrasonography demonstrated a single live intra-uterine pregnancy with concurrent hydatidiform mole. Conservative management with magnesium sulfate and anti-hypertensive medications was initiated however the patient developed HELLP syndrome and required urgent delivery at 33 weeks. Copious molar tissue was removed from the uterus during delivery. Four weeks post-partum, her β-HCG had dropped to 14,000 IU/ml and continued to decline at 6 weeks (2900 IU/ml). However, at eight weeks, it increased to 3500 IU/ml and the patient was treated with nine cycles of intramuscular methotrexate. Current guidelines for management of a twin pregnancy with coexistent mole recommend close clinical monitoring if the mother and fetus are stable and urgent delivery in the setting of complications. During the postpartum period, careful follow up with clinical evaluation and serial serum β-HCG is important for the diagnosis and treatment of persistent trophoblastic disease.
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Affiliation(s)
- L B Lipi
- Department of Obstetrics and Gynaecology, Dhaka Medical College Hospital, Dhaka, Bangladesh
| | - L Philp
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA 02114, United States
| | - A K Goodman
- Department of Obstetrics and Gynecology, Massachusetts General Hospital, Boston, MA 02114, United States
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23
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Zeng C, Chen Y, Zhao L, Wan B. Partial Hydatidiform Mole and Coexistent Live Fetus: A Case Report and Review of the Literature. Open Med (Wars) 2019; 14:843-846. [PMID: 31737788 PMCID: PMC6843492 DOI: 10.1515/med-2019-0098] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 09/30/2019] [Indexed: 01/13/2023] Open
Abstract
Twin pregnancy of a hydatidiform mole with a coexistent live fetus is very rare, and complete molar pregnancy is involved in most cases. A partial molar pregnancy almost always ends in miscarriage due to a triploid fetus. Here, we report a case of a 32-year-old Chinese woman with ultrasound diagnosis of a partial molar pregnancy. Amniocentesis suggested mosaicism, but the fetus was morphologically normal. The woman chose to continue the pregnancy after fully understanding the risk. The infant was delivered prematurely, and the presence of a large single placenta with molar changes. The baby’s peripheral blood chromosomes were diploid, and the pregnant woman had no serious complications. The diagnosis, management, and monitoring of this condition will remain challenging because of its rarity. Partial hydatidiform mole combined with pregnancy can result in delivering of a normal fetus and live birth under proper management.
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Affiliation(s)
- Chengying Zeng
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, Guangdong, China
| | - Yanbi Chen
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, Guangdong, China
| | - Lijuan Zhao
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, Guangdong, China
| | - Bo Wan
- Department of Obstetrics and Gynecology, The Third Affiliated Hospital of Southern Medical University, Guangzhou 510630, Guangdong, China
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Term Delivery of a Complete Molar Pregnancy with a Coexistent Normal Pregnancy. Case Rep Obstet Gynecol 2019; 2019:5090565. [PMID: 31687239 PMCID: PMC6800892 DOI: 10.1155/2019/5090565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Revised: 08/11/2019] [Accepted: 08/24/2019] [Indexed: 11/17/2022] Open
Abstract
Twin pregnancy with a complete mole and a coexistent normal fetus reaching term is a rare occurrence. We report a case of a 21-yrs G2P1L0 un-booked patient at 39 weeks who was referred for the same condition diagnosed incidentally on ultrasound scan which showed a singleton pregnancy in breech presentation with a normal placenta and a heterogeneous cystic lesion seen anteriorly, suggesting a coexistent molar pregnancy. Cesarean section was done, and a healthy male baby was delivered with a grossly normal placenta and a second placenta with grape like vesicles. Histopathology confirmed the diagnosis of complete mole and normal placenta. Postoperative period was uneventful, and the patient was kept on beta hcg follow-up to monitor progression to gestational trophoblastic neoplasia, but it normalized by 12 weeks.
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25
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Aggarwal A, Singh C, Sharma S, Reddy A, Kaul A. A Case of a Complete Hydatidiform Molar Pregnancy with a Co-existent Live Fetus. JOURNAL OF FETAL MEDICINE 2018. [DOI: 10.1007/s40556-018-0179-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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26
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Ohwaki A, Nishizawa H, Aida N, Kato T, Kambayashi A, Miyazaki J, Ito M, Urano M, Kiriyama Y, Kuroda M, Nakayama M, Sonta SI, Suzumori K, Sekiya T, Kurahashi H, Fujii T. Twin pregnancy with chromosomal abnormalities mimicking a gestational trophoblastic disorder and coexistent foetus on ultrasound. J OBSTET GYNAECOL 2018. [PMID: 29523025 DOI: 10.1080/01443615.2017.1401598] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Akiko Ohwaki
- a Department of Obstetrics and Gynecology , Fujita Health University School of Medicine , Toyoake , Japan.,b Division of Molecular Genetics , Institute for Comprehensive Medical Science, Fujita Health University , Toyoake , Japan
| | - Haruki Nishizawa
- a Department of Obstetrics and Gynecology , Fujita Health University School of Medicine , Toyoake , Japan
| | - Noriko Aida
- a Department of Obstetrics and Gynecology , Fujita Health University School of Medicine , Toyoake , Japan
| | - Takema Kato
- b Division of Molecular Genetics , Institute for Comprehensive Medical Science, Fujita Health University , Toyoake , Japan
| | - Asuka Kambayashi
- a Department of Obstetrics and Gynecology , Fujita Health University School of Medicine , Toyoake , Japan
| | - Jun Miyazaki
- a Department of Obstetrics and Gynecology , Fujita Health University School of Medicine , Toyoake , Japan.,b Division of Molecular Genetics , Institute for Comprehensive Medical Science, Fujita Health University , Toyoake , Japan
| | - Mayuko Ito
- a Department of Obstetrics and Gynecology , Fujita Health University School of Medicine , Toyoake , Japan.,b Division of Molecular Genetics , Institute for Comprehensive Medical Science, Fujita Health University , Toyoake , Japan
| | - Makoto Urano
- c Department of Diagnostic Pathology , Fujita Health University School of Medicine , Toyoake , Japan
| | - Yuka Kiriyama
- c Department of Diagnostic Pathology , Fujita Health University School of Medicine , Toyoake , Japan
| | - Makoto Kuroda
- c Department of Diagnostic Pathology , Fujita Health University School of Medicine , Toyoake , Japan
| | - Masahiro Nakayama
- d Department of Pathology and Laboratory Medicine , Osaka Medical Center and Research Institute for Maternal and Child Health , Izumi , Japan
| | | | | | - Takao Sekiya
- a Department of Obstetrics and Gynecology , Fujita Health University School of Medicine , Toyoake , Japan
| | - Hiroki Kurahashi
- b Division of Molecular Genetics , Institute for Comprehensive Medical Science, Fujita Health University , Toyoake , Japan
| | - Takuma Fujii
- a Department of Obstetrics and Gynecology , Fujita Health University School of Medicine , Toyoake , Japan
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27
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Kan ASY, Lau ETK, So CH, Chan WP, Wong WC, Lee KC, Pertile MD, Tang MHY. A fetus coexisting with a complete hydatidiform mole with trisomy 9 of maternal origin. J Obstet Gynaecol Res 2018; 44:955-959. [PMID: 29436108 DOI: 10.1111/jog.13598] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2017] [Accepted: 12/31/2017] [Indexed: 11/30/2022]
Affiliation(s)
- Anita Sik Yau Kan
- Department of Obstetrics and Gynaecology; Queen Mary Hospital; Hong Kong China
| | | | - Chun Hong So
- Department of Obstetrics and Gynaecology; Princess Margaret Hospital; Hong Kong China
| | - Wan Pang Chan
- Department of Obstetrics and Gynaecology; Princess Margaret Hospital; Hong Kong China
| | - Wing Cheuk Wong
- Department of Pathology; Princess Margaret Hospital; Hong Kong China
| | - Kam Cheong Lee
- Department of Pathology; Princess Margaret Hospital; Hong Kong China
| | - Mark D. Pertile
- Victorian Clinical Genetics Services, Murdoch Childrens Research Institute; Royal Children's Hospital; Melbourne Victoria Australia
- Department of Paediatrics; University of Melbourne; Melbourne Victoria Australia
| | - Mary Hoi Yin Tang
- Department of Obstetrics and Gynaecology; The University of Hong Kong; Hong Kong China
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28
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Multiple pregnancies with complete mole and coexisting normal fetus in North and South America: A retrospective multicenter cohort and literature review. Gynecol Oncol 2017; 145:88-95. [DOI: 10.1016/j.ygyno.2017.01.021] [Citation(s) in RCA: 42] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2016] [Revised: 01/12/2017] [Accepted: 01/19/2017] [Indexed: 11/18/2022]
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29
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Freis A, Elsässer M, Sohn C, Fluhr H. Twin Pregnancy with One Fetus and One Complete Mole - A Case Report. Geburtshilfe Frauenheilkd 2016; 76:819-822. [PMID: 27453586 DOI: 10.1055/s-0042-109398] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/30/2023] Open
Abstract
Twin pregnancy consisting of one fetus and one complete mole (CMCF, complete hydatidiform mole and a coexistent fetus) is an obstetric rarity with an incidence of 1/22 000 to 1/100 000 pregnancies. Associated risks include prematurity, intrauterine death, vaginal bleeding, preeclampsia, hyperthyroidism, theca lutein cysts, uterine rupture and the development of malignant neoplasia in the form of a trophoblastic tumour (GTD, persistent gestational trophoblastic disease), which is thought to be the most common complication. We report the case of a 33-year-old patient diagnosed with CMCF in the 15th week of pregnancy. After comprehensive counselling the patient chose to proceed with her pregnancy under close observation and prophylactic fetal lung maturation. We were able to extend the pregnancy to 32 weeks gestation when heavy vaginal bleeding forced a decision to deliver by caesarean section.
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Affiliation(s)
- A Freis
- Gynecological endocrinology and fertility disorders, University Hospital Heidelberg, Heidelberg, Germany
| | - M Elsässer
- Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
| | - C Sohn
- Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
| | - H Fluhr
- Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
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30
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Polonsky A, Olteanu I, Ben-David M, Mamet J, Agranat A, Fridman E. Viable triplet pregnancy coexisting with a complete molar pregnancy. Clin Case Rep 2016; 4:247-9. [PMID: 27014444 PMCID: PMC4771857 DOI: 10.1002/ccr3.417] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2015] [Revised: 08/09/2015] [Accepted: 09/18/2015] [Indexed: 11/13/2022] Open
Abstract
This case is extraordinary because it was never before described in English literature. The case describes a long‐standing debate about the safety of carrying this pregnancy to term. Some authors are for and some are against. The risks and benefits should be thoroughly reviewed before a decision is made.
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Affiliation(s)
- Ariel Polonsky
- Department of Obstetrics and Gynecology "Laniado" Medical Center Netanya Israel
| | - Ioana Olteanu
- Department of Obstetrics and Gynecology "Laniado" Medical Center Netanya Israel
| | - Mordechai Ben-David
- Department of Obstetrics and Gynecology "Laniado" Medical Center Netanya Israel
| | - Jacob Mamet
- Department of Obstetrics and Gynecology "Laniado" Medical Center Netanya Israel
| | - Avi Agranat
- Department of Obstetrics and Gynecology "Laniado" Medical Center Netanya Israel
| | - Eddie Fridman
- Department of Obstetrics and Gynecology "Laniado" Medical Center Netanya Israel
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31
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Hubinont C, Lewi L, Bernard P, Marbaix E, Debiève F, Jauniaux E. Anomalies of the placenta and umbilical cord in twin gestations. Am J Obstet Gynecol 2015; 213:S91-S102. [PMID: 26428508 DOI: 10.1016/j.ajog.2015.06.054] [Citation(s) in RCA: 43] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Revised: 06/24/2015] [Accepted: 06/25/2015] [Indexed: 02/08/2023]
Abstract
The frequency of twin gestations has increased over the last few decades, mainly due to maternal age at childbearing, and the use of assisted reproductive technologies. Twins are at higher risk of aneuploidy, structural anomalies, and placental abnormalities. Some of the placental and umbilical cord abnormalities found in twin gestations are nonspecific and can be found in singleton gestations (ie, placenta previa, placental abruption, single umbilical artery, velamentous cord insertion, vasa previa, etc). However, other anomalies are unique to twin gestations, and are mainly associated with monochorionic twins-these include intraplacental anastomosis and cord entanglement. Most of these conditions can be diagnosed with ultrasound. An accurate and early diagnosis is important in the management of twin gestations. Determination of chorionicity, amnionicity, and the identification of placental anomalies are key issues for the adequate management of twin pregnancies. Pathologic placental examination after delivery can help in assessing the presence of placental and umbilical cord abnormalities, as well as providing information about chorionicity and gaining insight into the potential mechanisms of disease affecting twin gestations.
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32
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Rathod S, Rani R, John LB, Samal SK. Successful Outcome of Twin Gestation with Partial Mole and Co-Existing Live Fetus: A Case Report. J Clin Diagn Res 2015; 9:QD01-2. [PMID: 26436001 DOI: 10.7860/jcdr/2015/13038.6268] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2015] [Accepted: 06/07/2015] [Indexed: 11/24/2022]
Abstract
Sad fetus syndrome comprising of a live twin gestation with a hydatidiform mole is a rare entity. The condition is even rarer when the co-existing live fetus is associated with a partial mole than a complete mole. We report the case of a 24-year-old G2P1L1 at 28 weeks gestation who presented to our casualty in the second stage of labour. She had a previous ultrasound scan at 13 weeks which showed a live fetus with a focal area of multicystic placenta. She delivered an alive preterm male fetus weighing 1.32 kg vaginally. Following expulsion of normal placenta of the live fetus, partial mole was expelled. The fetus was admitted to neonatal ICU and discharged after two weeks. Soon after delivery, β-hCG (human chorionic gonadotropin) was 1,21,993 mIU/ml which decreased to 30mIU/ml within two weeks. The patient was discharged with advice of regular follow up of β-hCG reports.
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Affiliation(s)
- Setu Rathod
- Assistant Professor, Department of Obstetrics and Gynaecology, Mahatma Gandhi Medical College and Research Institute , Puducherry, India
| | - Reddi Rani
- Professor, Department of Obstetrics and Gynaecology, Mahatma Gandhi Medical College and Research Institute , Puducherry, India
| | - Lopamudra B John
- Associate Professor, Department of Obstetrics and Gynaecology, Mahatma Gandhi Medical College and Research Institute , Puducherry, India
| | - Sunil Kumar Samal
- Assistant Professor, Department of Obstetrics and Gynaecology, Mahatma Gandhi Medical College and Research Institute , Puducherry, India
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33
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[Twin pregnancy with complete mole and coexisting fetus: Reach fetal viability is possible]. ACTA ACUST UNITED AC 2015; 44:887-90. [PMID: 25721351 DOI: 10.1016/j.jgyn.2015.01.012] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2014] [Revised: 01/11/2015] [Accepted: 01/20/2015] [Indexed: 11/21/2022]
Abstract
Twin pregnancies combining complete hydatidiform mole and coexistent fetus are a rare situation (incidence in 1/20,000 in 1/100,000 pregnancies) and a challenge for diagnosis. Their complications can be important - bleeding, preeclampsia, miscarriage - and their management remains complex and controversial. In case of continuing the pregnancy, nearly 40% of women have lives babies. Three quarters of fetal loss occur before 24weeks gestation. We report here three new cases; only one of these cases had a favorable outcome.
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34
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de Marcillac F, Akladios CY, Hui-bon-hoa I, Fritz G, Nisand I, Langer B. [Twin pregnancy with complete hydatiform mole and coexistent fetus: Report of 4 cases and review of literature]. ACTA ACUST UNITED AC 2015; 44:840-7. [PMID: 25613826 DOI: 10.1016/j.jgyn.2014.12.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2014] [Revised: 11/16/2014] [Accepted: 12/01/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE Twin pregnancy with complete hydatiform mole and coexistent fetus is a rare clinical condition, occurring in 1 in 22,000 to one in 100,000 pregnancies. Continuation of pregnancy in these cases is controversial because of a high risk of immediate and long-term maternal morbidity. It allows, however, in 33 % of the case the delivery of a healthy child. METHODS This retrospective study included all patients presenting a complete hydatiform mole coexisting with a live twin fetus antenatally diagnosed between 2007 and 2012 in the level III maternity of the Strasbourg University Hospital. Informations concerning diagnostic circumstances, pregnancy follow-up and outcome were studied. RESULTS Four pregnancies were included in the study, all of them were spontaneous. Medical termination of pregnancies was related to maternal reasons in the four cases. One before 17 weeks of gestation, the three other after 2 weeks of gestation, leading to delivery of a healthy child. All patients developed a mild to severe preeclampsia. One patient developed a gestational trophoblastic disease, requiring chemotherapy by methotrexate. There was no fatal evolution. CONCLUSION Twin pregnancy with complete hydatifom mole and coexistent fetus is associated with increased risk of gestational trophoblastic disease. This risk is not increased by continuation of pregnancy. In case of prenatal diagnosis of complete hydatiform mole coexisting with a live twin fetus, patients should be aware of the potential high risk of morbidity and a regular follow-up during and after the pregnancy should be intaured. In absence of maternal complications, continuation of the pregnancy is possible.
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Affiliation(s)
- F de Marcillac
- Département de gynécologie-obstétrique, hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France.
| | - C Y Akladios
- Département de gynécologie-obstétrique, hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - I Hui-bon-hoa
- Département de gynécologie-obstétrique, hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - G Fritz
- Département de gynécologie-obstétrique, hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - I Nisand
- Département de gynécologie-obstétrique, hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
| | - B Langer
- Département de gynécologie-obstétrique, hôpital de Hautepierre, 1, avenue Molière, 67098 Strasbourg cedex, France
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35
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Labadzhyan A, Brent GA, Hershman JM, Leung AM. Thyrotoxicosis of Pregnancy. JOURNAL OF CLINICAL AND TRANSLATIONAL ENDOCRINOLOGY 2014; 1:140-144. [PMID: 25243108 PMCID: PMC4166486 DOI: 10.1016/j.jcte.2014.07.008] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 12/03/2022]
Abstract
Thyrotoxicosis presenting during pregnancy is a common clinical problem and can be challenging to differentiate between physiologic patterns of thyroid dysfunction during gestation and intrinsic hyperthyroidism. This review provides a summary of the differential diagnosis, clinical presentation, diagnostic options, potential adverse effects of maternal thyrotoxicosis to the fetus, and treatment recommendations for thyrotoxicosis arising in pregnancy.
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Affiliation(s)
- Artak Labadzhyan
- Division of Endocrinology, Cedars-Sinai Medical Center and VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Gregory A Brent
- Division of Endocrinology, David Geffen School of Medicine, University of California Los Angeles
| | - Jerome M Hershman
- Division of Endocrinology, David Geffen School of Medicine, University of California Los Angeles
| | - Angela M Leung
- Division of Endocrinology, David Geffen School of Medicine, University of California Los Angeles
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36
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Kutuk MS, Ozgun MT, Dolanbay M, Batukan C, Uludag S, Basbug M. Sonographic findings and perinatal outcome of multiple pregnancies associating a complete hydatiform mole and a live fetus: a case series. JOURNAL OF CLINICAL ULTRASOUND : JCU 2014; 42:465-471. [PMID: 24867873 DOI: 10.1002/jcu.22169] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/23/2013] [Revised: 03/27/2014] [Accepted: 04/22/2014] [Indexed: 06/03/2023]
Abstract
BACKGROUND The aim of this case series was to present the ultrasonographic findings, clinical features, management, and outcome of multiple pregnancies with complete hydatidiform mole and coexisting fetus (CHMCF). METHODS Sonographic features and obstetrical and perinatal outcomes of seven cases with CHMCF were analyzed retrospectively. RESULTS A total of seven cases was included in the analysis. Six cases were twins and one case was quadruplet. The mean ± SD maternal age was 25.3 ± 1.9 years (median: 25; range: 23-29). The mean gestational age at diagnosis was 16.1 ± 4.6 weeks (median: 17; range: 11-23). Two pregnancies were achieved by ovulation induction. Two couples opted for pregnancy termination. Four pregnancies resulted in fetal loss between the 11th and 23th week of gestation. One pregnancy ended with the preterm delivery of a live-born neonate at 34 weeks due to pre-eclampsia. One patient developed persistent trophoblastic disease, which was treated by hysterectomy. The mean ± SD time for β-human chorionic gonadotropin clearance was 3.7 ± 0.5 weeks (median: 4; range: 3-4) in the six patients without persistent trophoblastic disease. CONCLUSIONS Spontaneous fetal loss is the most likely outcome for CHMCF. However, on the basis of our experience, we recommend carefully monitored continuation of pregnancy as long as maternal complications are not present or are controllable.
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Affiliation(s)
- Mehmet Serdar Kutuk
- Erciyes University, Faculty of Medicine, Department of Obstetrics and Gynecology, Kayseri, Turkey
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37
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Term delivery of a complete hydatidiform mole with a coexisting living fetus followed by successful treatment of maternal metastatic gestational trophoblastic disease. Taiwan J Obstet Gynecol 2014; 53:397-400. [DOI: 10.1016/j.tjog.2013.02.005] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/06/2013] [Indexed: 11/21/2022] Open
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38
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Dalmia S, Sivakumar K, Kathirvel R, Phillips K, Coady AM. Twin pregnancy with a complete hydatidiform mole and co-existent healthy fetus: unusual case of complete resorption of molar pregnancy. J OBSTET GYNAECOL 2013; 33:312-3. [PMID: 23550870 DOI: 10.3109/01443615.2012.761187] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- S Dalmia
- Department of Obstetrics and Gynaecology, Women and Children's Hospital, UK.
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39
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Jauniaux E, Ben-Ami I, Maymon R. Do assisted-reproduction twin pregnancies require additional antenatal care? Reprod Biomed Online 2013; 26:107-19. [DOI: 10.1016/j.rbmo.2012.11.008] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2012] [Revised: 11/06/2012] [Accepted: 11/07/2012] [Indexed: 10/27/2022]
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40
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Aguin E, Aguin V, Cisneros L, Aguin T, Van de Ven C, Bahado-Singh R. Does cerclage improve neonatal outcomes in a molar pregnancy and a coexistent fetus? A case report. BMC Res Notes 2012; 5:621. [PMID: 23126487 PMCID: PMC3507754 DOI: 10.1186/1756-0500-5-621] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/06/2012] [Accepted: 10/29/2012] [Indexed: 11/21/2022] Open
Abstract
Background Complete hydatiform mole and coexistent viable fetus is very rare. The use of a cervical cerclage for cervical indications in the presence of this condition has never been reported. Although the diagnosis was made postnatal, the objective is to present a case with good neonatal outcome. Case presentation A patient presented with vaginal spotting around 23 weeks. She has a history of four preterm deliveries. Her cervix was dilated and a cerclage was placed. She presented again with PPROM around 25 weeks. She went into spontaneous preterm labor and delivered a viable fetus that is a healthy girl today. Eventually the pathology of the placenta showed a complete hydatidiform mole. Conclusion It is necessary to inform patients about the potential risks and poor outcomes of this condition. For those who desire all potential interventions, cerclage placement could be considered.
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Affiliation(s)
- Eduardo Aguin
- Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Michigan, Ann Arbor, MI 48109, USA.
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41
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Placental mesenchymal dysplasia. Am J Obstet Gynecol 2011; 205:e3-5. [PMID: 21974990 DOI: 10.1016/j.ajog.2011.08.019] [Citation(s) in RCA: 30] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2011] [Revised: 07/30/2011] [Accepted: 08/15/2011] [Indexed: 11/21/2022]
Abstract
Placental mesenchymal dysplasia is a benign condition that can be confused with a molar pregnancy by ultrasound scanning and gross examination. Conservative management should be considered with a normal-appearing singleton fetus and a cystic-appearing placenta. We present a case of placental mesenchymal dysplasia with a favorable outcome.
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42
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Singh M, Shaltoot N, Emovon E. Twin pregnancy with complete hydatidiform mole and co-existent viable fetus. J OBSTET GYNAECOL 2011; 31:767-8. [PMID: 22085073 DOI: 10.3109/01443615.2011.615955] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Affiliation(s)
- M Singh
- Department of Obstetrics and Gynaecology, Doncaster Royal Infirmary, Doncaster, UK.
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43
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Chesnais AL, Le Breton F, Devouassoux-Shisheboran M, Huissoud C, Massardier J, Quilichini B, Allias F. Grossesse gémellaire avec môle complète et fœtus vivant : à propos d’un cas non diagnostiqué en anténatal. Ann Pathol 2011; 31:299-302. [DOI: 10.1016/j.annpat.2011.01.003] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2010] [Revised: 11/22/2010] [Accepted: 01/06/2011] [Indexed: 10/18/2022]
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44
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Copeland JW, Stanek J. Dizygotic twin pregnancy with a normal fetus and a nodular embryo associated with a partial hydatidiform mole. Pediatr Dev Pathol 2010; 13:476-80. [PMID: 20151788 DOI: 10.2350/09-11-0735-cr.1] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Although twin pregnancies complicated by a coexisting complete hydatidiform mole are uncommon, those with partial hydatidiform mole (PHM) are exceedingly rare; there are only several well-documented cases diagnosed antenatally. Here we present the first case of a twin placenta containing a nodular embryo associated with PHM diagnosed on routine placental examination. This dizygotic twin pregnancy featured viable embryos at 8 weeks' gestation, death of 1 embryo at 12 weeks, and delivery of a healthy infant by caesarean section at 28 weeks because of worsening maternal reflux nephropathy. Macroscopic and microscopic placental examination and fluorescence in situ hybridization showed one part of the placenta to be diploid and the other to contain a vanishing triploid embryo and a PHM, which had eluded antenatal ultrasound diagnosis. Careful pathologic examination of vanishing twins and their placentas may disclose an unexpected PHM, which can be associated, albeit infrequently, with persistent gestational trophoblastic disease or a trophoblastic tumor.
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Affiliation(s)
- Justin William Copeland
- Department of Anatomical Pathology, Canterbury Health Laboratories, Christchurch, New Zealand
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45
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Makary R, Mohammadi A, Rosa M, Shuja S. Twin gestation with complete hydatidiform mole and a coexisting live fetus: case report and brief review of literature. Obstet Med 2010; 3:30-2. [PMID: 27582837 DOI: 10.1258/om.2009.090038] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2009] [Indexed: 11/18/2022] Open
Abstract
Complete hydatidiform (also referred to as hydatiform) mole with coexisting live fetus is an exceedingly rare event. The fetus usually has a normal karyotype, and approximately 25-40% chance of survival, if pregnancy is allowed to continue until reasonable fetal lung maturity is achieved. However, risk of maternal complications including preeclampsia and subsequent trophoblastic disease are significant. We report a case of a 19-year-old primigravida, at 25 weeks gestation with a complete hydatidiform mole and a coexisting live fetus. She developed severe preeclampsia with uncontrolled hypertension, and pregnancy was terminated by caesarean section, after a short course of dexamethasone to accelerate fetal lung maturity. A morphologically normal live female fetus and placenta were delivered without complications, along with a separate mass of complete mole. The postpartum course was complicated by uterine choriocarcinoma with metastases to lung and left kidney, which responded to chemotherapy. Our case is a rare example of a twin gestation composed of a complete hydatidiform mole with a coexisting live fetus, and illustrates the associated spectrum of maternal complications that mandate close pre- and post-natal surveillance.
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Affiliation(s)
- Raafat Makary
- Department of Pathology, University of Florida , COM-Jacksonville Campus, Jacksonville, FL , USA
| | - Amir Mohammadi
- Department of Pathology, University of Florida , COM-Jacksonville Campus, Jacksonville, FL , USA
| | - Marilin Rosa
- Department of Pathology, University of Florida , COM-Jacksonville Campus, Jacksonville, FL , USA
| | - Sania Shuja
- Department of Pathology, University of Florida , COM-Jacksonville Campus, Jacksonville, FL , USA
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Lee SW, Kim MY, Chung JH, Yang JH, Lee YH, Chun YK. Clinical findings of multiple pregnancy with a complete hydatidiform mole and coexisting fetus. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2010; 29:271-280. [PMID: 20103799 DOI: 10.7863/jum.2010.29.2.271] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
OBJECTIVE The aim of this series was to evaluate the clinical features, management, and outcomes of multiple pregnancy with a complete hydatidiform mole and coexisting fetus (CHMCF). METHODS Between 1998 and 2008, we investigated 6 women with a diagnosis of a CHMCF. The gestational age at diagnosis, symptoms, serum b-human chorionic gonadotropin levels, cytogenetic and molecular analysis findings, complications, routes of delivery, and pregnancy outcomes were assessed. RESULTS All cases were diagnosed before 14 weeks' gestation by sonography. Only 1 ended with the delivery of a live-born neonate, whereas the other 5 cases required termination of pregnancy (TOP) before 21 weeks' gestation because of severe maternal complications (eg, preeclampsia, thyrotoxicosis, lung metastasis, and heavy bleeding) or intrauterine fetal death. The pathologic diagnosis of a complete hydatidiform mole was confirmed in all cases. Two patients required methotrexate for treatment of persistent trophoblastic disease (PTD). CONCLUSIONS On the basis of our experience, in cases with a normal karyotype and no gross fetal abnormalities on sonography, we carefully recommend continuation of pregnancy as long as maternal complications are absent or controllable. However, updated treatment criteria are still needed, and intensive maternal follow-up is necessary in the postpartum period because maternal complications during pregnancy and PTD after TOP are not uncommon.
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Affiliation(s)
- Si Won Lee
- Department of Obstetrics and Gynecology, Cheil General Hospital and Women's Healthcare Center, 1-19 Mukjeong Dong, Jung-gu, Seoul 100-380, Korea
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Gestación gemelar con mola hidatiforme completa y feto vivo a término. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2009. [DOI: 10.1016/j.gine.2008.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Massardier J, Golfier F, Journet D, Frappart L, Zalaquett M, Schott AM, Lenoir VT, Dupuis O, Hajri T, Raudrant D. Twin pregnancy with complete hydatidiform mole and coexistent fetus. Eur J Obstet Gynecol Reprod Biol 2009; 143:84-7. [DOI: 10.1016/j.ejogrb.2008.12.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2008] [Revised: 10/24/2008] [Accepted: 12/22/2008] [Indexed: 11/17/2022]
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Sebire NJ, Jauniaux E. Fetal and placental malignancies: prenatal diagnosis and management. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2009; 33:235-244. [PMID: 19009536 DOI: 10.1002/uog.6246] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
Fetal and placental malignancies are rare complications during pregnancy, but when they occur they may present significant challenges for the perinatology team. Owing to their rarity, there is limited information on many of these entities, with much data derived from individual case reports or small case series. Prenatal diagnosis of these entities is rare and inconsistent, usually in the form of isolated case reports. In the majority of fetal tumors, prenatal features are those of a mass lesion, with or without other non-specific features of fetal compromise such as polyhydramnios, fetal hydrops or intrauterine death, the final diagnosis in most cases being based on postnatal pathological examination.Expectant management is almost always indicated antenatally, with serial ultrasound examinations performed to detect rapid enlargement, metastasis or secondary fetal complications, such as non-immune hydrops, which may require intervention. Delivery should be planned in a specialist center in conjunction with pediatric surgeons and oncologists to allow appropriate neonatal management. Placental malignancy is most commonly in the form of gestatational trophoblastic disease, which requires assessment and management in specialist centers.
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Affiliation(s)
- N J Sebire
- Department of Paediatric Pathology, Great Ormond Street Hospital, London, UK
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