A twin pregnancy with partial hydatidiform mole and a coexisting normal fetus delivered at term: A case report and literature review

Rare Case Report: Coexistence of Complete Hydatidiform Mole and Normal Fetus in a Twin Pregnancy

Background

The coexistence of a complete hydatidiform mole with a normal fetus in a twin pregnancy is a rare, high-risk obstetric condition with an extremely low incidence rate, presenting numerous clinical management challenges. The rarity of such cases, coupled with the scarcity of comprehensive literature, makes the successful management of this case a source of valuable experience and novel insights for clinical practice.

Case Presentation

A 32-year-old patient conceived following a clomiphene-induced ovulation regimen. Mid-pregnancy ultrasound indicated a twin pregnancy (one viable fetus, the other consistent with the appearance of a complete hydatidiform mole), and the patient chose to continue the pregnancy. At 36+4 weeks of gestation, the patient was admitted for pregnancy-induced hypertension and underwent a cesarean section, delivering a healthy female infant and simultaneously removing the molar tissue. Postoperative pathological examination confirmed a complete hydatidiform mole with invasive lesions, which progressed to an invasive hydatidiform mole. The patient underwent seven cycles of methotrexate combination chemotherapy, with a follow-up period of three years showing no recurrence, ensuring the health of both mother and child.

Conclusion

Managing twin gestations involving a complete hydatidiform mole and a normal fetus necessitates a multidisciplinary approach, grounded in individualized assessment. The successful treatment of this case demonstrates that standardized diagnosis, close postoperative follow-up, and chemotherapy are crucial factors in improving maternal and fetal outcomes, offering significant clinical reference value.

A Rare Case of Spontaneous Heterotopic Pregnancy at 12 weeks of Gestation Following Natural Conception With Literature Review

BACKGROUND

Spontaneous heterotopic pregnancy is an uncommon and possibly serious problem characterized by maternities at unique implantation sites, with only one occurring in the intrauterine cavity. Its incidence is approximately 1 in 30,000 natural pregnancies, posing significant threats to maternal health. The complexity of clinical and laboratory findings complicates its diagnosis, necessitating a high index of suspicion for prompt intervention.

CASE PRESENTATION

We reported the case of a 36-year-old woman diagnosed with heterotopic pregnancy at 12 weeks of gestation following spontaneous conception, who presented with severe abdominal pain. Initial beta-human chorionic gonadotropin (β-hCG) levels were 57,278.00 mIU/mL. Transvaginal ultrasound (TVUS) revealed a single live fetus in the uterus, estimated at 12 weeks and six days, alongside a thick-walled cystic structure in the right ovary and an irregular hypoechoic mass inferior to the right ovary. An urgent laparoscopic salpingectomy was performed under general anesthesia, revealing a distended right fallopian tube (3.5 cm) with a thickened appearance, bluish-purple discoloration, and a 2 mm rupture with active bleeding surrounded by clots. Histopathological examination confirmed ectopic pregnancy. Postoperative β-HCG levels were 49,213 mIU/mL and 57,577 mIU/mL on the second and third days, respectively.

CONCLUSION

Clinicians should maintain vigilance for heterotopic pregnancy, especially in the absence of infertility treatments or known risk factors. Lower quadrant abdominal or pelvic pain should prompt consideration of heterotopic pregnancy, as the presence of an intrauterine pregnancy does not exclude a concurrent ectopic pregnancy.

Complete mole coexisting with a normal fetus in a dichorionic diamniotic pregnancy: a case report

INTRODUCTION

A molar pregnancy coexisting with a normal fetus is a very rare occurrence. It can present as a complete mole with a normal fetus or a partial mole with a normal fetus. There is paucity of data on optimal management of such patients who have this presentation, which mostly ends with a poor prognosis.

CASE PRESENTATION

We present a case of 26-year-old woman of African descent, a para 1 + 0 gravida 2, who came with a compete molar pregnancy coexisting with a normal fetus in the second trimester and the complexity of her management. Patient presented in second trimester for an anomaly scan, in which the complete mole coexisting with a normal fetus was diagnosed. The molar pregnancy was also covering the cervical os. The patient was advised to terminate the pregnancy due to the risk of massive hemorrhage, but she was keen on continuing with the pregnancy. She was admitted two times with bleeding and in the last admission she also had chorioamnionitis, which warranted a hysterotomy at 25 weeks 1 day. Patient made a good recovery, unfortunately the neonate had an early neonatal death at a different facility due to respiratory complications.

CONCLUSION

In this case a patient with a normal fetus coexisting with a complete mole and complete previa was closely monitored, but a hysterotomy was done at 25 weeks 1 day gestation due to chorioamnionitis. The diagnosis was made by ultrasound, in which there was a snowstorm appearance of one of the gestational sacs while the other sac had a normal fetus. This is a rare entity that puts the doctor in a dilemma due to potential maternal and fetal complications. The take-home message is that a patient who presents with a complete mole and a coexisting normal fetus can be supported to a viability stage. Chorioamnionitis interfered with the continuation of this pregnancy.

Complete Hydatidiform Mole with Twin Live Fetuses in a Triplet Pregnancy: A Case Report and Literature Review

Introduction

The coexistence of a complete hydatidiform mole with twin live fetuses in a triplet pregnancy is an extremely rare condition with an unknown incidence.

Case Report

This report presents a case of a dichorionic diamniotic triplet pregnancy complicated by the coexistence of a complete hydatidiform mole and twin live fetuses. The pregnancy resulted in a preterm delivery at 30 weeks and 5 days of gestation, with both live fetuses surviving to date. During the pregnancy, the patient was diagnosed with pre-eclampsia and intrahepatic cholestasis. Post-delivery, she was found to have an invasive mole with lung metastases, which was ultimately successfully treated.

Conclusion

This report highlights critical considerations for managing a multiple pregnancy complicated by a complete hydatidiform mole, alongside the associated potential complications. In light of the limited literature on the clinical management of this condition, our findings offer valuable insights into navigating the risks and optimizing patient outcomes.

Evaluation and analysis of influencing factors of placental mesenchymal dysplasia diagnosed using prenatal ultrasonography and pregnancy outcomes: case series

Background

Placental mesenchymal dysplasia (PMD) is a rare placental vascular malformation of unknown etiology. PMD may coexist with a healthy fetus, and its ultrasound appearance is similar to that of a hydatidiform mole, especially the partial type. Prenatal ultrasonography is vital for accurate diagnosis of these conditions. This study aimed to summarize the characteristics of prenatal ultrasonographic images across different gestational weeks (W) for PMD and evaluate and analyze factors that influence pregnancy outcomes related to PMD. The goal is to improve the diagnosis of PMD, effectively assess fetal prognosis, and provide a reference for prenatal consultations and clinical management.

Case Description

Of the 15 included patients, 4, 8, and 3 had PMD in early pregnancy (<13+6 W), mid-pregnancy (approximately 14-27+6 W), and late pregnancy (>28 W), respectively. Among the 15 patients, 5 successfully underwent delivery, thereby resulting in fetal survival; 3 experienced intrauterine death, 1 had a miscarriage, and 6 pregnancies were terminated. During early pregnancy, ultrasonographic manifestations of PMD included microscopic anechoic cystic areas in the placental parenchyma. In the second trimester, the placenta exhibited diffuse enlargement and thickening, with the placental parenchyma showing cellular anechoic cystic areas clearly separated from the surrounding normal placental tissue. As the pregnancy progressed, the cystic areas gradually reduced in the third trimester. Additionally, localized umbilical blood vessels showed tumorous lesions, sometimes accompanied by intravascular thrombosis. Some cases exhibited tortuosity and dilation in the umbilical vein.

Conclusions

PMD exhibited varying ultrasonographic characteristics across different gestational stages and demonstrated regular disease evolution corresponding to gestational W. This condition is associated with adverse pregnancy outcomes, with the location, extent, and severity of lesions being crucial factors affecting fetal development in utero.

Hydatidiform Mole-Between Chromosomal Abnormality, Uniparental Disomy and Monogenic Variants: A Narrative Review

A hydatidiform mole (HM) or molar pregnancy is the most common benign form of gestational trophoblastic disease characterized by a proliferation of the trophoblastic epithelium and villous edema. Hydatidiform moles are classified into two forms: complete and partial hydatidiform moles. These two types of HM present morphologic, histopathologic and cytogenetic differences. Usually, hydatidiform moles are a unique event, but some women present a recurrent form of complete hydatidiform moles that can be sporadic or familial. The appearance of hydatidiform moles is correlated with some genetic events (like uniparental disomy, triploidy or diandry) specific to meiosis and is the first step of embryo development. The familial forms are determined by variants in some genes, with NLRP7 and KHDC3L being the most important ones. The identification of different types of hydatidiform moles and their subsequent mechanisms is important to calculate the recurrence risk and estimate the method of progression to a malign form. This review synthesizes the heterogeneous mechanisms and their implications in genetic counseling.

Editorial on the Special Issue Titled "Pathology and Diagnosis of Gynecologic Diseases"

In the medical and diagnostic daily routine, gynecologic diseases present many different scenarios [...].