Triplet pregnancy with partial hydatidiform mole coexisting with two fetuses: a case report

Termination of a partial hydatidiform mole and coexisting fetus: A case report

BACKGROUND

We describe the treatment strategy for a patient who was found to have a partial hydatidiform mole and coexisting fetus (PHMCF) during the second trimester. The patient was a 38-year-old Chinese woman who had become pregnant following in vitro fertilization and embryo transplantation. We wanted to determine the safest therapeutic strategy to terminate the PHMCF during the second trimester.

CASE SUMMARY

In this case, we present a patient who was found to have a PHMCF complicated with serious continuous vaginal bleeding and pre-eclampsia during the second trimester. After careful evaluation, the pregnancy was considered to be unsustainable and was terminated via caesarean section (CS). An infant with weak vital signs and a partially cystic placenta measuring 110 mm × 95 mm × 35 mm were delivered by CS. The patient was discharged after 4 d. The serum levels of β-human chorionic gonadotropin decreased to within a normal range 5 wk after the operation, and no evidence of persistent trophoblastic disease or lung metastases was noticed at the 6-mo follow-up.

CONCLUSION

CS termination of PHMCF during the second trimester may be a relatively safe therapeutic strategy.

Medical termination of a partial hydatidiform mole and coexisting fetus during the second trimester: A case report

Partial hydatidiform mole and coexisting fetus (PHMCF) is a rare condition that presents a dilemma for physicians and the parents of the fetus, particularly when PHMCF is detected during the second trimester of pregnancy. The present study reports a case of PHMCF terminated by induction of labor via administration of Rivanol at 17 weeks. Follow-up measurements of serum β-human chorionic gonadotropin (β-HCG) levels, as well as imaging studies, indicated the presence of persistent trophoblastic disease (PTD) and lung metastases. The patient was therefore admitted for three courses of chemotherapy. Subsequently, the metastases receded and β-HCG levels decreased to within the normal range. The patient demonstrated no disease recurrence for 1 year. Following a review of the relevant literature, to the best of our knowledge, all PHMCF cases terminated by medical induction of labor during the second trimester resulted in the development of PTD and lung metastases. However, three cases of PHMCF that were terminated by caesarean section during the third trimester did not develop PTD or metastases. The present study therefore hypothesized that medical termination may not be a safe therapeutic strategy for the treatment of PHMCF during the second trimester, and that pregnancy should be allowed to continue empirically.

Partial hydatidiform mole progression into invasive mole with lung metastasis following in vitro fertilization

In the present study, the case of a 34-year-old Chinese female who underwent in vitro fertilization resulting in a twin pregnancy was reported. Following in vitro fertilization, the patient was found to have a partial hydatidiform mole (PHM) with a co-existing twin by transvaginal sonography (TVS). At 16 weeks, the pregnancy was terminated and a normal-looking fetus with a HM placenta was delivered, in addition to a normal fetus with a normal placenta. Following termination of the pregnancy, the PHM progressed into an invasive mole with lung metastasis, a rare event. Serum human chorionic gonadotrophin (hCG) concentrations decreased in the first week following delivery, but over the following 21 days hCG levels showed a continuous increase. Following 2 cycles of combinative chemotherapy consisting of fluorouracil (5-FU) and dactinomycin (KSM), hCG concentrations decreased to normal levels. The patient was then administered 1 cycle of repeated chemotherapy and hCG levels remained negative for the following 2 years.

Clinical findings of multiple pregnancy with a complete hydatidiform mole and coexisting fetus

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.