Management of a dichorionic twin pregnancy with a normal fetus and an androgenetic diploid complete hydatidiform mole

Complete molar pregnancy with coexisting normal twin complicated by hyperthyroidism that resulted in normal alive delivery: A case report from Wolaita Sodo, Ethiopia

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.

Complete Hydatidiform Mole with Lung Metastasis and Coexisting Live Fetus: Unexpected Twin Pregnancy Mimicking Placenta Accreta

Twin pregnancy with a complete hydatidiform mole and coexisting fetus (CHMCF) is an exceedingly rare condition with an incidence of about 1 in 20,000-100,000 pregnancies. It can be detected by prenatal ultrasonography and an elevated maternal serum beta-human chorionic gonadotropin (BhCG) level. Herein, the author reports a case of CHMCF which was incidentally diagnosed through pathologic examination without preoperative knowledge. The 41-year-old woman, transferred due to preterm labor, delivered a female baby by cesarean section at 28 + 5 weeks of gestation. Clinically, the surgeon suspected placenta accreta on the surgical field, and the placental specimen was sent to the pathology department. On gross examination, focal vesicular and cystic lesions were identified separately from the normal-looking placental tissue. The pathologic diagnosis was CHMCF and considering the fact that placenta accreta was originally suspected, invasive hydatidiform mole was not ruled out. After radiologic work-up, metastatic lung lesions were detected, and methotrexate was administered in six cycles at intervals of every two weeks. The author presents the clinicopathological features of this unexpected CHMCF case accompanied by pulmonary metastasis, compares to literature review findings, and emphasizes the meticulous pathologic examination.