When a vesicular placenta meets a live fetus: case report of twin pregnancy with a partial hydatidiform mole

Twin pregnancy with incomplete hydatidiform mole and coexistent normal live fetus: A case report and review of the literature

RATIONALE

A pregnancy with incomplete mole is very rare case. Hydatidiform mole (HM) with live fetus is associated with a risk of a wide variety to maternal and fetal complications. The incidence of a normal live fetus and an incomplete mole such as the case we describe is extremely rare.

PATIENT CONCERN

We report a case of multiparous 34-year-old at Culiacan Mexico woman with incomplete mole coexisting with normal fetus, pregnant 35.3 weeks who presented anemia grade II.

DIAGNOSIS

The initial diagnosis of the mole was by ultrasound.

INTERVENTIONS

KERR-type cesarean section and bilateral tubal occlusion. The newborn was morphologically normal, and she did not require intervention or treatment.

OUTCOMES

The newborn was feminine, morphologically normal, weighing 2380 g and 47 cm, APGAR score 8 to 9, delivered prematurely, and there was a large placental plate. The blood loss on surgery was estimated at 1000 mL. Histopathology report of an incomplete hydatidiform mole, negative for malignancy. Histopathology diagnostic was confirmed by immunohistochemistry staining for p57KIP2.

LESSONS

Although the incidence of this pregnancy is very rare, early recognition, diagnosis and divulge of the cases of medical community is very important for patient care.

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

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.

Partial hydatidiform mole pregnancy ended in full-term delivery of a normal infant: a case presentation

BACKGROUND

Twin pregnancy with a partial hydatidiform mole (PHM) and a coexistent live fetus is extremely rare. The fetus usually has a normal karyotype. The surviving rate of the fetus till lung maturity is only about 25-40%. PHM pregnancy almost ends in abortion due to the presence of triploid embryo. Here, we report a case of PHM coexistent with a live fetus resulting in a live baby.

CASE PRESENTATION

A PHM pregnancy was diagnosed by ultrasonography in a 28-year-old Chinese woman, with normal fetal morphology and mosaicism as indicated by amniocentesis. After being fully informed of the risks, the woman chose to proceed with the pregnancy and finally gave birth to a baby girl and the infant was delivered at term. A single placenta with vesicular changes and peripheral blood diploid chromosomes were observed. There were no serious maternal complications. In conclusion, the diagnosis, management, and monitoring of this condition, which is very rare in clinical practice, remain challenging. Under proper management, a PHM-combined pregnancy can still end in full-term delivery of a normal living fetus.

A Twin Pregnancy of Partial Mole Coexisting with a Normal Fetus: A Case Report

Background

Twin pregnancy with partial hydatidiform mole and a co-existing normal fetus (PHMCF) is a very rare clinical condition. It presents with various complications like preterm labor, pre-eclampsia, hyperthyroidism and fetal anomalies.

Case Presentation

We report the case of a 40-year-old G13P10A2 mother who was referred to our hospital at 28 weeks as a case of twin pregnancy and pre-eclampsia. She had headache, epigastric pain, bilateral leg swelling, and decreased fetal movement for two days. Her physical examination was remarkable for raised blood pressure and uterus larger than gestational age. Ultrasound findings showed honeycomb-like echo suggestive of a molar pregnancy with a co-existing normal fetus. After she was admitted and managed for severe pre-eclampsia, a cesarean section was done to affect the delivery of a male neonate weighing 1400 grams. Histopathology confirmed the diagnosis of a partial mole with no malignant features. In follow-up, the serum β-HCG level normalized by the 7th week.

Conclusion

PHMCF is a rare obstetric condition. Despite these pregnancies having a greater risk of complications, strict follow-up at a tertiary care hospital and timely management of complications can result in good outcomes for both the mother and the fetus.