Cover Image

A successful outcome in a twin pregnancy with a complete hydatidiform mole and a normal viable foetus : A case report

Shilpa Reddy T, Usha Rani S .

Abstract


Background : Twin pregnancy with CHMF (complete hydatidiform mole coexisting with a live twin fetus) resulting in a healthy  baby is rare, with only less than 60 cases documented in detail in literature. CHMF cases are at high risk of spontaneous abortion, preterm delivery, intrauterine fetal death, bleeding, preeclampsia and persistent trophoblastic disease (PTD). Management of such cases is always problematic because the possibility of fetal survival should always be weighed against the risk of complications of molar pregnancy.We hereby report a case   encountered  at our hospital  that resulted in a healthy live new born with no maternal and foetal complications.  Case presentation : A 24 year old woman gravida 2 para1 was referred to our centre in view of mild spotting pv on and off in her 2nd trimester.She  had conceived after ovulation induction.An ultrasound done at 22 weeks  of gestational age  revealed a twin pregnancy with a complete hydatidiform mole and a coexisting viable foetus. The foetal anatomy, growth, liquor and cardiac activity were all normal in the viable co twin.On biochemical screening elevated levels of  Beta HCG were noted.The couple was counselled thoroughly regarding the risks of maternal and foetal complications associated with continuation of pregnancy. However pregnancy was continued as per the patient’s desire. The patient was monitored closely for symptoms of thyrotoxicosis and preeclampsia.At 30 weeks she had premature preterm (PPROM) rupture of membranes .An LSCS was done and a  1.25 kg healthy boy baby was delivered with no maternal and foetal complications. Her beta HCG normalized over  a period of 12 weeks and she was under follow up for about 2 yrs.  Conclusion : As many of these molar pregnancies occur following the induction of ovulation, the desire to continue pregnancy often outweighs that of termination. Thus, a twin pregnancy with a hydatidiform mole and a coexisting live foetus requires a thorough evaluation, and pregnancy may be continued under close surveillance for an optimal outcome.


Full Text:

PDF

References


Moini A, Riazi K. Molar pregnancy with a coexisting fetus progressing to a viable infant. Int J Gynaecol Obstet. 2003;82(1):63–4.doi: 10.1016/S0020-7292(03)00039-0.

Sebire NJ, Foskett M, Paradinas FJ, Fisher RA, Francis RJ, Short D, et al. Outcome of twin pregnancies with complete hydatidiform mole and healthy co-twin. Lancet. 2002;359(9324):2165–6. doi: 10.1016/S0140-6736(02)09085-2.

Steller MA, Genest DR, Bernstein MR, Lage JM, Goldstein DP, Berkowitz RS. Natural history of twin pregnancy with complete hydatidiform mole and coexisting fetus. ObstetGynecol. 1994;83(1):35–42.

Niemann I, Sunde L, Petersen LK. Evaluation of the risk of persistent trophoblastic disease after twin pregnancy with diploid hydatidiform mole and coexisting normal fetus. Am J ObstetGynecol. 2007;197(1):45 e1–5.

Sebire NJ. Prenatal diagnosis and management of twin pregnancies complicated by a co-existing molar pregnancy. PrenatDiagn. 2006;26(4):373.

. Piura B, Rabinovich A, Hershkovitz R, Maor E, Mazor M. Twin pregnancy with a complete hydatidiform mole and surviving co-existent fetus. ArchGynecolObstet. 2008;278:377–382.

Klatt TE, Franciosi RA, Cruikshank DP. Normal fetus with a twin presenting as both a complete hydatidiform mole and placenta previa. ObstetGynecol. 2006;107:527–530.

Matsui H, Sekiya S, Hando T, Wake N, Tomoda Y. Hydatidiform mole coexistent with a twin live fetus: A national collaborative study in Japan. Hum Reprod. 2000;15:608–11. doi: 10.1093/humrep/15.3.608.

Massardier J, Golfier F, Journet D, Frappart L, Zalaquett M, Schott AM, et al. Twin pregnancy with complete hydatidiform mole and coexistent fetus: Obstetrical and oncological outcomes in a series of 14 cases. Eur J ObstetGynecolReprodBiol. 2009;143:84–7. doi:10.1016/j.ejogrb.2008.12.006.


Refbacks

  • There are currently no refbacks.


Creative Commons License
This work is licensed under a Creative Commons Attribution-NoDerivatives 4.0 International License.

An Initiative of The Tamil Nadu Dr MGR Medical University