Abstract
Introduction
Twin pregnancy with complete hydatidiform mole and co-existent fetus (CHMF) resulting in a healthy take-home baby is rare, with only 30 cases documented in detail in the literature.
Case report
A 29-year-old woman conceived following two cycles of ovulation induction with clomiphene citrate. Successive ultrasound examinations demonstrated a normally growing live fetus alongside a normal placenta and an additional intrauterine echogenic mass with features of hydatidiform mole. At 17 week gestation, serum β-hCG level was 25.38 multiples of the median. Genetic amniocentesis at 18.5 week gestation showed normal fetal 46XX karyotype. A cesarean section performed at 28 week gestation resulted in the delivery of a live normal female infant and two adjoining placentas. One placenta was normal and the other placenta was composed of vesicles of various sizes. Microscopic examination of the abnormal placenta confirmed complete hydatidifrom mole. The baby did well and serial maternal serum β-hCG levels showed a declining trend and were undetectable by 7 weeks after delivery.
Conclusion
Continuation of a twin pregnancy with CHMF is an acceptable option. There is, however, an increased risk of developing pre-eclampsia and fetal loss due to miscarriage. The chance of a live term birth is <50% with nearly 33% of the mothers developing persistent gestational trophoblastic disease after delivery. Thus, close surveillance of an ongoing twin pregnancy with CHMF is mandatory to detect potential early signs of maternal and fetal complications.
Similar content being viewed by others
References
Bruchim I, Kidron D, Amiel A, Altaras M, Fejgin MD (2000) Complete hydatidiform mole and a coexistent viable fetus: report to two cases and review of the literature. Gynecol Oncol 77:197–202
Moini A, Riazi K (2003) Molar pregnancy with a coexisting fetus progressing to a viable infant. Int J Gynaecol Obstet 82:63–64
Matsui H, Sekiya S, Hando T, Wake N, Tomoda Y (2000) Hydatidiform mole coexisting with a twin live fetus: a national collaborative study in Japan. Hum Reprod 15:608–611
Vaisbuch E, Ben-Arie A, Dgani R, Perlman S, Sokolovsky N, Hagay Z (2005) Twin pregnancy consisting of a complete hydatidifrom mole and co-existent fetus: report of two cases and review of literature. Gynecol Oncol 98:19–23
Wee L, Jauniaux E (2005) Prenatal diagnosis and management of twin pregnancies complicated by a co-existing molar pregnancy. Prenat Diagn 25:772–776
Steller MA, Genest DR, Bernstein MR, Lage JM, Goldstein DP, Berkowitz RS (1994) Natural history of twin pregnancy with complete hydatidiform mole and coexisting fetus. Obstet Gynecol 83:35–42
Shahabi S, Naome G, Cobin L, Veroughstruele A, Musters L, Zengbe V, Noel JC, Avni EF, Donner C, Vershet A, Foulon W, Rodesch F (1977) Complete hydatidiform mole and coexisting fetus. A case report of two cases with contrasting outcomes. J Reprod Med 42:756–760
Block MF, Merill JA (1982) Hydatidifrom mole with coexistent fetus. Obstet Gynecol 60:129–134
Miller D, Jackson R, Ehlen T, McMurtie E (1993) Complete hydatidiform mole coexistent with a twin live fetus. Clinical course of four cases with complete cytogenic analysis. Gynecol Oncol 50:119–123
Jinno M, Ubukata Y, Hanya I, Satou M, Yoshimura Y, Nakamura Y (1994) Hydatidiform mole with a surviving coexistent fetus following in-vitro fertilization. Hum Reprod 9:1770–1772
Bristow RE, Shurmway JB, Khouzami AN, Witter FR (1996) Complete hydatidiform mole and surviving coexistent twin. Obstet Gynecol Surv 51:705–709
Anderson CK, Deiter RWM, Motz MJ, Goldstein JA (1996) Complete hydatidiform mole with a coexistent healthy, viable fetus near term: a case report. J Reprod Med 41:55–58
Chen EP (1997) Molar pregnancy and living normal fetus coexistent until term: prenatal biochemical and sonographic diagnosis. Hum Reprod 12:853–856
Fishman DA, Padilla LA, Keh P, Cohen L, Frederiksen M, Lurian JR (1998) Management of twin pregnancies consisting of a complete hydatidiform mole and a normal fetus. Obstet Gynecol 91:546–550
Ishii J, Litsuka Y, Takano H, Mutsui H, Osada H, Sekiya S (1998) Genetic differentiation of complete hydatidiform moles coexisting with normal fetuses by short tandem repeat-derived deoxyribonucleic acid polymorphism analysis. Am J Obstet Gynecol 179:628–634
Montes-de-Oca-Valero F, Macara L, Shaker A (1999) Twin pregnancy with a complete mole and co-existing fetus following in-vitro fertilization. Hum Reprod 14:2905–2907
Abbi M, Kriplani A, Uppal R, Takkar D (1999) Term twin pregnancy with hydatidiform mole and normal fetus. Arch Gynecol Obstet 262:189–191
Makrydimas G, Sebire HJ, Thornton SE, Zagorianakou N, Lolis D, Fisher RA (2002) Complete hydatidiform mole and normal live birth: a novel case of confined placental mosaicism. Hum Reprod 17:2459–2463
Wax JR, Pinette MG, Chard R, Blackstone J, Cartin A (2003) Prenatal diagnosis by DNA polymorphism analysis of complete mole with coexisting twin. Am J Obstet Gynecol 188:1105–1106
Bovicelli L, Ghi T, Pilu G, Farina A, Savelli L, Simonazzi G, Calzolari E, Ferlini A, Santini D, Valeri B (2004) Prenatal diagnosis of a complete mole coexisting with a dichorionic twin pregnancy: case report. Hum Reprod 19:1231–1234
Marcorelles P, Audrezet MP, Le Bris MJ, Luarent Y, Chabaud JJ, Ferec C, de Braekeleer M, Collet M, Lagarde N (2005) Diagnosis and outcome of complete hydatidifrom mole coexisting with a live twin fetus. Eur J Obstet Gynecol Reprod Biol 118:21–27
Hyodo M, Samura O, Miharu N, Ohama K, Kudo Y (2005) Molar DNA in maternal serum in a case of 46,XY heterozygous complete hydatidiform mole coexisting with a 46,XX twin live fetus. Clin Chem 51:676–677
Hamanoue H, Umezu N, Okuda M, Harada N, Ohata T, Sakai H, Mizuguchi T, Ishikawa H, Takahashi T, Miura K, Hirahara F, Matsumoto N (2006) Complete hydatidiform mole and normal live birth following intracytoplasmic sperm injection. J Hum Genet 51:477–479
Klatt TE, Franciosi RA, Cruikshank DP (2006) Normal fetus with a twin presenting as both a complete hydatidiform mole and placenta previa. Obstet Gynecol 107:527–530
Mahmoud MS, Merhi Z (2007) Complete hydatidiform mole with a surviving coexistent twin in a woman with sickle cell disease: a case report. J Reprod Med 52:567–569
Niemann I, Sunde L, Peterson LK (2007) Evaluation of the risk of persistent trophoblastic disease after twin pregnancy with diploid hydatidiform mole and coexisting normal fetus. Am J Obstet Gynecol 197:45.e1–45.e5
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Piura, B., Rabinovich, A., Hershkovitz, R. et al. Twin pregnancy with a complete hydatidiform mole and surviving co-existent fetus. Arch Gynecol Obstet 278, 377–382 (2008). https://doi.org/10.1007/s00404-008-0591-x
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00404-008-0591-x