A partial molar pregnancy associated with a fetus with intrauterine growth restriction delivered at 31 weeks: a case report

Pasquale De Franciscis,Antonio Schiattarella,Domenico Labriola,Carolina Tammaro,Enrico Michelino Messalli,Elvira La Mantia,Marco Montella,Marco Torella

doi:10.1186/s13256-019-2150-4

Pasquale De Franciscis, Antonio Schiattarella + Show 6 more

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https://doi.org/10.1186/s13256-019-2150-4

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IntroductionMolar pregnancies belong to a group of diseases classified as gestational trophoblastic diseases, which result from an altered fertilization. Partial molar pregnancy with a live fetus is a very rare condition, occurring in 0.005 to 0.01% of all pregnancies; it presents a challenging diagnosis, especially when clinical signs are almost completely absent.Case presentationHere we report a rare case of partial molar pregnancy in which a normal-appearing male fetus with diploid karyotype was delivered at 31 weeks gestation by a 37-year-old white woman. The pregnancy was characterized by an episode of threatened abortion in the first trimester and an ultrasonographic diagnosis of intrauterine growth restriction. Our patient did not report any suspicious symptoms for trophoblastic disease. Due to impaired umbilical artery velocimetry with an absence of the diastolic phase, she underwent an emergency caesarean section at 31 weeks and delivered an 880 g male baby. The male baby was normal without any complications at 3-month and 12-month follow-up and the mother had no evidence of recurrence after 3 and 12 months of follow-up. Pathological examination of the placenta showed changes of partial hydatidiform mole.ConclusionPartial molar pregnancy with a live fetus is a very rare condition that presents a challenging diagnosis. Recognizing it is of primary importance for patient care and the placenta should always be investigated at birth, especially in a newborn with intrauterine growth restriction.

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Molar pregnancies belong to a group of diseases classified as gestational trophoblastic diseases, which result from an altered fertilization
Hydatidiform mole belongs to a group of diseases classified as gestational trophoblastic disease, which results from an impaired fertilization [1, 2]
Case presentation Our patient was informed of all procedures she was to undergo; she signed a consent allowing data collection for research purposes, and gave full approval for the report and publishing of the case. This case is in accordance with the Declaration of Helsinki, in accordance with the Consensusbased Clinical Case Reporting Guideline Development, and the Committee on Publication Ethics (COPE) guidelines, and approved by the Institutional Review Board (IRB) of the university hospital in which it was reported [6]

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The diagnosis was not suspected and only the anomalous presence of IUGR could be interpreted as a sign of a placental defect and, among the various causes, could be referred to as a molar pregnancy. Histological examination of the placenta is essential in all cases of IUGR. It is mandatory to check the patient until there have been 12 consecutive months of negative hCG levels. In every case of molar pregnancy suspect for a normal fetus, adequate counseling of the patient and a strict follow-up during and after pregnancy for the risk of persistence of the trophoblastic pathology are necessary [18–20]

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