Case report: complete hydatiform mole coexisting with a twin live fetus

Abstract

Objective: To discuss a case of complete hydatiform mole fetus (CHMF) with a twin live fetus.Case description: A 30-year-old black woman, gravida 4, para 2, was seen at 25 weeks of gestation with vaginal bleeding and premature contractions. A sonogram revealed a single fetus of 25 weeks of gestation, consistent with LMP and fundal height and a 7 × 6 cm intrauterine soft tissue mass separate from the placenta. On day 10, she delivered a breech-presenting, 732-g male with normal appearing placenta by cesarean birth. A 7 × 6 cm brownish-colored cystic mass was expelled vaginally while the patient was en route to the operating room. Postoperatively, the patient remained stable and β-human chorionic gonadotropin levels were negative at 8 weeks.Results: A CHMF coexisting with a twin surviving fetus is rare. Only nine cases have been documented since 1966. CHMFs are diagnosed at a later gestational age and have a greater propensity for developing persistent gestational trophoblastic disease. This may be due to a delay in diagnosis or an intrinsic aggressive propensity of this phenomenon. The twin molar gestation resulting in a viable live-born infant also had a significantly smaller discrepancy between uterine size at evacuation than expected by dates (1.0 week in viable group versus 8.1 weeks in a previable group).Conclusions: More cases are needed to establish treatment criteria. Expectant management to fetal viability can be accomplished in patients with declining serum human chorionic gonadotropin level and normal fetal karyotype.