Abstract
Partial hydatidiform mole is a histopathologic entity characterised by focal trophoblastic hyperplasia with villous hydrops together with identifiable fetal tissue. 90% of partial moles are due to diandric triploidy. In Type I placenta is modified; in type II placenta is normal. We report a case of PHM type I with increased fetal NT and other fetal anomalies (Dandy-Walker complex and tetralogy of Fallot). A 32 year old woman (gravida 2, para 0 with a miscarriage) was referred to Fetal Medicine AOUI Verona Centre for an increased fetal NT (4.6 mm) and vacuole formations in the placenta diagnosed at I trimester US scan. An expert US scan which reported nuchal edema (5.2 mm), vacuole formations in the placenta and heart anomalies was performed at 15+2 weeks. Amniocentesis showed a 69 XXY fetal karyotype. US scan at 18 weeks showed a IUGR, Dandy-Walker Complex, Tetralogy of Fallot, molar changes of placenta and ovaries enlarged with multiple bilateral theca lutein cysts. The patient had no clinical symptoms of molar pregnancy. BHCG was 1.255.660 UI/L. Pregnancy was terminated at 19+4 weeks by induction of labour with intravaginal Gemeprost. A fetus with molar placenta was delivered; suction and curettage were performed. Histopathologic analysis and immunohistochemistry confirmed the diagnosis of partial hydatiform mole. Cytogenetic analysis showed a triploid kariotype. Fetal autopsy wasn't done under request of the patient. Chest-X- ray was negative. BHCG levels were checked every 2 weeks until the values were within the normal range. A closed follow up is still being performed. Definitive diagnosis of partial mole by ultrasound is often difficult especially in the early scan. It might be confused with missed abortions or blighted ovum. Triploidy is usually incompatible with life. In this case the fetus survived up to the second trimester with IUGR and a major anomaly of the heart. Molar pregnancies generally have severe outcomes. Serial follow up of HCG levels after termination of pregnancy is necessary. Cytogenetic pattern has to be correlated with histopathological diagnosis.
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