Recurrent Hydatidiform Mole

Abstract

INTRODUCTION: Hydatidiform mole is an abnormal pregnancy characterized by proliferation of trophoblastic tissue and hydropic placental villi. The incidence is approximately 0.1% of pregnancies. We present a case involving a patient with four molar pregnancies and address management strategies to improve future pregnancy outcomes. CASE REPORT: A 23-year-old woman, gravida 5 para 0040, presented for obstetric care at 9 weeks of gestation. Her obstetric history included three histologically proven complete molar pregnancies and one spontaneous abortion. Initial ultrasonography demonstrated a snowstorm appearance and no fetal pole. The patient underwent suction dilation and curettage. Pathology confirmed complete hydatidiform mole. Serial quantitative human chorionic gonadotropin levels were followed to resolution. The patient and her partner had normal karyotypes. DISCUSSION: The cytogenetics of molar pregnancy may shed light on management options. In complete hydatidiform mole, the genetic material is paternal in origin resulting from fertilization of an oocyte without maternal genetic information. Recurrent complete molar pregnancy may indicate abnormal maternal oocyte formation. In vitro fertilization (IVF) with intracytoplasmic sperm injection (ICSI) and preimplantation genetic diagnosis is reasonable under such circumstances. If maternal oocytes consistently do not contain a haploid chromosome complement, oocyte or embryo donation may be required for a successful pregnancy. CONCLUSION: In the setting of recurrent molar pregnancy, IVF with ICSI and preimplantation genetic diagnosis may be offered. Other management options would include oocyte or embryo donation.