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Abstract
IntroductionTriploid pregnancies have an increased risk of early preeclampsia. Twin pregnancies consisting of one healthy fetus and one complete or partial molar, with or without a triploid fetus, are rare and management is complex.Case presentationA 33-year-old Caucasian woman presented with a dichorionic diamniotic twin pregnancy. One fetus showed early growth restriction resulting in fetal death at 20 weeks. The placenta was enlarged with some cysts. Chorionic villus biopsy confirmed triploidy. At 21 weeks, the patient developed preeclampsia with a blood pressure of 154/98 mmHg and proteinuria (24 hour protein excretion of 2.5 g/L), for which she was hospitalized. Without pharmacological interventions, the blood pressure normalized and proteinuria disappeared. At 35 weeks, she again developed preeclampsia. A cesarean section was performed at 38 weeks and a healthy child was born.ConclusionsSurvival of the healthy fetus is possible in a twin pregnancy with a triploid fetus complicated by early preeclampsia. The pregnancy should not be terminated if the triploid twin has died and as long as conservative management is safe.
Highlights
Triploid pregnancies have an increased risk of early preeclampsia
Case presentation: A 33-year-old Caucasian woman presented with a dichorionic diamniotic twin pregnancy
Survival of the healthy fetus is possible in a twin pregnancy with a triploid fetus complicated by early preeclampsia
Summary
Triploidy is a genetic disorder with an extra haploid set of chromosomes resulting in a total of 69 chromosomes. Type I, with the additional chromosome set being of paternal origin (diandric), is consistent with normal growth of the fetus, with increased nuchal translucency, and an enlarged and partially multicystic placenta with elevated levels of maternal serum beta human chorionic gonadotropin (b-hCG). In three cases [4,5,6] of five concerning a triploid fetus and a healthy co-twin, a therapeutic abortion was performed, two of which were for severe preeclampsia. We present the first reported patient with triploid twin pregnancy with a successful outcome for the healthy co-twin after early transient preeclampsia. No abnormalities of the placenta were documented Her blood pressure was 125/70 mmHg. The pregnancy was complicated by episodes of vaginal bleeding at 16 weeks’ gestation. At 35 weeks, the patient developed preeclampsia again and was hospitalized Her blood pressure increased to 170/105 mmHg and proteinuria to 0.8 g/L. The level had already decreased to 440 IU/L
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