Abstract
IntroductionTwin pregnancy with complete hydatidiform mole represents a very rare obstetric problem. Management of such cases is always problematic because the possibility of fetal survival should always be weighed against the risk of complications of molar pregnancy.Case presentationA 34-year-old Caucasian woman presented to our center with mild vaginal bleeding. Our patient was 16 weeks pregnant after a seven-year period of primary infertility. She became pregnant following a non-prescribed regimen of clomiphene citrate extending from the second day to the 13th day of her last cycle. A transabdominal ultrasound examination revealed a twin pregnancy with complete hydatidiform mole and a coexisting fetus. Serum β human chorionic gonadotropin was falsely low as identified by serial dilution of the sample (the 'hook effect'). Our patient refused termination of pregnancy and she was hospitalized for strict observation and follow-up. Unfortunately, she developed an attack of severe vaginal bleeding and a hysterotomy was performed. The fetus died shortly after birth.ConclusionsTwin pregnancy with complete hydatidiform mole represents a matter of controversy. We suggest that conservation should always be considered whenever tertiary care services and strict observation are available.
Highlights
Twin pregnancy with complete hydatidiform mole represents a very rare obstetric problem
Twin pregnancy with complete hydatidiform mole represents a matter of controversy
We suggest that conservation should always be considered whenever tertiary care services and strict observation are available
Summary
Twin pregnancy with complete hydatidiform mole and coexisting fetus is rarely seen during clinic practice. In spite of her testing positive, her serum b-hCG level was relatively low for a patient with complete molar pregnancy (8354 mIU/mL and 7799 mIU/mL in two serum samples drawn two days apart). Anti-hypertensive drugs were not given in order not to mask her actual blood pressure She experienced palpitation, flushing and excessive sweating from day five and the thyroid function test was repeated; the results indicated thyrotoxicosis (T4 = 3.26 ng/dL, free T3 = 5.95 pg/mL, thyroid stimulating hormone (TSH) = 0.022 μIU/mL). The patient developed a severe attack of vaginal bleeding; a hysterotomy was inevitable She delivered a 680 g viable boy with no apparent congenital anomalies; the placenta was complete, about 15 cm in diameter and adjacent but identifiable from the coexisting molar pregnancy. Serial dilution of the sample was no longer needed after termination
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