Vol 91, No 10 (2020)
Research paper
Published online: 2020-10-30

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Twin pregnancy with a partial hydatidiform mole and a coexistent live fetus. Diagnostic and therapeutic dilemmas. A case report and the review of literature

Malgorzata Gajewska1, Aleksandra Zygula1, Miroslaw Wielgos1, Grzegorz Szewczyk2
Pubmed: 33184826
Ginekol Pol 2020;91(10):589-594.

Abstract

Objectives: We report the case of a twin pregnancy with a partial hydatidiform mole and a coexistent live fetus diagnosed
in a 28-year-old primipara at 15 weeks of gestation and discuss the problems associated with the ultrasound diagnosis,
histopathological examination of molar tissue samples and treatment.
Material and methods: A systematic research of the literature was conducted in PubMed database and Cochrane Library,
including case reports and case series. A new case was also discussed. We collected data regarding the patient’s serum
human chorionic gonadotropin (hCG) level, initial symptoms, diagnosis and treatment.
Results: Most of the cases reported in the literature are those of a multiple pregnancy with complete hydatidiform
mole (CHM) and a coexistent live fetus. The coexistence of a twin pregnancy with partial hydatidiform mole (PHM)
and a live fetus in two separate amniotic sacs is extremely rare as a partial mole usually causes miscarriage of early
pregnancy. Ultrasound is an important diagnostic tool, but the correct diagnosis is made only in 68% of cases.
With further histological assessment of molar specimens and biochemical assays, the rates of correct early diagnoses should
increase contributing to early therapeutic decisions and fewer adverse events.
Conclusions: The diagnosis, management, and monitoring of this condition will remain challenging because of its rarity.
Because of that, all cases of a suspected multiple pregnancy with a hydatidiform mole and a coexistent live fetus should be
referred to and managed at a tertiary center which specializes in the diagnosis and treatment of gestational trophoblastic
disease.

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