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2022-RA-1013-ESGO Twin pregnancy with complete hydatiform mole and coexistent fetus
  1. Maha Najla Bouyahia,
  2. Zemni Zeineb,
  3. Rebai Mohamed,
  4. Amari Sarah,
  5. Linda Mustapha and
  6. Fethi Zhioua
  1. Azizaothmana Hospital, Tunis, Tunisia


Introduction/Background Twin pregnancy with complete mole is a rare entity, with high risk and non-standardized management. This case allows us to share our experience regarding this entity.

Methodology We report the case of a twin pregnancy with complete mole managed in the gynaecology-obstetrics department of the Aziza Othmana hospital in Tunis in April 2022.

Results This is a 39 year old patient, chronically hypertensive, who consulted our emergency at 22 weeks of amenorrhea (WA) + 3 days for metrorrhagia. She was a nulliparous woman with a history of early spontaneous miscarriage and fetal death in utero at 6 months in relation with pre-eclampsia. Her 1st trimester ultrasound showed a single fetus with fine nuchal translucency and bilateral uterine artery notch. Her maternal 1st trimester serum markers revealed an elevated trisomy risk of 1/101 and a beta HCG level at 15.35 mom. Ultrasound on admission revealed a 21 (WA) fetus in severe oligohydramnios with a 65*58 mm heterogeneous honeycomb overlying placenta opposite the internal cervical os suggestive of partial mole. The patient presented with heavy metrorrhagia requiring a transfusion of 3 packed red blood cells and a caesarean section revealing a vesicular overlying placental mass and a fetus of 21 (WA), the end of the operation was uneventful with a blood loss of 500cc. The weekly bhcg levels kinetics were as follows: initial value 11768 mUI/L, at day 7 post operative 242 mUI/L with no image of retention, until it was negated in less than 8 weeks.

Conclusion This rare neoplastic pathology cannot be diagnosed by ultrasound or macroscopic examination of the placenta with certainty; only anatomopathological examination provides the diagnosis

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