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Abstract
Introduction/Background A twin pregnancy with a complete hydatidiform mole (CHM) and a coexisting fetus is an exceptionally rare condition, occurring in approximately 1:22,000 to 1:100,000 pregnancies. We herein report a case of a 20-year-old woman diagnosed with CHM coexisting with a healthy fetus at 17th week of gestation.
Methodology After prenatal counseling, where potential complications of a molar pregnancy were explained, and laparotomy evacuation was discussed, the patient declined invasive testing or medical interruption of the pregnancy. Consequently, we opted for a conservative approach involving regular ß-HCG monitoring every 2 weeks until 3 months post-partum, obstetrical ultrasound scans every 2 weeks, regular blood pressure measurement and proteinuria screening, along with thyroid function tests and a chest X-Ray at the time of diagnosis. A Cesarean section was performed at 34 weeks of gestation, accompanied by the evacuation of the molar pregnancy.
Results An obstetrical ultrasound uncovered a twin pregnancy: Pregnancy A proved to be a normally developing fetus at 18w+1d along with a normally inserted placenta while pregnancy B revealed to be heterogenous cystic placental lesions with snowstorm appearance and no fetal silhouette. Primary laboratory analysis revealed ß-HCG and TSH levels of 308,480 mIU/ml and 0.13 mIU/ml respectively. Furthermore, T3-T4 levels, urinalysis, and chest X-ray were unremarkable. Serial obstetrical ultrasounds demonstrated normal fetal growth while ß-HCG levels were declining reaching 158,989 mIU/ml before delivery. At 34 weeks of gestation, a Cesarean section was performed without complications, resulting in the delivery of a healthy newborn weighing 2,000g. Surveillance via regular gynecological ultrasounds and ß-HCG testing depicted an uneventful progression, with an undetectable level of ß-HCG at 5 months postpartum.
Conclusion Due to the scarcity of such cases, no clear recommendations are available for patients who decide to carry their pregnancy to term. In our case, a disciplined follow-up regimen proved to be a satisfactory management plan.
Disclosures This case was presented as an abstract during the 32nd World Congress on Ultrasound in Obstetrics and Gynecology in September 2022. Additional analysis and discussion have been incorporated since that time. The patient provided informed consent for the scientific use of images and information.
