CC BY-NC-ND 4.0 · AJP Rep 2022; 12(01): e96-e107
DOI: 10.1055/a-1678-3563
Case Report

Complete Molar Pregnancies with a Coexisting Fetus: Pregnancy Outcomes and Review of Literature

1   Department of Obstetrics, Gynecology and Reproductive Sciences, Division of Maternal Fetal Medicine, University of California San Francisco, San Francisco, California
,
Kerry Holliman
2   Austin Maternal-Fetal Medicine, Austin, Texas
,
Michelle Debbink
3   Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, University of Utah, Salt Lake City, Utah
,
Lori Day
4   Obstetrix Medical Group, Beacon Memorial Hospital, Division of Maternal Fetal Medicine, South Bend, Indiana
,
Krista Mehlhaff
5   Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Walter Reed National Military Medical Center, Bethesda, Maryland
,
Lisa Gill
6   Department of Obstetrics, Gynecology, and Women's Health, Division of Maternal Fetal Medicine, University of Minnesota, Minneapolis, Minnesota
,
Cara Heuser
7   Department of Obstetrics and Gynecology, Division of Maternal Fetal Medicine, Intermountain Healthcare and University of Utah, Salt Lake City, Utah
,
Alisa Kachikis
8   Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, University of Washington, Seattle, Washington
,
Kristine Strickland
9   Prevea Health, Maternal Fetal Medicine, Green Bay, Wisconsin
,
Justin Tureson
10   Department of Obstetrics and Gynecology, Naval Readiness and Training Command, Twentynine Palms, Twentynine Palms, California
,
Jessica Shank
11   Department of Obstetrics and Gynecology, Division of Gynecologic Oncology, Tulane University School of Medicine, New Orleans, Louisiana
,
Rachel Pilliod
12   Department of Obstetrics and Gynecology, Oregon Health & Science University, Division of Maternal Fetal Medicine, Portland, Oregon
,
Chitra Iyer
13   Obstetrix Medical Group of Texas, Fort Worth, Texas
,
2   Austin Maternal-Fetal Medicine, Austin, Texas
› Author Affiliations

Abstract

Objective The objective of the study was to review the obstetric outcomes of complete hydatidiform molar pregnancies with a coexisting fetus (CHMCF), a rare clinical entity that is not well described.

Materials and Methods We performed a retrospective case series with pathology-confirmed HMCF. The cases were collected via solicitation through a private maternal-fetal medicine physician group on social media. Each contributing institution from across the United States (n = 9) obtained written informed consent from the patients directly, obtained institutional data transfer agreements as required, and transmitted the data using a Health Insurance Portability and Accountability Act of 1996 (HIPAA) compliant modality. Data collected included maternal, fetal/genetic, placental, and delivery characteristics. For descriptive analysis, continuous variables were reported as median with standard deviation and range.

Results Nine institutions contributed to the 14 cases collected. Nine (64%) cases of CHMCF were a product of assisted reproductive technology and one case was trizygotic. The median gestational age at diagnosis was 12 weeks and 2 days (9 weeks–19 weeks and 4 days), and over half were diagnosed in the first trimester. The median human chorionic gonadotropin (hCG) at diagnosis was 355,494 mIU/mL (49,770–700,486 mIU/mL). Placental mass size universally enlarged over the surveillance period. When invasive testing was performed, insufficient sample or no growth was noted in 40% of the sampled cases. Antenatal complications occurred in all delivered patients, with postpartum hemorrhage (71%) and hypertensive disorders of pregnancy (29%) being the most frequent outcomes. Delivery outcomes were variable. Four patients developed gestational trophoblastic neoplasia.

Conclusion This series is the largest report of obstetric outcomes for CHMCF to date and highlights the need to counsel patients about the severe maternal and fetal complications in continuing pregnancies, including progression to gestational trophoblastic neoplastic disease.

Key Points

  • CHMCF is a rare obstetric complication and may be associated with the use of assisted reproductive technology.

  • Universally, patients with CHMCF who elected to manage expectantly developed antenatal complications.

  • The risk of developing gestational trophoblastic neoplasia after CHMCF is high, and termination of the pregnancy did not decrease this risk.



Publication History

Received: 20 October 2020

Accepted: 08 October 2021

Accepted Manuscript online:
25 October 2021

Article published online:
14 February 2022

© 2022. The Author(s). This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

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