Geburtshilfe Frauenheilkd 2016; 76(07): 819-822
DOI: 10.1055/s-0042-109398
Case Report
GebFra Science
Georg Thieme Verlag KG Stuttgart · New York

Twin Pregnancy with One Fetus and One Complete Mole – A Case Report

Zwillingsschwangerschaft aus einem Fetus und einer kompletten Mole – ein Fallbericht
A. Freis
1   Gynecological endocrinology and fertility disorders, University Hospital Heidelberg, Heidelberg, Germany
,
M. Elsässer
2   Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
,
C. Sohn
2   Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
,
H. Fluhr
2   Gynecology and Obstetrics, University Hospital Heidelberg, Heidelberg, Germany
› Author Affiliations
Further Information

Publication History

received 16 February 2016
revised 24 May 2016

accepted 29 May 2016

Publication Date:
20 July 2016 (online)

Abstract

Twin pregnancy consisting of one fetus and one complete mole (CMCF, complete hydatidiform mole and a coexistent fetus) is an obstetric rarity with an incidence of 1/22 000 to 1/100 000 pregnancies. Associated risks include prematurity, intrauterine death, vaginal bleeding, preeclampsia, hyperthyroidism, theca lutein cysts, uterine rupture and the development of malignant neoplasia in the form of a trophoblastic tumour (GTD, persistent gestational trophoblastic disease), which is thought to be the most common complication. We report the case of a 33-year-old patient diagnosed with CMCF in the 15th week of pregnancy. After comprehensive counselling the patient chose to proceed with her pregnancy under close observation and prophylactic fetal lung maturation. We were able to extend the pregnancy to 32 weeks gestation when heavy vaginal bleeding forced a decision to deliver by caesarean section.

Zusammenfassung

Die Situation einer Zwillingsschwangerschaft, bestehend aus einem Fetus und einer kompletten Mole (CMCF, complete hydatidiform mole and a coexistent fetus) ist ein seltenes geburtshilfliches Ereignis und kommt in 1/22 000 bis 1/100 000 Schwangerschaften vor. Die Risiken hierfür umfassen Frühgeburtlichkeit, einen intrauterinen Fruchttod, vaginale Blutungen, Präeklampsie, Hyperthyreose, Thekaluteinzysten, Uterusruptur, und, als wohl größtes Risiko, die Entwicklung eines Trophoblastentumors als maligne Neoplasie (GTD, persisting gestational trophoblast disease). Wir berichten über eine 33-jährige Patientin, bei der wir in der 15. Schwangerschaftswoche die Diagnose einer CMCF gestellt haben. Die Patientin entschied sich nach ausführlicher Beratung für ein Fortführen der Schwangerschaft unter engmaschiger Vorsorge sowie Durchführung einer prophylaktischen Lungenreifung. Unter diesen Umständen konnten wir die Schwangerschaft bis in die 32. Schwangerschaftswoche verlängern, als uns starke vaginale Blutungen zur Entbindung via Sectio caesarea zwangen.

Supporting Information

 
  • References

  • 1 Massardier J, Golfier F, Journet D et al. Twin pregnancy with complete hydatidiform mole and coexistent fetus: obstetrical and oncological outcomes in a series of 14 cases. Eur J Obstet Gynecol Reprod Biol 2009; 143: 84-87
  • 2 Wee J, Jauniaux E. Prenatal diagnosis and management of twin pregnancies complicated by a co-existing molar pregnancy. Prenat Diagn 2005; 25: 772-776
  • 3 Vaisbuch E, Ben-Arie A, Dgani R et al. Twin pregnancy consisting of a complete hydatidiform mole and co-existent fetus: report of two cases and review of literature. Gynecol Oncol 2005; 98: 19-23
  • 4 Himoto Y, Kido A, Minamiguchi S et al. Prenatal differential diagnosis of complete hydatidiform mole with a twin live fetus and placental mesenchymal dysplasia by magnetic resonance imaging. J Obstet Gynaecol Res 2014; 40: 1894-1900
  • 5 Mangili G, Bergamini A, Giorgione V et al. [18F]fluorodeoxyglucose positron emission tomography/computed tomography and trophoblastic disease: the gynecologist perspective. Q J Nucl Med Mol Imaging 2016; 60: 103-116
  • 6 Sánchez-Ferrer ML, Hernández-Martínez F, Machado-Linde F et al. Uterine rupture in twin pregnancy with normal fetus and complete hydatidiform mole. Gynecol Obstet Invest 2014; 77: 127-133
  • 7 Starikov R, Goldman R, Dizon DS et al. Placental mesenchymal dysplasia presenting as a twin gestation with complete molar pregnancy. Obstet Gyecol 2011; 118: 445-448
  • 8 Marcorelles P, Audrezet MP, Le Bris MJ et al. Diagnosis and outcome of complete hydatidiform mole coexisting with a live twin fetus. Eur J Obstet Gynecol Reprod Biol 2005; 118: 21-27
  • 9 Shaik S, Al-Riyami N, Mathew NR et al. Twin pregnancy with a complete hydatidiform mole and a coexisting live fetus-rare entity. Sultan Qaboos Univ Med J 2015; 15: e550
  • 10 Rohilla M, Singh P, Kaur J et al. Individualistic approach to the management of complete hydatidiform mole with coexisting live fetus. Eur J Obstet Gynecol Reprod Biol 2015; 191: 39-42
  • 11 Sebire NJ, Foskett M, Paradinas FJ et al. Outcome of twin pregnancies with complete hydatidiform mole and healthy co-twin. Lancet 2002; 359: 2165-2166
  • 12 Herek D, Karabulut N. The role of magnetic resonance imaging in the diagnosis of complete hydatidiform mole in a twin pregnancy. Int J Gynaecol Obstet 2013; 123: 77