Ávila-Vergara MA, Cardona-Osuna ME, Guzmán-Gutiérrez LE, Espínola-Magaña KM, Caballero-Rodríguez CB, Di Castro-Stringher P, Vadillo-Ortega F

Language: Spanish
References: 29
Page: 853-861
PDF size: 616.72 Kb.

ABSTRACT

Background: Coexistance of molar pregnancy and alive fetus is an extremely rare condition but a medical challenge when it is present. Several maternal medical complications are associated with these pregnancies including both mother and fetus life-threatening conditions.
Clinical cases: Two cases of molar pregnancies are presented in this paper. First was a twin pregnancy with a complete hydatidiform coexisting with a live fetus and cesarean birth at 33 weeks of gestation of a live female weighing 1,530 g. that survived without complications. Second case was an incomplete mole complicated with severe pre-eclampsia, hypertiroidism, and placenta previa; pregnancy was interrupted at 24 weeks of gestation and a fetus weighing 625 g was extracted by cesarean section, the neonate did not survive.
Conclusion: In the presence of molar pregnancy coexisting with a live viable fetus, the present or potential complications that determine the risk of maternal and perinatal death, must be carefully assessed. A third-level perinatal facilities must be available for this kind of pregnancy complication.

REFERENCES

1. Seckl MJ, Sebire NJ, Berkowitz RS. Gestational trophoblastic disease. Lancet 2010;376(9742):717-729.

2. Vassilakos P, Riotton G, Kajii T. Hydatidiform mole: two entities. A morphologic and cytogenetic study with some clinical consideration. Am J Obstet Gynecol. 1977;127(2):167-170.

3. Stevens FT, Katzorke N, Tempfer C, Kreimer U, Bizjak GI, Fleisch MC, Fehm TN. Gestational trophoblastic disorders: an update in 2015. Geburtshilfe Frauenheilkd 2015;75(10):1043-1050.

4. Lurain JR. Gestational trophoblastic disease I: Epidemiology, pathology, clinical presentation and diagnosis of gestational trophoblastic disease, and management of hydatidiform mole. Am J Obstet Gynecol. 2010;203(6):531-539.

5. Juárez-Azpilcueta A, Islas-Dominguez L, Durán-Padilla MA. Mola hidatiforme parcial con feto vivo del segundo trimestre. Rev Chil Obstet Ginecol 2010; 75(2):137-139.

6. Matsui H, Sekiya S, Hando T, Wake N, Tomoda Y. Hydatidiform mole coexistente with a twin live fetus: a national collaborative study in Japan. Hum Reprod. 2000;15(3):608- 611.

7. Makrydimas G, Sebire NJ, Thornton SE, Zagorianakou N, Lolis D, Fisher RA. Complete hydatidiform mole and normal live birth: a novel case of confined placental mosaicism: case report. Hum Reprod. 2002;17(9):2459-2463.

8. Nwosu EC, Ferriman E, McCormack MJ, Williams JH, Gosden CM. Partial hydatidiform mole and hypertension associate with a live fetus –variable presentation in two cases. Hum Reprod. 1995;10(9):2459-2462.

9. Lembert A, Zorlu CG, Yalçin HR, Seçkin B, Ekici E. Partial hydatidiform mole with diploid karyotype in a live fetus. Int J Gynaecol Obstet. 2000;69(2):149-152.

10. Steller MA, Genest DR, Bernstein MR, Lage JM, Goldstein DP, Berkowitz RS. Clinical features of multiple conception with partial or complete molar pregnancy and coexisting fetuses. J Reprod Med. 1994;39(3):147-154.

11. Graham JM, Rawnsley EF, Simmons GM, Wurster-Hill DH, Park JP, Marin-Padilla M, Crow HC. Tripoidy: pregnancy complications and clinical findings in seven cases. Prenat Diag. 1989;9(6):409-419.

12. Lin LH, Maestá I, Braga A, Sun SY, Fushida K, Francisco RP, Elias KM, Horowitz N, Goldstein DP, Berkowitz RS. Multiple pregnancies with complete mole and coexisting normal fetus in North and South America: a retrospective multicenter cohort and literature review. Gynecol Oncol. 2017;145(1):88-95.

13. Jauniaux E. Partial moles: from postnatal to prenatal diagnosis. Placenta. 1999; 20:379-388.

14. Sebire NJ, Fisher RA, Foskett M, Rees H, Seckl MJ, Newlands ES. Risk of recurrent hydatidiform mole and subsequent pregnancy outcome following complete or partial hydatidiform molar pregnancy. 2003;110:22-26.

15. Gupta K, Venkatesan B, Kumaresan M, Chandra T. Early detection by ultrasound of partial hydatidiform mole with a coexistent live fetus. WMJ. 2015;114(5):208-211.

16. Fowler DJ, Lindsay I, Seckl MJ, Sebire NJ. Histomorphometric features of hydatidiform moles in early pregnancy: relationship to detectability by ultrasound examination. Ultrasound Obstet Gynecol. 2007;29:76-80.

17. Petignat P, Billieux MH, Blouin JL, Dahoun S, Vassilakos P. Is genetic analysis useful in the routine management of hydatidiform mole? Hum Reprod. 2003;18(2):243-249.

18. Szulman AE, Surti U. The syndromes of hydatidiform mole. I. Cytogenetic and morphologic correlations. Am J Obstet Gynecol. 1978;131(6):665-671.

19. Genest DR. Partial hydatidiform mole: clinicopathological features, differential diagnosis, ploidy and molecular studies, and gold standards for diagnosis. Int J Gynecol Pathol. 2001;20(4):315-322.

20. Rohilla M, Singh P, Kaur J, Jain V, Gupta N. Individualistic approach to the management of complete hydatidiform mole with coexisting live fetus. Eur J Obstet Gynecol Reprod Biol. 2015;191:39-42.

21. Suksai M, Suwanrath C, Kor-Anantakul O, Geater A, Hanprasertpong T, Atjimakul T,Pichatechaiyoot A. Complete hydatidiform mole with co-existing fetus:predictors of live birth. Eur J Obstet Gynecol Reprod Biol. 2017;212:1-8.

22. Goldstein DP, Berkowitz RS. Current management of complete and partial mole. J Reprod Med. 1994;39(3):139-46.

23. Lembet A, Zorlu CG, Yalçin HR, Seçkin B, Ekici E. Partial hydatidiform mole with diploid karyotype in a live fetus. Int J Gynaecol Obstet. 2000;69(2):149-152.

24. Vejerslev LO. Clinical management and diagnostic possibilities in hydatidiform mole with coexistent fetus. Obstet Gynecol Surv. 1991;46(9):577-588.

25. Steller A, Genest DR, Bernstein MR, Lage JM, Golstein DP,Berkowitz RS. Natural history of twin pregnancy with complete hydatidiform mole and coexisting fetus. Obstet Gynecol.1994;83(1):35-42.

26. Wee L, Jauniaux E. Prenatal diagnosis and management of twin pregnancies complicated by a co-existing molar pregnancy. Prenat Diagn. 2005;25(9):772-776.

27. Piura B, Ravinovich A, Hershkovitz R, Maor E, Mazor M. Twin pregnancy with a complete hydatidiform mole and surviving co-existent fetus. Arch Gynecol Obstet. 2008;278(4):377-382.

28. Sebire NJ, Foskett M,Paradinas FJ, Fisher RA, Francis RJ, Short D, Newlands ES, Seckl MJ. Outcome of twin pregnancies with complete hydatidiform mole and healthy co-twin. Lancet. 2002;359(9324):2165-2166.

29. Hui P, Buza N, Murphy K, Ronnett B. Hydatidiform moles: genetic basis and precision diagnosis. Ann Rev Pathol Mech Dis 2017:12:449-85.