EP22.37: Partial hydatidiform mole with a coexisting live fetus: a case report

A 26-year-old primigravid lady at 11 weeks of gestation presented with painless vaginal spotting. Pelvic ultrasound showed a single live intrauterine pregnancy of 10 weeks. Additionally a multicystic ill-defined lesion was noted in the uterine cavity caudal to the fetus. It demonstrated internal cystic pockets of variable sizes with no internal vascularity and measured 7x4.3x5.3cm. βHCG was 781972.7 IU/L. Diagnosis was made of one live fetus and one hydatidiform mole from a dichorionic diamniotic pregnancy. The patient was counselled about potential maternal and fetal complications. These include massive hemorrhage, early pre-eclampsia, thyroid storm, risk of invasive moles and malignancies, prematurity, growth restriction and fetal death. Suction evacuation was performed and uterus was confirmed to be empty on scan. Histopathology confirmed complete mole. βHCG level was gradually dropping until six weeks and then it started going up. She was referred to gynecology oncology for assessment of trophoblastic neoplasia. CT scan findings were negative for metastasis. She was given Actinomycin-D as a single-agent chemotherapy. A total of five therapeutic cycles were administered. βHCG levels were monitored weekly. It showed gradual drop and was negative for the subsequent six weeks. Only about 200 cases of hydatidiform mole with coexisting fetuses have been reported worldwide, counselling and management of such a condition remain controversial. Several authors have suggested that in the absence of fetal anomalies or pre-eclampsia, pregnancy continuation might be advised. In contrast, others recommended immediate termination when a hydatidiform mole is detected with a coexisting fetus due to the possibility of developing persistent trophoblastic tumour and other maternal medical complications. All women with such cases should be counselled. As in our case, the patient decided to terminate her pregnancy after receiving comprehensive counselling.