Multiple pregnancies with hydatidiform mole and coexisting fetus:a retrospective case series study

MAI Feng-ming; WANG Kun; CAI Li-jun; LI Jia; SU Chun-hong; CHEN Dun-jin

doi:10.19538/j.fk2024110119

Abstract：Objective To assess the obstetric outcome of multiple pregnancies with hydatidiform mole and coexisting fe-tus(HMCF).Methods Retrospectively collecting data of 23 patients with HMCF who were admitted to the Third Hospi-tal of Guangzhou Medical University from January 2003 to December 2022.A case series of 13 multiple pregnancies con-firmed histologically were reported with regard to the prenatal diagnosis,pregnancy outcome,and prognosis of gestational trophoblastic neoplasia(GTN).Results Among the 13 multiple pregnancies(one triple pregnancy and twelve twin preg-nancies),we identified 10(76.9％)with complete hydatidiform mole and coexisting fetus(CHMCF)and 3(23.1％)with partial hydatidiform mole and coexisting fetus(PHMCF).During pregnancy,nine women presented vaginal bleeding,one had abdominal pain,three developed early-onset preeclampsia and two were asymptomatic.There were eight patients who chose to terminate before 24 weeks of gestation,including six vaginal evacuations,one cesarean section and one hys-terectomy.Another five continued pregnancy and underwent cesarean delivery,resulting in a 100％live-birth rate with four cases of single live-bom infant and one case of two live-bom infants.There were six women who re-ceived blood transfusion and five who experienced repeated curettage for remnants in the perioperative period.After termination of pregnancy,six women showed serum β-hCG spontaneously turning nega-tive,while seven needed to receive chemotherapy.The overall incidence of GTN in HMCF was 53.8％(7/13),including 3 cases of lung metastases which were from CHMCF.The incidence of GTN was 50.0％(4/8)and 60.0％(3/5)in women who terminated before 24 weeks of gestation and those who chose to continue the pregnancy,respectively.One out of the two term deliveries developed GTN.Except the case who underwent hysterectomy,we followed up the others for subse-quent fertility,and no recurrent trophoblastic disease was reported.There were six women with normal term delivery,two infertile,two lost to follow up,and two with no plans for further fertility.Conclusions In cases of HMCF,the prevalence of CHMCF is higher than that of PHMCF.Repeated vaginal bleeding and intrauterine mixed echo are the most common clinical manifestations,and the combination with serum β-hCG is helpful in the differential diagnosis.Continuation of pregnancy does not add the risk of persistent GTN compared with termination before 24 weeks,but CHMCF is associated with a higher incidence of GTN.Obstetricians should individualize the management of multiple pregnancies with HMCF and weigh the indications for termination of pregnancy.