Twin Pregnancy Presenting with Hydatidiform Mole and Co-existing Living Fetus with Ovarian Venous Thrombosis: A Case Report at Thammasat University Hospital
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Abstract
Background This case was a twin pregnancy with a complete hydatidiform mole (CHM) and a co-existing fetus. Gestational trophoblastic neoplasia (GTN) and ovarian venous thrombosis (OVT) were diagnosed during the postpartum period.
Case A 25-year-old pregnant woman, Gravid 2, Para1 presented with vaginal bleeding. Ultrasonography showed multi-cystic placenta separated from a normal placenta and a living fetus. The patient had a vaginal delivery at 31+5 weeks of gestation. Placental histology described a CHM and negative P57 immunohistochemistry. Post-molar GTN was diagnosed after one month of delivery. Low-risk GTN was diagnosed with OVT. Clinical symptoms subsided after administrating of single-agent methotrexate and an anticoagulant and without complication during one year follow up.
Conclusion CHM with a co-existing fetus needs imaging, prenatal genetics, and pathological plus P57 immunohistochemistry for diagnosis.
Teaching point Probability of delivering a viable fetus is approximately 50%, Two-thirds of a viable fetuses are preterm. The rate of maternal-fetal complications and post-molar GTN were higher than singleton CHM. Therefore, the management of this situation should be discussed with the patient. In addition, OVT was diagnosed by clinical symptoms and imaging techniques. Treatment of asymptomatic OVT patients was also debated between using anticoagulants plus antibiotics, only anticoagulants, or no medication.
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