High-risk metastatic post-molar neoplasia complicating twin pregnancy with complete mole and coexisting fetus. Case report and review of the literature

Abstract

Objective: To raise awareness of the recognition of twin pregnancy with complete hydatidiform mole and normal coexisting fetus (CHMCF). CHMCF are at high risk of developing preeclampsia, prematurity and up to 50% fetal loss. Additionally, about 35% develop gestational trophoblastic neoplasia, irrespectively of the duration of the pregnancy. Case report: The patient was a primigravida with poorly controlled type 1 diabetes who became pregnant after ovulation stimulation and intrauterine insemination. She suffered from vaginal bleeding, hyperthyroidism and preeclampsia. CHMCF was suspected at 28 weeks of gestation. A caesarean section was performed at 30 weeks due to progressive high-risk diabetic retinopathy. The patient developed a high-risk metastatic post molar neoplasia with lung metastases and was treated with multidrug chemotherapy. Conclusion: It is important to recognize early CHMCF to manage maternal and fetal complications, and inform patients about related risks and to allow them to decide about the continuation or termination of pregnancy.