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:: Volume 28, Issue 3 (Scientific Journal of Kurdistan University of Medical Sciences 2023) ::
SJKU 2023, 28(3): 117-123 Back to browse issues page
Twin Pregnancy with one Fetus and a Concomitant Mole: A Case Report
Shamsi Zare1 , Nasrin Sufizadeh2 , Sara Mohammadi3 , Payman Rezagholi 4
1- Assistant Professor, Department of Obstetrics and Gynecology,Faculty of Medicine, Kurdistan University of Medical Sciences, Sanandaj, Iran
2- Assistant Professor, Department of Obstetrics and Gynecology,Faculty of Medicine,Behsat Hospital ,Kurdistan University of Medical Sciences, 98, Iran
3- Instructor, Department of Operating Room, School of Allied Medical Sciences, Ilam University of Medical Sciences, Ilam, Iran.
4- Instructor,Department of Operating Room, Faculty of Nursing and Midwifery, Kurdistan University of Medical Sciences,Sanandaj,Iran , paimanrezagholy@gmail.com
Abstract:   (1017 Views)
Background and Aim: Gestational trophoblastic disease consists of a wide range of tumors related to the uterus, including complete and incomplete hydatidiform mole, placental trophoblastic tumor, and choriocarcinoma, which have different tendencies to local invasion and metastasis. In this study, we report a case of twin pregnancy with one fetus and a concomitant mole in a 40-year-old woman.
Case report: A 40-year-old woman at 17-week of pregnancy referred with complaints of shortness of breath, headache and high blood pressure. Fetal heart rate was 110. According to the ultrasound of the fetus, the size of the placenta was much larger than normal and had cystic areas. The patient was diagnosed as a case of twin pregnancy with one fetus and a concomitant mole. Emergency hysterotomy was performed. The patient was discharged from the hospital after one week in good general condition and recommended to check weekly βHCG titer test and control blood pressure.
conclusion: Molar pregnancy is diagnosed by abdominal ultrasound and serum βHCG measurement. Considering pregnancy complications such as gestational hypertension and metabolic disorders such as hyperthyroidism and bleeding which can increase after such pregnancies, early diagnosis and treatment are essential to reducing maternal mortality. In addition, after termination of such pregnancies, examination of the patients for early detection of trophoblastic tumors is very important.
 
Keywords: Twin pregnancy, Molar pregnancy
Full-Text [PDF 637 kb]   (457 Downloads)    
Type of Study: case report | Subject: Medicine - Obstetrics and Gynecology
Received: 2022/11/2 | Accepted: 2023/04/10 | Published: 2023/07/31
References
1. Lok C, Frijstein M, van Trommel N. Clinical presentation and diagnosis of gestational trophoblastic disease. Best Pract Res Clin Obstet Gynaecol 2021 Jul 1;74:42-52. doi.org/10.1016/j.bpobgyn.2020.12.001.
2. Schorge JO, Goldstein DP, Bernstein MR, Berkowitz RS. Recent advances in gestational trophoblastic disease. J Reprod Med. 2000;45(9):692.
3. Talati NJ. The pattern of benign gestational trophoblastic disease in Karachi.JPMA. 1998;48:296-9.
4. Sivanesaratnam V. Management of gestational trophoblastic disease in developing countries. Best Pract Res Clin Obstet Gynaecol. 2003;17(6):925-42.
5. Abike F, Temizkan O, Payasli A, Avsar F, Karahan N, Baspinar S. Postmenopausal complete hydatidiform mole: a case report. Maturitas. 2008;59(1):95-8. doi.org/10.1016/j.cub.2017.05.064
6. Radhouane A, Imen BA, Khaled N. Twin pregnancy with both complete hydatiform mole and coexistent alive fetus: Case report. Asian Pac J Reprod. 2015;4(4):331-3. doi.org/10.1016/j.apjr.2015.07.013
7. Kang A, Struben H. Pre-eclampsia screening in first and second trimester. Ther Umsch. 2008;65(11):663-6. DOI: 10.1024/0040-5930.65.11.663.
8. Schena FP, Thomas W, Griffiths M, Nelson-Piercy C, Sinnamon K. Pre-eclampsia before 20-week gestation: diagnosis, investigation and management. NDT journal. 2012;5(6):597-9. doi.org/10.1093/ckj/sfs101.
9. Turner JA. Diagnosis and management of pre-eclampsia: an update. IJWHC. 2010;2:327.
10. Copeland JW, Stanek J. Dizygotic Twin Pregnancy with a Normal Fetus and a Nodular Embryo Associated with a Partial Hydatidiform Mole. Pediatr Dev Pathol. 2010;13(6):476-480. doi:10.2350/09-11-0735-CR.1.
11. Kim CH, Kim YH, Kim JW, Kim KM, Cho MK, Kim SM, et al. Triplet pregnancy with partial hydatidiform mole coexisting with two fetuses: a case report. J Obstet Gynaecol Res 2008;34(4 Pt2):641-4. doi.org/10.1111/j.1447-0756.2008.00899.x.
12. Berkowitz RS, Goldstein DP. Molar pregnancy. NEJM. 2009;360(16):1639-45.
13. Ogura T, Katoh H, Satoh S, Tsukimori K, Hirakawa T, Wake N, et al. Complete mole coexistent with a twin fetus. J Obstet Gynaecol Res 2006;32(6):593-601. doi.org/10.1111/j.1447-0756.2006.00463.x.
14. Ozarpaci C, Yalti S, Gürbüz B, Ceylan S, Cakar Y. Complete hydatidiform mole with coexistent live fetus in dichorionic twin gestation. Arch Gynecol Obstet 2005;271(3):270-3. doi.org/10.1007/s00404-004-0642-x.
15. Growdon WB, Wolfberg AJ, Feltmate CM, Goldstein DP, Genest DR, Chinchilla ME, et al. Postevacuation hCG levels and risk of gestational trophoblastic neoplasia among women with partial molar pregnancies. J Reprod Med. 2006;51(11):871-4. DOI: 10.1097/01.AOG.0000174583.51617.25.
16. Wie J, Kwon J, Ko H, Lee Y, Shin J, Park I. Thyroid storm and early-onset proteinuric hypertension caused by a partial molar pregnancy. J Obstet Gynaecol. 2016;36(3):351-2.
17. Pourali L, Ayati S, Vahidroodsari F, Taghizadeh A, Sadat Hosseini R. Uterine rupture following incomplete molar pregnancy: a case report. TUMJ. 2013;70(12): 798-801.
18. Braga A, Mora P, de Melo AC, Nogueira-Rodrigues A, Amim-Junior J, Rezende-Filho J, Seckl MJ. Challenges in the diagnosis and treatment of gestational trophoblastic neoplasia worldwide. WJCO. 2019 Feb 2;10(2):28. doi: 10.5306/wjco.v10.i2.28
19. Lok C, Frijstein M, van Trommel N. Clinical presentation and diagnosis of gestational trophoblastic disease. Best Pract Res Clin Obstet Gynaecol 2021 Jul 1;74:42-52. doi.org/10.1016/j.bpobgyn.2020.12.001.
20. Schorge JO, Goldstein DP, Bernstein MR, Berkowitz RS. Recent advances in gestational trophoblastic disease. J Reprod Med. 2000;45(9):692.
21. Talati NJ. The pattern of benign gestational trophoblastic disease in Karachi.JPMA. 1998;48:296-9.
22. Sivanesaratnam V. Management of gestational trophoblastic disease in developing countries. Best Pract Res Clin Obstet Gynaecol. 2003;17(6):925-42.
23. Abike F, Temizkan O, Payasli A, Avsar F, Karahan N, Baspinar S. Postmenopausal complete hydatidiform mole: a case report. Maturitas. 2008;59(1):95-8. doi.org/10.1016/j.cub.2017.05.064
24. Radhouane A, Imen BA, Khaled N. Twin pregnancy with both complete hydatiform mole and coexistent alive fetus: Case report. Asian Pac J Reprod. 2015;4(4):331-3. doi.org/10.1016/j.apjr.2015.07.013
25. Kang A, Struben H. Pre-eclampsia screening in first and second trimester. Ther Umsch. 2008;65(11):663-6. DOI: 10.1024/0040-5930.65.11.663.
26. Schena FP, Thomas W, Griffiths M, Nelson-Piercy C, Sinnamon K. Pre-eclampsia before 20-week gestation: diagnosis, investigation and management. NDT journal. 2012;5(6):597-9. doi.org/10.1093/ckj/sfs101.
27. Turner JA. Diagnosis and management of pre-eclampsia: an update. IJWHC. 2010;2:327.
28. Copeland JW, Stanek J. Dizygotic Twin Pregnancy with a Normal Fetus and a Nodular Embryo Associated with a Partial Hydatidiform Mole. Pediatr Dev Pathol. 2010;13(6):476-480. doi:10.2350/09-11-0735-CR.1.
29. Kim CH, Kim YH, Kim JW, Kim KM, Cho MK, Kim SM, et al. Triplet pregnancy with partial hydatidiform mole coexisting with two fetuses: a case report. J Obstet Gynaecol Res 2008;34(4 Pt2):641-4. doi.org/10.1111/j.1447-0756.2008.00899.x.
30. Berkowitz RS, Goldstein DP. Molar pregnancy. NEJM. 2009;360(16):1639-45.
31. Ogura T, Katoh H, Satoh S, Tsukimori K, Hirakawa T, Wake N, et al. Complete mole coexistent with a twin fetus. J Obstet Gynaecol Res 2006;32(6):593-601. doi.org/10.1111/j.1447-0756.2006.00463.x.
32. Ozarpaci C, Yalti S, Gürbüz B, Ceylan S, Cakar Y. Complete hydatidiform mole with coexistent live fetus in dichorionic twin gestation. Arch Gynecol Obstet 2005;271(3):270-3. doi.org/10.1007/s00404-004-0642-x.
33. Growdon WB, Wolfberg AJ, Feltmate CM, Goldstein DP, Genest DR, Chinchilla ME, et al. Postevacuation hCG levels and risk of gestational trophoblastic neoplasia among women with partial molar pregnancies. J Reprod Med. 2006;51(11):871-4. DOI: 10.1097/01.AOG.0000174583.51617.25.
34. Wie J, Kwon J, Ko H, Lee Y, Shin J, Park I. Thyroid storm and early-onset proteinuric hypertension caused by a partial molar pregnancy. J Obstet Gynaecol. 2016;36(3):351-2.
35. Pourali L, Ayati S, Vahidroodsari F, Taghizadeh A, Sadat Hosseini R. Uterine rupture following incomplete molar pregnancy: a case report. TUMJ. 2013;70(12): 798-801.
36. Braga A, Mora P, de Melo AC, Nogueira-Rodrigues A, Amim-Junior J, Rezende-Filho J, Seckl MJ. Challenges in the diagnosis and treatment of gestational trophoblastic neoplasia worldwide. WJCO. 2019 Feb 2;10(2):28. doi: 10.5306/wjco.v10.i2.28
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zare S, sufizadeh N, mohammadi S, rezagholi P. Twin Pregnancy with one Fetus and a Concomitant Mole: A Case Report. SJKU 2023; 28 (3) :117-123
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Volume 28, Issue 3 (Scientific Journal of Kurdistan University of Medical Sciences 2023) Back to browse issues page
مجله علمی دانشگاه علوم پزشکی کردستان Scientific Journal of Kurdistan University of Medical Sciences
مجله علمی دانشگاه علوم پزشکی کردستان Scientific Journal of Kurdistan University of Medical Sciences
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