Coexistent molar pregnancy with a normal fetus-a rare presentation of gestational trophoblastic disease

A coexistent molar pregnancy with a normal fetus is rare, with an incidence of 1 in 22.000 to 100.000 pregnancies-only 200 cases reported in the last two decades. The ultrasound is essential for an earlier diagnosis, and the management of these cases is challenging due to the increased risk of obstetrics complications and the possibility of posterior gestational trophoblastic neoplasia. Here we describe a 33-year-old healthy woman with a first-trimester twin pregnancy, presented with a normal fetus and a heterogeneous and vacuolar structure suggestive of complete hydatidiform mole. The pregnancy was interrupted, and a histological diagnosis confirmed complete hydatidiform mole in dichorionic/diamniotic twin pregnancy at 14 weeks. Molar twin pregnancy is a rare condition, and do not exist any consensus protocol to guide the clinical approach, so the decision to continue the pregnancy depends on the couple’s desire and maternal and fetal complications.

PRENATAL DIAGNOSIS AND POSTNATAL MANAGEMENT OF THE COMPLETE MOLAR PREGNANCY WITH COEXISTING NORMAL FETUS

Hydatidiform mole with a coexisting fetus is an extremely rare phenomenon; the incidence of such an occurrence ranges from 1 in 10 000 to 1 in 100000 gestations(Cunningham et al., 1997).There were two possible conditions:a partial mole with an abnormaltriploid fetus, and a complete mole combined with a normal fetus and placenta. Most cases suffer severe complications, such as pre-eclampsia, abortion and preterm delivery,or termination immediately after the diagnosis.

Evaluation the angle of posterosuperior horn of normal fetal Sylvian fissure and its morphological changes by trans-cerebellar section

Objective On the basis of retrospectively analysis the trans-cerebellar section showing the Sylvian fissure of normal fetus is better than trans-thalamic section in middle and late trimester, we prospectively studied the morphological changes of the Sylvian fissure of normal fetus on the trans-cerebellar section in order to provide valuable information for the diagnosis of fetal cerebral cortical dysplasia. Methods A prospective cross-sectional study was conducted on 845 normal fetuses at 21 to 32 weeks of gestation from January 2019 to September 2020. The angle of the posterosuperior horn of the Sylvian fissure was measured. Based on the angle, the morphology of the Sylvian fissure was divided into four shapes included trapezoid shape (Angle >90), square shape (Angle=90); T shape (Angle <90) and I shape (Angl=0). Results The angle of the posterosuperior horn of the Sylvian fissure was negatively correlated with gestational age which correlation coefficient was 0.966 (P < 0.001). Taking gestational age as the independent variable and the angle of posterosuperior horn of the Sylvian fissure as the dependent variable, it showed that there was a linear relationship between the gestational age and the angle of posterosuperior horn of the Sylvian fissure. We got a simple correlation formula that the angle of posterosuperior horn of the Sylvian fissure =140-13X(gestational weeks-21). It was found that the morphological changes of the Sylvian fissure were related to the gestational age. The morphology of the Sylvian fissure was trapezoid shaped at 21 to 24 weeks of gestation, square shaped at 25 to 26 weeks of gestation, T shaped at 26 to 30 weeks of gestation, and the Sylvian fissure was almost closed and appeared I shaped after 31 to 32 weeks of gestation. Conclusion This study preliminarily elucidates that the morphological changes of the posterosuperior horn of the Sylvian fissure of normal fetuses at 21 to 32 weeks of gestation through the trans-cerebellar section, which could provide valuable information for the evaluation of the normal development of the Sylvian fissure and the prenatal diagnosis of cerebral cortical hypoplasia of fetuses. Key words Fetus; Sylvian fissure; posterosuperior horn; morphology; trans-cerebellar section

Evaluation of the depth and width of normal fetal Sylvian fissure by trans-cerebellar section

Objective On the basis of retrospectively analysis the trans-cerebellar section showing the Sylvian fissure of normal fetus is better than trans-thalamic section in middle and late trimester, we prospectively established the normal reference range of developmental parameters related to the Sylvian fissure of normal fetus in the trans-cerebellar section in order to provide valuable information for the diagnosis of fetal cerebral cortical dysplasia. Methods A prospective cross-sectional study was conducted on 845 normal fetuses at 21 to 32 weeks of gestation from January 2019 to September 2020. The depth and width of the Sylvian fissure was measured respectively, and regression analysis was performed according to different gestational age groups. Results The depth of Sylvian fissure was positively correlated with gestational weeks, and the width of Sylvian fissure was negatively correlated with gestational weeks, with correlation coefficients 0.751 and 0.825 respectively (all P < 0.001).Taking gestational weeks as the independent variable, and the depth and width of Sylvian fissure of fetus as the dependent variables, linear regression analysis showed that there was a linear relationship between the independent variables and the dependent variables. The obtained equation was simplified to a formula: Fetal Sylvian fissure depth (mm)=7+0.6X(gestational weeks-21), Sylvian fissure width (mm)=8-0.6X(gestational weeks-21). Conclusion The reference range of the depth and width of Sylvian fissure of normal fetus at 21 to 32 weeks of pregnancy through the trans-cerebellar section was established, which could provide valuable information for the evaluation of the normal development of the lateral fissure of fetus and the prenatal diagnosis of fetal cortical hypoplasia. Key words Fetus; Sylvian fissure; depth; width; trans-cerebellar section

Molar Changes with a Normal Viable Fetus: A Case Report

Objective: The presence of a normal fetus with normal karyotype accompanied by molar changes in the placenta is a rare condition, which carries a significant risk to the mother and fetus. There is a controversy regarding the proper management of this condition. Here, we present the case of a singleton pregnancy that showed molar changes in the pathological study of the placenta, but ended up with a normal viable neonate. Case Report: A 23-year-old primigravida woman, with a 3-year history of infertility, presented with vaginal bleeding and spotting. Her ß-human chorionic gonadotropin (HCG) at 13th week was 36500 mIU/ml. Serial sonography assessments were suggestive for molar changes and a normal fetus with growth retardation but normal Doppler assessment. The patient underwent elective Cesarean section at 37 weeks gestation and a healthy female neonate with an Apgar score of 9-10, weighing 2270 g was born. Pathological assessment of the placenta confirmed the diagnosis of incomplete hydatidiform mole. After two months, the mother had no complications, her ß-HCG level was untraceable, and the infant was in good condition. Conclusion: Despite being a rare condition, partial moles can be accompanied by delivery of a normal fetus. The management of this condition still remains challenging and should be done under close monitoring with extreme caution.

A Rare Case of Dystocia Due to Hydroamnion Coupled with Fetal Anasarca in a Doe

A non-descript doe was presented with the complaint of excessive bilateral abdominal distension and with unknown breeding history. Ultrasound examination revealed excessive anechoic area in uterus along with two fetuses. On caesarean section, dropsy of amnion was observed and one normal fetus co-twin with “bulldog” anasarcous fetus was removed.

Cell-Free DNA as an Addition to Ultrasound for Screening of a Complete Hydatidiform Mole and Coexisting Normal Fetus Pregnancy: A Case Report

Background Complete hydatidiform mole and coexisting normal fetus pregnancies (CHMCF) are rare and can be life-threatening to the mother. Definitive diagnosis can be made with chorionic villus sampling or amniocentesis. However invasive procedures carry a risk of bleeding. We present the case of a twin molar pregnancy where a cell-free DNA screening test was utilized to evaluate for CHMCF pregnancy. Case A patient presented at 15-week gestational age with suspected CHMCF pregnancy. Ultrasound revealed a normal-appearing pregnancy abutting a multicystic lesion concerning for a complete mole. Cell-free DNA was obtained and was suggestive of complete paternal uniparental disomy. Pathological evaluation of the products of conception confirmed the diagnosis of CHMCF. Conclusion In atypical cases, cell-free DNA may be useful in evaluation of molar pregnancy.

Delivery of Euthyroid Baby following Hyperthyroidism in Twin Gestation with Coexisting Complete Hydatidiform Mole

Context. Gestational trophoblastic disease (GTD) is a rare complication of pregnancy, ranging from molar pregnancy to choriocarcinoma. Twin pregnancies with GTD and coexisting normal fetus are extremely rare with an estimated incidence of 1 case per 22,000–100,000 pregnancies. Molecular mimicry between human chorionic gonadotrophin (hCG) and thyroid-stimulating hormone (TSH) leads to gestational trophoblastic hyperthyroidism (GTH) which is further associated with increased maternal and fetal complications. This is the first reported case in literature describing the delivery of a baby with biochemical euthyroid status following a twin pregnancy with hydatidiform mole (HM) associated with gestational trophoblastic hyperthyroidism (GTH). Case Description. A 24-year-old G4 P3 Caucasian female with twin gestation was admitted to hospital for gestation trophoblastic hyperthyroidism. She was later diagnosed to have twin pregnancy with complete mole and coexisting normal fetus complicated by gestational trophoblastic hyperthyroidism (GTH). Despite the risk associated with the continuation of molar pregnancy, per patient request, pregnancy was continued till viability of the fetus. The patient underwent cesarean section due to worsening preeclampsia and delivered a euthyroid baby at the 24th week of gestation. Conclusions. Twin pregnancy with gestational trophoblastic disease and coexisting normal fetus is associated with high risk of hyperthyroidism, and careful monitoring of the thyroid function test along with dose titration of thionamides is of utmost importance throughout the gestation. If normal thyroid hormone levels are maintained during the pregnancy, euthyroidism could be successfully achieved in the baby.

Partial hydatidiform mole and coexistent live fetus: a case report and review of the literature

Twin pregnancy of a hydatidiform mole with a coexistent live fetus is very rare, and complete molar pregnancy is involved in most cases. A partial molar pregnancy almost always ends in miscarriage due to a triploid fetus. Here, we report a case of a 32-year-old Chinese woman with ultrasound diagnosis of a partial molar pregnancy. Amniocentesis suggested mosaicism, but the fetus was morphologically normal. The woman chose to continue the pregnancy after fully understanding the risk. The infant was delivered prematurely, and the presence of a large single placenta with molar changes. The baby’s peripheral blood chromosomes were diploid, and the pregnant woman had no serious complications. The diagnosis, management, and monitoring of this condition will remain challenging because of its rarity. Partial hydatidiform mole combined with pregnancy can result in delivering of a normal fetus and live birth under proper management.