Molar Pregnancy with Co-Existing Viable Fetus Delivered Preterm at 24 Weeks Gestation: A Case Report

Abstract

Introduction and Importance

It is unusual and challenging to have a molar pregnancy and a viable fetus at the same time. Bleeding per vagina, anemia, hyperemesis gravidarum, hypertension, thyrotoxicosis, and uterine enlargement disproportionate to uterine age are common clinical presentations that should alert the clinician to this uncommon illness. Pregnancy of a hydatidiform mole with a coexistent live fetus in most cases is a complete molar pregnancy. Partial molar pregnancy with fetus is rare and almost always ends in miscarriage due to triploid fetus.

Case Presentation

In this case study, we present a 19-year-old woman who presented with acute vaginal bleeding and pelvic discomfort. Transabdominal ultrasound revealed fetal heart rate and identified the fetus at 24 weeks gestation. A large heterogeneous and complex cystic mass was found in the fundus, which was diagnosed as an abnormal placenta with a strong suspicion of molar pregnancy. The cervix was dilated by 4 cm at the time of hospital admission and four hours later, she gave birth to a healthy female fetus. The placenta emerged along with the membrane and abundant grape-like cystic tissue.

Clinical Discussion

A case study showed a coexisting live fetus that was 24 weeks gestational age and had a partial hydatidiform mole, along with severe vaginal bleeding and uterine contraction. A partial mole was identified through histology analysis of the placenta.

Conclusion

Maternal b-HCG levels fell to undetectable levels one month after birth without treatment. She was doing well and a follow-up six months later revealed no evidence of retained tissue or recurrence.

Keywords:

• molar pregnancy
• preterm delivery
• prenatal diagnosis
• patient
• vaginal bleeding

Highlights

Pregnancy of a hydatidiform mole with a coexistent live fetus in most cases is a complete molar pregnancy. Partial molar pregnancy with fetus is rare and almost always ends in miscarriage due to triploid fetus.

Molar pregnancy usually appears in the first trimester and is accompanied by a variety of symptoms such as vaginal bleeding, uterine ovarian enlargement.

Abbreviations

B hCG, Beta hCG; GTD, Gestational Trophoblastic Disease; CHM, Complete hydatid form mole; PHM, Partial hydatid form mole; PSTT, placental site trophoblastic tumors.

Ethics Approval and Consent to Participate

Ethical approval was waived by the ethical committee of Mogadishu Somali Turkey, Recep Tayyip Erdogan Training and Research Hospital.

Written informed consent was obtained from the patient for the publication of this case report and accompanying images.

Acknowledgment

We acknowledge the education and research committees of Mogadishu, Somalia, Turkey, Recep Tayyip Erdogan Training and Research Hospital.

We acknowledge S.A, who allowed us to use her clinical information, reports, and images for this case report. Reports, and images for this case report.

Author Contributions

All authors made a significant contribution to the work reported, whether that is in the conception, study design, execution, acquisition of data, analysis and interpretation, or in all these areas; took part in drafting, revising or critically reviewing the article; gave final approval of the version to be published; have agreed on the journal to which the article has been submitted; and agree to be accountable for all aspects of the work.

Disclosure

The authors have no affiliation with any organization with a direct or indirect financial interest in the subject matter discussed in the manuscript.

Additional information

Funding

No funding was received.