Clinical Analysis of Six Cases of Complete Hydatidiform Mole with Co-Existing Fetus

doi:10.12280/gjfckx.20220945

Abstract

Abstract:

Objective: To investigate the clinical characteristics, diagnosis and management of complete hydatidiform mole with co-existing fetus (CHMCF). Methods: The clinical data of 6 cases of twin pregnancy consisting of a CHMCF admitted to the First Affiliated Hospital of Zhengzhou University, from January 2019 to December 2021 were retrospectively analyzed, and the data were analyzed by descriptive methods. Results: The mean age of the six patients were (27.8±5.3) years old, with 3 (1-6) times of pregnancies. Six cases were identified at 14⁺¹ (8⁺⁵-24) gestational weeks. Recurrent vaginal bleeding during pregnancy occurred in 4 cases, nausea and vomiting in 2 cases, and hyperthyroidism in mid-pregnancy in a case. In the 6 patients, the summit serum human chorionic gonadotrophin-β (β-hCG) level was 389 527 (225 354-1 323 961) U/L. The ultrasound results revealed that 5 cases of CHMCF, and a case was partial hydatidiform mole. Prenatal diagnosis is normal in a case, which was refused in the remaining cases. Four cases were induced due to recurrent vaginal bleeding, a case was found to require abortion in early pregnancy, and a case was delivered by cesarean section at 36 weeks of gestation. The gross examination of all 6 cases showed two separate tissues, one was normal placental and the other was mole. Normal placental villi were well developed with hydatidiform mole villi edematous. All short tandem repeat (STR) gene detections showed that the mole tissue was homozygous, conforming to complete mole. None of the 6 patients developed gestational trophoblastic neoplasia, and the median time of β-hCG turning negative was 2.5 (2-6) months. Conclusions: CHMCF is rare. Correct diagnosis is of great clinical significance for prognosis. STR gene detection can help confirm the diagnosis.

Key words: Pregnancy, twin, Hydatidiform mole, Fetus, Symbiosis, Genetic testing

LI Ling-yan, ZHAO Xian-lan. Clinical Analysis of Six Cases of Complete Hydatidiform Mole with Co-Existing Fetus[J]. Journal of International Obstetrics and Gynecology, 2023, 50(2): 142-146.

Figures/Tables 5

References 16

[1]	Sebire NJ, Foskett M, Paradinas FJ, et al. Outcome of twin pregnancies with complete hydatidiform mole and healthy co-twin[J]. Lancet, 2002, 359(9324):2165-2166. doi: 10.1016/S0140-6736(02)09085-2. doi: 10.1016/S0140-6736(02)09085-2 pmid: 12090984
[2]	Irani RA, Holliman K, Debbink M, et al. Complete Molar Pregnancies with a Coexisting Fetus: Pregnancy Outcomes and Review of Literature[J]. AJP Rep, 2022, 12(1):e96-e107. doi: 10.1055/a-1678-3563. doi: 10.1055/a-1678-3563 pmid: 35178283
[3]	谢幸, 孔北华, 段涛. 妇产科学[M]. 9版. 北京: 人民卫生出版社, 2018:324-328.
[4]	Suksai M, Suwanrath C, Kor-Anantakul O, et al. Complete hydatidiform mole with co-existing fetus: Predictors of live birth[J]. Eur J Obstet Gynecol Reprod Biol, 2017, 212:1-8. doi: 10.1016/j.ejogrb.2017.03.013. doi: S0301-2115(17)30116-1 pmid: 28301807
[5]	Nayeri UA, West AB, Grossetta Nardini HK, et al. Systematic review of sonographic findings of placental mesenchymal dysplasia and subsequent pregnancy outcome[J]. Ultrasound Obstet Gynecol, 2013, 41(4):366-374. doi: 10.1002/uog.12359. doi: 10.1002/uog.12359 pmid: 23239538
[6]	Himoto Y, Kido A, Minamiguchi S, et al. Prenatal differential diagnosis of complete hydatidiform mole with a twin live fetus and placental mesenchymal dysplasia by magnetic resonance imaging[J]. J Obstet Gynaecol Res, 2014, 40(7):1894-1900. doi: 10.1111/jog.12441. doi: 10.1111/jog.12441
[7]	Imafuku H, Miyahara Y, Ebina Y, et al. Ultrasound and MRI Findings of Twin Pregnancies with Complete Hydatidiform Mole and Coexisting Normal Fetus: Two Case Reports[J]. Kobe J Med Sci, 2018, 64(1):E1-E5. pmid: 30282891
[8]	韦玉月, 梁伟璋, 陈秉钧, 等. 宫内妊娠合并葡萄胎十例临床分析[J]. 中华围产医学杂志, 2021, 24(11):834-839. doi: 10.3760/cma.j.cn113903-20210122-00074. doi: 10.3760/cma.j.cn113903-20210122-00074
[9]	Lu B, Ma Y, Shao Y, et al. Twin pregnancy with complete hydatidiform mole and co-existing fetus: A report of 15 cases with a clinicopathological analysis and DNA genotyping[J]. Pathol Res Pract, 2022, 238:154116. doi: 10.1016/j.prp.2022.154116. doi: 10.1016/j.prp.2022.154116
[10]	Sumigama S, Itakura A, Yamamoto T, et al. Genetically identified complete hydatidiform mole coexisting with a live twin fetus: comparison with conventional diagnosis[J]. Gynecol Obstet Invest, 2007, 64(4):228-231. doi: 10.1159/000106496. doi: 10.1159/000106496
[11]	Gabra MG, Gonzalez MG, Bullock HN, et al. Cell-Free DNA as an Addition to Ultrasound for Screening of a Complete Hydatidiform Mole and Coexisting Normal Fetus Pregnancy: A Case Report[J]. AJP Rep, 2020, 10(2):e176-e178. doi: 10.1055/s-0040-1709981. doi: 10.1055/s-0040-1709981
[12]	Lin LH, Maestá I, Braga A, et al. Multiple pregnancies with complete mole and coexisting normal fetus in North and South America: A retrospective multicenter cohort and literature review[J]. Gynecol Oncol, 2017, 145(1):88-95. doi: 10.1016/j.ygyno.2017.01.021. doi: S0090-8258(17)30065-3 pmid: 28132722
[13]	Wang G, Cao J, Xu X, et al. Delivery management of a complete hydatidiform mole and co-existing viable fetus: A meta-analysis and systematic review[J]. J Gynecol Obstet Hum Reprod, 2022, 51(1):102269. doi: 10.1016/j.jogoh.2021.102269. doi: 10.1016/j.jogoh.2021.102269
[14]	Zilberman Sharon N, Melcer Y, Maymon R. Is a Complete Hydatidiform Mole and a Co-existing Normal Fetus an Iatrogenic Effect?[J]. Isr Med Assoc J, 2019, 21(10):653-657. pmid: 31599505
[15]	计鸣良, 赵峻, 向阳. 葡萄胎诊治的研究进展[J]. 中国癌症防治杂志, 2020, 12(2):126-130. doi: 10.3969/j.issn.1674-5671.2020.02.02. doi: 10.3969/j.issn.1674-5671.2020.02.02
[16]	Liang H, Pan NP, Wang YF, et al. Obstetrical and oncological outcomes of twin pregnancies with hydatidiform mole and coexisting fetus[J]. Taiwan J Obstet Gynecol, 2022, 61(3):453-458. doi: 10.1016/j.tjog.2022.03.010. doi: 10.1016/j.tjog.2022.03.010 pmid: 35595437

病列	年龄（岁）	孕产史	妊娠方式	发现孕周（周）	临床表现	β-hCG最高值（U/L）	彩色超声结果
例1	34	孕4产1	IVF-ET	8⁺⁵	妊娠剧吐	383 035	CHMCF^①
例2	22	孕1产0	自然妊娠	13⁺¹	反复阴道出血	396 020	CHMCF^②
例3	30	孕6产3	促排卵	13⁺⁵	反复阴道出血	702 774	CHMCF^③
例4	28	孕3产2	自然妊娠	14⁺⁴	反复阴道出血	225 354	部分性葡萄胎^④
例5	32	孕3产2	自然妊娠	17	反复阴道出血、甲状腺功能亢进	1 323 961	CHMCF^⑤
例6	21	孕1产0	自然妊娠	24	妊娠剧吐	316 118	CHMCF^⑥

病列	年龄（岁）	孕产史	妊娠方式	发现孕周（周）	临床表现	β-hCG最高值（U/L）	彩色超声结果
例1	34	孕4产1	IVF-ET	8⁺⁵	妊娠剧吐	383 035	CHMCF^①
例2	22	孕1产0	自然妊娠	13⁺¹	反复阴道出血	396 020	CHMCF^②
例3	30	孕6产3	促排卵	13⁺⁵	反复阴道出血	702 774	CHMCF^③
例4	28	孕3产2	自然妊娠	14⁺⁴	反复阴道出血	225 354	部分性葡萄胎^④
例5	32	孕3产2	自然妊娠	17	反复阴道出血、甲状腺功能亢进	1 323 961	CHMCF^⑤
例6	21	孕1产0	自然妊娠	24	妊娠剧吐	316 118	CHMCF^⑥

病例	终止妊娠孕周（周）	终止妊娠方式	终止原因	病理检查	STR	GTN	β-hCG转阴时间（个月）
例1	9⁺¹	清宫术	个人原因放弃	水泡状胎块	单精空卵（纯合型）	否	2
例2	15⁺⁶	引产+钳夹+清宫术	反复阴道出血	水泡状胎块	单精空卵（纯合型）	否	3
例3	14⁺¹	引产+清宫术	反复阴道出血	水泡状胎块	单精空卵（纯合型）	否	3
例4	14⁺⁶	引产+清宫术	反复阴道出血	水泡状胎块	单精空卵（纯合型）	否	2
例5	17⁺⁴	引产+剖宫取胎术	反复阴道出血	水泡状胎块	单精空卵（纯合型）	否	6
例6	36	剖宫产娩一活婴	个人要求	水泡状胎块	单精空卵（纯合型）	否	2

病例	终止妊娠孕周（周）	终止妊娠方式	终止原因	病理检查	STR	GTN	β-hCG转阴时间（个月）
例1	9⁺¹	清宫术	个人原因放弃	水泡状胎块	单精空卵（纯合型）	否	2
例2	15⁺⁶	引产+钳夹+清宫术	反复阴道出血	水泡状胎块	单精空卵（纯合型）	否	3
例3	14⁺¹	引产+清宫术	反复阴道出血	水泡状胎块	单精空卵（纯合型）	否	3
例4	14⁺⁶	引产+清宫术	反复阴道出血	水泡状胎块	单精空卵（纯合型）	否	2
例5	17⁺⁴	引产+剖宫取胎术	反复阴道出血	水泡状胎块	单精空卵（纯合型）	否	6
例6	36	剖宫产娩一活婴	个人要求	水泡状胎块	单精空卵（纯合型）	否	2