A Case of Twin Pregnancy with Complete Hydatidiform Mole and Coexisting Fetus Following IVF-ET

Kang, E H; Chu, H S; Chae, H D; Kim, J H; Kang, B M; Chang, Y S

Abstract

Twin pregnancy consisting of complete hydatidiform mole [H-mole] and a coexisting fetus occurs in an estimated incidence of one per 22,000-100,000. This entity is different from a partial molar pregnancy because there are two separate conceptuses with a normal placenta in one twin and a complete molar gestation in the other. Because of the high risk of persistent or metastatic gestational trophoblastic tumor, the diagnosis and management of twin pregnancy consisting of complete H-mole and a coexisting fetus is very important. However, there are limited data to guide the antenatal management of this pregnancy. The incidence of this twin pregnancy with complete H-mole and a coexisting fetus after in vitro fertilization and embryo transfer [IVF-ET] is not increased compared with that of general population, however, with the more widespread use of ovulation induction, it is expected that multiple gestations containing complete H-mole will occur with increasing frequency. Because of their propensity to develop medical complications and persistent gestational trophoblastic tumor, patients with complete H-mole and a coexisting fetus remain an imposing clinical challenge. We present an unusual pregnancy with complete H-mole and a coexisting fetus that occured following IVF-ET and was evacuated at 21 weeks gestation and developed into nonmetastatic gestational trophoblastic disease that required the MTX-CF [methotrexate-citrovorum factor] chemotherapy to achieve complete remission with brief review of literatures.