Partial molar pregnancy with live fetus complicated by intrauterine growth restriction and severe preeclampsia. Case report and review of the literature / Mola parcial con feto vivo, complicado con restricción de crecimiento intrauterino y preeclamsia severa. Reporte de caso y revisión de la literatura

RESUMEN Objetivo: reportar un caso de mola parcial con feto vivo y realizar una revisión de la literatura sobre las complicaciones maternas y fetales asociadas a esta condición. Materiales y métodos: se presenta el reporte de un caso de mola parcial y feto vivo de 33 semanas, complicado por restricción de crecimiento intrauterino, oligoamnios y preeclampsia severa. Después de seguimiento del recién nacido a un año reportamos un resultado satisfactorio materno-fetal. Se realiza una búsqueda de la literatura en Medline vía PubMed, Lilacs, OVID, Uptodate y Google Scholar, con los siguientes términos MESH: "hiditadiform mole", "partial mole", "live fetus", "coexisting live fetus". Se seleccionaron estudios de series de caso y reportes de caso de gestantes con coexistencia de mola parcial y feto vivo al momento del diagnóstico, y se extrajo información sobre el pronóstico materno-fetal. Resultados: se identificaron inicialmente 129 títulos relacionados, de los cuales 29 cumplieron los criterios de inclusión, 4 artículos fueron excluidos por no obtener acceso al texto completo. Se analizaron 31 casos reportados, 9 casos terminaron en aborto, 8 terminaron en óbito o muerte perinatal y 14 (45 %) casos terminaron con un recién nacido vivo. La complicación materna más frecuente fue preeclampsia, en 6 (19,35 %) casos. Conclusión: la coexistencia de mola parcial con feto vivo presenta un riesgo alto de resultado perinatal adverso y preeclampsia. Se requiere más información sobre esta rara condición para determinar de mejor manera posibles intervenciones en los casos de fetos euploides y dar una adecuada asesoría en la práctica clínica, por lo que es importante el reporte de estos casos para tener suficiente evidencia sobre el comportamiento natural de la enfermedad.

ABSTRACT Objective: To report the case of a partial molar pregnancy with live fetus and conduct a review of the literature regarding maternal and fetal complications associated to this condition. Materials and methods: Case report of a partial mole with a 33 weeks live fetus complicated by intrauterine growth restriction, oligohydramnios and severe preeclampsia. We report satisfactory maternal and neonatal outcomes and 1-year follow-up. A search was conducted in the Medline via Pubmed, Lilacs, Ovid, Uptodate and Google Scholar databases using the following MESH terms: hiditadiform mole, partial mole, live fetus, coexisting live fetus. Case series and case reports of pregnant women with coexisting partial mole and live fetus at the time of diagnosis were selected and information regarding maternal and fetal prognosis was extracted Results: Initially, 129 related titles were identified. Of these, 29 met the inclusion criteria, and 4 articles were excluded due to failed access to the full text. Overall, 31 reported cases were included; 9 ended in miscarriage, 8 in fetal demise or perinatal death, and 14 (45 %) resulted in a live neonate. The most frequent maternal complication was preeclampsia in 6 (19.35 %) cases. Conclusion: The coexistence of a partial mole with a live fetus poses a high risk of adverse perinatal outcomes and preeclampsia. The volume of information regarding this rare condition must be increased in order to better determine potential interventions in cases of euploid fetuses and to provide adequate counseling in clinical practice. Therefore, reporting these cases is important to build sufficient evidence about the natural course of this condition.

Embarazo molar con feto vivo y éxito perinatal. Reporte de un caso y revisión bibliográfica / Molar pregnancy with live fetus, and perinatal success. Case report and bibliographical review

Resumen ANTECEDENTES: la mola parcial o incompleta representa 30% de las enfermedades trofoblásticas gestacionales; sin embargo, la incidencia de mola parcial con feto vivo es una manifestación poco frecuente, que ocurre en 1 de cada 100,000 embarazos. CASO CLÍNICO: paciente de 27 años de edad, con antecedentes ginecoobstétricos de 3 embarazos y 2 partos, sin comorbilidades ni alteraciones de importancia para el padecimiento actual; embarazo de 30.1 semanas según la fecha de la última menstruación y diagnóstico de enfermedad trofoblástica gestacional (mola parcial), placenta previa y útero arcuato. El ultrasonido evidenció vesículas hidrópicas, compatibles con enfermedad trofoblástica gestacional (mola parcial), por lo que se realizó amniocentesis a las 16.3 semanas del embarazo, sin incidentes ni complicaciones. Se encontró el cariotipo 46,XX. Se decidió la interrupción del embarazo por cesárea de urgencia. Puesto que se trataba de un embarazo con alta morbilidad y mortalidad, y la paciente tenía paridad satisfecha, se decidió realizar cesárea-histerectomía con la técnica de Esperanza-Bautista. Nació una niña de 1416 g, Capurro de 3 semanas y Apgar 7/9. El reporte de patología fue: proliferación anormal del trofoblasto, vesículas y vellosidades hidrópicas. La paciente continuó en seguimiento semanal sin complicaciones aparentes. CONCLUSIONES: el embarazo molar con feto vivo es una alteración poco frecuente. El diagnóstico temprano, seguimiento prenatal estrecho y tratamiento multidisciplinario representan factores importantes para la viabilidad del recién nacido.

Abstract BACKGROUND: The partial or incomplete mole represents 30% of gestational trophoblastic diseases. However, the incidence of partial mole with a viable fetus is an uncommon presentation, with an incidence of 1 per 100,000 pregnancies. CASE REPORT: a 27-year-old female with a gyneco-obstetric history of 3 pregnancies and 2 births, without comorbidities or alterations of importance for the current condition; pregnancy of 30.1 weeks according to the date of last menstruation and diagnosis of gestational trophoblastic disease (partial spring), placenta previa and arcuate uterus. The ultrasound evidenced hydropic vesicles, compatible with gestational trophoblastic disease (incomplete mole). The amniocentesis was performed at 16.3 weeks of pregnancy. The karyotype 46, XX was found. It was decided to terminate the pregnancy by emergency cesarean section. Since it was a pregnancy with high morbidity and mortality, and the patient had parity satisfied, it was decided to perform a cesarean-hysterectomy using the Esperanza-Bautista technique. A female newborn was born, weighing 1416 g, Capurro 3 weeks and APGAR 7/9. The pathology report was abnormal proliferation of the trophoblast, vesicles and villi. At the moment the patient remains in weekly follow-up with no apparent complications. CONCLUSIONS: Molar pregnancy with a viable fetus has an infrequent presentation. Early diagnosis, close prenatal follow-up, and multidisciplinary management condition perinatal success.

Mola hidatiforme coexistente con feto vivo después de las 20 semanas de gestación: reporte de dos casos / Hydatidiform mole coexisting with a live fetus greater than 20 weeks of gestation: Two cases report

Resumen Antecedentes: el embarazo molar coexistente con un feto vivo es una rareza y un reto médico porque se asocia con complicaciones maternas graves que ponen en riesgo la vida de la madre y su hijo. Casos clínicos: Caso 1: paciente con embarazo gemelar, con mola completa coexistente con feto vivo y terminación del embarazo por cesárea a las 33 semanas, nació una niña viva, de 1530 g, que sobrevivió sin complicaciones. Caso 2: paciente con mola parcial, embarazo complicado con preeclampsia severa, hipertiroidismo y placenta previa. La gestación se interrumpió por cesárea a las 24 semanas, el feto pesó 625 g y no sobrevivió a las maniobras de reanimación neonatal. Conclusiones: en las pacientes con embarazo molar coexistente con feto vivo deben valorarse las complicaciones presentes o potenciales que condicionan el riesgo de muerte materna y perinatal. La atención médica debe ser multidisciplinaria y siempre de común acuerdo con los padres.

Abstract Background: Coexistance of molar pregnancy and alive fetus is an extremely rare condition but a medical challenge when it is present. Several maternal medical complications are associated with these pregnancies including both mother and fetus life-threatening conditions. Clinical case: Two cases of molar pregnancies are presented in this paper. First was a twin pregnancy with a complete hydatidiform coexisting with a live fetus and cesarean birth at 33 weeks of gestation of a live female weighing 1,530 g. that survived without complications. Second case was an incomplete mole complicated with severe pre-eclampsia, hypertiroidism, and placenta previa; pregnancy was interrupted at 24 weeks of gestation and a fetus weighing 625 g was extracted by cesarean section, the neonate did not survive. Conclusion: In the presence of molar pregnancy coexisting with a live viable fetus, the present or potential complications that determine the risk of maternal and perinatal death, must be carefully assessed. A third-level perinatal facilities must be available for this kind of pregnancy complication.

Mola hidatiforme completa y feto vivo a término coexistente: reporte de caso / Complete hydatidiform mole and alive fetus to term coexistent. case report

Se presenta el caso de una mola hidatiforme completa y feto vivo a término coexistente en una paciente de 30 años, II gestas I para, con embarazo de 29 semanas y elevación de la presión arterial. La imagen ecográfica al ingreso de la placenta sugirió la presencia de mola hidatiforme junto a un feto normal. Se realizó seguimiento expectante hasta las 37 semanas, cuando presentó un episodio de sangrado genital por lo que se realizó una cesárea y se obtuvo un recién nacido vivo masculino normal, placenta y una tumoración de un tejido vesicular. El examen de anatomía patológica del tejido vesicular reportó mola hidatiforme completa.

A case of complete hydatiform mole with live term coexisting fetus in a 30-year-old patient, II gravida, 1 para, with a pregnancy of 29 weeks and rise of blood pressure is presented. Ultrasound image at admission suggested the presence of hydatiform mole together a live fetus. Patient was followed until 37 weeks, when presented an episode of vaginal bleeding cause a cesarean section was done and a live normal male newborn, placenta and a vesicular tissue tumor were obtained. Pathology exam of vesicular tissue reported complete hydatiform mole.

Gestação gemelar de mola hidatiforme completa com feto vivo / Twin pregnancy with complete hydatidiform mole and living fetus

A gestação gemelar de uma mola hidatiforme completa coexistindo com um feto vivo é uma entidade rara. Os poucos casos descritos na literatura mostram que, em geral, esse tipo de gestação cursa com risco aumentado de aborto espontâneo, parto prematuro, morte fetal intraútero, sangramento, pré-eclâmpsia e doença trofoblástica persistente. Neste artigo, descreveremos o caso de uma primigesta de 20 anos de idade que apresentou uma gestação gemelar de feto vivo com mola completa, a qual transcorreu sem intercorrências e complicações e cujo diagnóstico diferencial com degeneração da placenta foi feito com anatomopatológico.

Twin pregnancy with a complete hydatidiform mole and a living fetus is a rare entity. According to the few cases described in the literature, this kind of gestation commonly has higher risks of miscarriage, preterm delivery, intrauterine fetal death, bleeding, preeclampsia and persistent trophoblastic disease. This study reports the case of a 20 years old primiparous patient with complete hydatidiform mole and living fetus, whose pregnancy was successfully carried to term. The differential diagnosis with placental degeneration was reached through anatomopathological investigation.

A Case of Complete Hydatidiform Mole with Coexistent Live Fetus / 대한산부인과학회잡지

Hydatidiform moles are generally separated into two clasifications. Complete hydatidiform moles are characterized by cystic swlling of all villi, often pronounced trophoblastic hyperplasia, lack of fetal parts, all 46 chromosomes of paternal origin(androgenesis), and a major risk for persistent trophoblastic tumor. Partial hydatidiform moles appear to be a milder version of complete moles with both normal and cystic villi, focal trophoblastic hyperplasia, a fetus or indications of previous fetal existence, 69 chromosomes with a maternal contribution, and a malignant potential less than described for complete moles. Hydatidiform mole with coexistent fetus is a very rare phenomenon, with an estimated incidence of 0.005 to 0.01 percent of all pregnancies. The rarity of live-born, surviving children may in part be due to termination of pregnancies, when molar parts are observed and without access to current advanced diagnostic procedures. Progress in techniques for first trimester prenatal diagnosis and improved surveillance of first trimester pregnancies through prenatal chromosomal analysis, ultrasound scan, maternal serum-hCG and serum- AFP screening has created complex situation, allowing confirmation of hydatidiform mole with coexisitng fetus. We recently experienced one case of unusual pregnancy with complete hydatidiform mole and coexisiting live fetus.