[Multiple (quadruple) pregnancy involving complete hydatidiform mole and 3 fetuses]. / Embarazo múltiple de alto orden fetal (cuádruple), involucrando mola hidatidiforme completa y tres fetos.

The rate of hydatidiform mole in our country oscillates from 1:144 to 1:552 pregnancies. We report the second case of hydatidiform mole coexisting with a spontaneous multiple pregnancy (three fetuses and one hydatidiform mole). The patient was a 34 year old woman. She had not received hormonal therapy for anovulation. At 13th weeks of gestation she presented vaginal spotting and hyperemesis. An ultrasonographic examination revealed three living fetuses and the multiple cystic echo typical of an hydatidiform mole. At 14 weeks of pregnancy she was diagnosed to have clinical symptoms of severe preeclampsia. We did not have an adequate response to the antihypertensive drugs and the patient underwent therapeutic termination of the pregnancy. The thyroid hormones were in normal levels. The serum beta-hCG was up to 500,000 mU/ml. Two fetuses were female weighing 55 g. each one. One fetus was male weighing 50 g. All of them had a normal karyotype. The patient development a gestational trophoblastic disease. These have been only three reports of complete hydatidiform mole in triplet pregnancy with two fetuses. These cases were pregnancies occurring after ovulation inducing therapy. We analyzed the clinical aspects and treatment of hydatidiform mole coexisting with multiple pregnancy.

[HELLP syndrome. 7-year experience at the National Institute of Perinatology]. / Síndrome Hellp. Siete años de experiencia en el Instituto Nacional de Perinatología.

We studied 36 patients with Hellp syndrome and her newborn during seven years in the National Institute of Perinatology (INPer). The objective of this study is show the epidemiology and clinic features, unite diagnostic criteria and classification, furthermore establish morbidity and mortality maternal and perinatal. The 44.6% (16/36) was type I, and 55.6% (20) was type II. The average of pregnancies was 3. The 38.9% (14/36) received regular prenatal control. Both types were more common in patients with preterm pregnancies, between 28-36 weeks. The patients with severe preeclampsia and eclampsia were more common. The cases with type I had more complications and stayed on hospital more time. The maternal mortality was 5.55%. Perinatal outcomes were unsatisfactory, with high incidence of asphyxiated newborn. The newborn of patients with type I had more severe complications and stayed more time on the hospital. The perinatal mortality was 32.43%.