Pregnancy-Associated Cardiomyopathy in a Late-Diagnosed Partial Hydatidiform Mole: A Case Report.

BACKGROUND: The hydatidiform mole presents as either a complete or partial mole. They are differentiated by morphology, histopathology, karyotype, and the risk of malignancy. Partial hydatidiform moles are the only type of trophoblastic gestational disease associated with the presence of a fetus (with or without positive cardiac response). However, early intrauterine fetal death often occurs with triploidy. Therefore, a partial hydatidiform mole is often misdiagnosed as an incomplete abortion. This case is unique due to the rare occurrence of a partial hydatidiform mole complicated by severe pregnancy-associated cardiomyopathy. To date, only five similar cases have been reported, all describing cardiorespiratory symptoms from left ventricular dysfunction in previously healthy women around abortion induction.

CASE REPORT: We present the case of a 19-year-old 1 gravida, 0 para with partial hydatidiform mole and late miscarriage in the 18th week of pregnancy. Abortion induction occurred, followed by severe maternal cardiac complications. The patient developed a pregnancy-associated cardiomyopathy with acute heart failure on the basis of a newly severely restricted biventricular function with dilatation and secondary mitral valve insufficiency, congestion and forward failure led to congestive pneumonia, acute renal failure, and metabolic acidosis. After histological examination of the fetal tissue, a partial mole can be assumed on the basis of the histological findings, immunohistochemistry, and the trisomy of the X chromosome detected by fluorescence in situ hybridization.

CONCLUSION: In case of a hydatidiform mole, an early diagnosis is essential to prevent serious complications during medical course. Particularly, if cardiac symptoms occur, early diagnosis should be carried out. Close cardiological and gynecological follow-up must be carried out to prevent late complications.