Complete hydatidiform mole coexisting with a normal fetus delivered at 33 weeks of gestation and involving maternal lung metastasis: a case report.

BACKGROUND

Complete mole and coexisting fetus is rare. The incidence is 1 in 22,000-100,000 pregnancies. The optimal management of complete mole and coexisting fetus is uncertain because of severe maternal complications. The decision to continue or discontinue a current pregnancy is difficult. We report a case of complete mole and coexisting fetus delivered at 33 weeks of gestation with maternal lung metastases development.

CASE: A 36-year-old female, G2 P1 A1, was sent to us for further evaluation at 15 weeks of gestation with a placental abnormality. Ultrasonography revealed that the fetal growth was normal, however, the placenta consisted of two parts. One part indicated a normal placenta and the other showed a typical classic molar pattern. Urine hCG was 440,000 mIU/mL and chest X-ray showed no metastatic finding. Genetic amniocentesis showed that the fetal karyotype was normal 46,XY. Diagnosis was determined to be a complete mole and coexisting fetus. Extensive informed consent was obtained from the parents, and they decided to continue the current pregnancy. We carefully monitored the patient, and periodic hCG measurement and chest X-ray were done at every prenatal check. At 32 weeks chest X-ray showed suddenly multiple lung metastases confirmed by CT scan. At 33 weeks and 4 days labor occurred spontaneously, and a newborn, 1,830-g male infant was delivered without any difficulty. Two days after delivery we started single-agent chemotherapy with dactinomycin. Lung metastases disappeared and the patient achieved remission.

CONCLUSION

It is possible to achieve a healthy newborn in cases of complete mole and coexisting fetus in spite of subsequent gestational trophoblastic neoplasia. Patients should be carefully monitored and receive thorough informed consent.