Piura Benjamin, Rabinovich Alex, Hershkovitz Relly, Maor Ester, Mazor Moshe
Unit of Gynecologic Oncology, Department of Obstetrics and Gynecology, Soroka Medical Center and Faculty of Health Sciences, Ben-Gurion University of the Negev, PO Box 151, Beer-Sheva 84101, Israel.
Arch Gynecol Obstet. 2008 Oct;278(4):377-82. doi: 10.1007/s00404-008-0591-x. Epub 2008 Feb 14.
Twin pregnancy with complete hydatidiform mole and co-existent fetus (CHMF) resulting in a healthy take-home baby is rare, with only 30 cases documented in detail in the literature.
A 29-year-old woman conceived following two cycles of ovulation induction with clomiphene citrate. Successive ultrasound examinations demonstrated a normally growing live fetus alongside a normal placenta and an additional intrauterine echogenic mass with features of hydatidiform mole. At 17 week gestation, serum beta-hCG level was 25.38 multiples of the median. Genetic amniocentesis at 18.5 week gestation showed normal fetal 46XX karyotype. A cesarean section performed at 28 week gestation resulted in the delivery of a live normal female infant and two adjoining placentas. One placenta was normal and the other placenta was composed of vesicles of various sizes. Microscopic examination of the abnormal placenta confirmed complete hydatidiform mole. The baby did well and serial maternal serum beta-hCG levels showed a declining trend and were undetectable by 7 weeks after delivery.
Continuation of a twin pregnancy with CHMF is an acceptable option. There is, however, an increased risk of developing pre-eclampsia and fetal loss due to miscarriage. The chance of a live term birth is <50% with nearly 33% of the mothers developing persistent gestational trophoblastic disease after delivery. Thus, close surveillance of an ongoing twin pregnancy with CHMF is mandatory to detect potential early signs of maternal and fetal complications.
双胎妊娠合并完全性葡萄胎及共存胎儿（CHMF）并产下健康活婴的情况罕见，文献中仅有30例详细记录。
一名29岁女性在接受两轮枸橼酸氯米芬促排卵治疗后怀孕。连续超声检查显示，一个正常生长的活胎旁有一个正常胎盘，子宫内还有一个具有葡萄胎特征的回声团块。妊娠17周时，血清β-hCG水平为中位数的25.38倍。妊娠18.5周时进行的遗传羊膜腔穿刺术显示胎儿核型为正常的46XX。妊娠28周时行剖宫产，娩出一名正常活女婴和两个相连的胎盘。一个胎盘正常，另一个胎盘由大小不一的水泡组成。对异常胎盘进行显微镜检查确诊为完全性葡萄胎。婴儿情况良好，产后母亲血清β-hCG水平呈下降趋势，产后7周时检测不到。
双胎妊娠合并CHMF继续妊娠是一个可接受的选择。然而，发生子痫前期和因流产导致胎儿丢失的风险增加。足月活产的几率<50%，近33%的母亲产后会发生持续性滋养细胞疾病。因此，对双胎妊娠合并CHMF进行密切监测以发现母婴并发症的潜在早期迹象是必不可少的。
