Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, Delhi, India.
Obstetrics and Gynecology, All India Institute of Medical Sciences, New Delhi, Delhi, India
BMJ Case Rep. 2021 Feb 4;14(2):e238977. doi: 10.1136/bcr-2020-238977.
An unusual presentation of gestational trophoblastic disease is twin molar pregnancy, rarest in triplets with differentials being partial/complete mole, placental mesenchymal dysplasia (PMD), placental cysts or chorioangioma each with different complications. Counselling to continue pregnancy depends on diagnosis. A 37-year-old GPL, donor oocyte In vitro fertlisation (IVF) twin pregnancy was referred at 24 weeks with cystic areas in placenta. Probability of twin partial mole or PMD was assessed. The scan of fetuses showed normal growth, no structural anomalies. Biochemical markers showed high maternal beta human chorionic gonadotropin (β-hCG). Amniocentesis of molar fetus revealed normal karyotype. Likely diagnosis made as twin partial mole. The patient delivered by caesarean section at 28 weeks due to preterm labour. Twins, a male and a female baby, were delivered with three placentas, two normal and the third with molar changes and no fetal parts. Diagnosis was revised as triplet with partial mole, which was confirmed on histopathology. Serial monitoring of β-hCG became undetectable by eighth week. The male baby died on day 4. The mother and the female baby were discharged.
葡萄胎妊娠的一种不常见表现为双胎葡萄胎妊娠，三胎中极罕见，鉴别诊断包括部分性/完全性葡萄胎、胎盘间质发育不良（PMD）、胎盘囊肿或绒毛膜血管瘤，每种疾病都有不同的并发症。继续妊娠的咨询取决于诊断。一位 37 岁的 GPL，供卵体外受精（IVF）双胎妊娠，在 24 周时因胎盘内囊性区域而被转诊。评估了双胎部分性葡萄胎或 PMD 的可能性。胎儿扫描显示正常生长，无结构异常。生化标志物显示母体β人绒毛膜促性腺激素（β-hCG）水平较高。对摩尔胎儿进行羊膜穿刺术显示正常核型。可能的诊断为双胎部分性葡萄胎。由于早产，孕妇在 28 周时行剖宫产分娩。分娩出一对龙凤胎，有三个胎盘，两个正常，第三个胎盘有葡萄胎样改变且无胎儿组织。诊断修订为三胎部分性葡萄胎，组织病理学检查证实了这一诊断。β-hCG 的连续监测在第八周时已无法检测到。男婴于第 4 天死亡。母亲和女婴已出院。
