Santoso Dhanny P J, Anton Anton, Nugrahani Annisa D, Pribadi Adhi, Kurniadi Andi
Department of Obstetrics and Gynaecology, Fetomaternal Division, Slamet General District Garut - Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital.
Department of Obstetrics and Gynaecology, Faculty of Medicine, Universitas Padjadjaran - Dr. Hasan Sadikin General Hospital, Bandung, Indonesia.
Ann Med Surg (Lond). 2023 Apr 3;85(5):2020-2023. doi: 10.1097/MS9.0000000000000492. eCollection 2023 May.
Partial molar pregnancy with a coexistent live fetus is very rare. This type of mole mostly ends in the early termination of pregnancy due to an abnormally developed fetus.
Here, we report a case of a 24-year-old Indonesian woman with an ultrasonographic appearance of partial hydatidiform mole with initial placenta covering the internal uterine ostium in the late first trimester which then became marginal placenta previa in the third trimester. The woman decided to continue the pregnancy after considering the risks and benefits. The normal anatomy of the premature infant was vaginally delivered alive with a large and hydropic placenta.
Proper diagnosis, management, and monitoring remain challenging as this case is still rarely reported. Although embryos from partial mole forms generally do not survive since the first trimester, our case reported the singleton pregnancy with the coexistent normal fetus and the partial mole characteristic of the placenta. Diploid karyotype, few and focal extent of hydatidiform tissue of placenta, low rate of molar degeneration, and the absence of fetal anemia hypothesized as the factors that influenced survival of the fetus. There were two maternal complications such as hyperthyroidism and frequent vaginal bleeding without subsequent anemia in this patient.
A rare case of partial hydatidiform mole coexistent with a live fetus with placenta previa was reported in this study. There were also maternal complications. Thus, prompt and regular monitoring of maternal and fetal condition holds an important role.
部分性葡萄胎合并存活胎儿极为罕见。此类葡萄胎大多因胎儿发育异常而在妊娠早期终止。
在此，我们报告一例24岁印度尼西亚女性病例，其超声表现为部分性葡萄胎，孕早期胎盘最初覆盖子宫内口，孕晚期发展为边缘性前置胎盘。该女性在权衡风险和益处后决定继续妊娠。早产活婴解剖结构正常，胎盘巨大且呈水肿状，经阴道分娩。
由于此类病例报道仍较少，准确诊断、管理及监测仍具有挑战性。尽管部分性葡萄胎形成的胚胎通常在孕早期就无法存活，但我们的病例报告了单胎妊娠中同时存在正常胎儿及胎盘具有部分性葡萄胎特征的情况。二倍体核型、胎盘绒毛膜组织较少且局限、绒毛膜变性率低以及胎儿无贫血被推测为影响胎儿存活的因素。该患者出现了两种母体并发症，即甲状腺功能亢进和频繁阴道出血但未继发贫血。
本研究报告了一例罕见的部分性葡萄胎合并存活胎儿及前置胎盘的病例，同时存在母体并发症。因此，及时且定期监测母胎状况至关重要。
