Hassan Hiba Bashir, Hassan Yasmin Bashir, Omar Abdi Karim Ali
Obstetrics and Gynecology Department, Mogadishu Somali Turkey, Recep Tayyip Erdogan Training and Research Hospital, Mogadishu, Somalia.
Int Med Case Rep J. 2023 Oct 6;16:651-654. doi: 10.2147/IMCRJ.S412528. eCollection 2023.
It is unusual and challenging to have a molar pregnancy and a viable fetus at the same time. Bleeding per vagina, anemia, hyperemesis gravidarum, hypertension, thyrotoxicosis, and uterine enlargement disproportionate to uterine age are common clinical presentations that should alert the clinician to this uncommon illness. Pregnancy of a hydatidiform mole with a coexistent live fetus in most cases is a complete molar pregnancy. Partial molar pregnancy with fetus is rare and almost always ends in miscarriage due to triploid fetus.
In this case study, we present a 19-year-old woman who presented with acute vaginal bleeding and pelvic discomfort. Transabdominal ultrasound revealed fetal heart rate and identified the fetus at 24 weeks gestation. A large heterogeneous and complex cystic mass was found in the fundus, which was diagnosed as an abnormal placenta with a strong suspicion of molar pregnancy. The cervix was dilated by 4 cm at the time of hospital admission and four hours later, she gave birth to a healthy female fetus. The placenta emerged along with the membrane and abundant grape-like cystic tissue.
A case study showed a coexisting live fetus that was 24 weeks gestational age and had a partial hydatidiform mole, along with severe vaginal bleeding and uterine contraction. A partial mole was identified through histology analysis of the placenta.
Maternal b-HCG levels fell to undetectable levels one month after birth without treatment. She was doing well and a follow-up six months later revealed no evidence of retained tissue or recurrence.
同时发生葡萄胎妊娠和存活胎儿的情况较为罕见且具有挑战性。阴道出血、贫血、妊娠剧吐、高血压、甲状腺毒症以及子宫增大与孕周不符是常见的临床表现，这些应提醒临床医生注意这种罕见疾病。大多数情况下，葡萄胎妊娠合并存活胎儿为完全性葡萄胎妊娠。胎儿合并部分性葡萄胎妊娠罕见，且由于三倍体胎儿几乎总会以流产告终。
在本病例研究中，我们介绍了一名19岁女性，她出现急性阴道出血和盆腔不适。经腹超声显示有胎心，并确定胎儿处于妊娠24周。在子宫底部发现一个大的异质性复杂囊性肿物，诊断为异常胎盘，高度怀疑为葡萄胎妊娠。入院时宫颈扩张4厘米，四小时后，她产下一名健康女婴。胎盘与胎膜一同娩出，还有大量葡萄样囊性组织。
一项病例研究显示，一名妊娠24周的存活胎儿合并部分性葡萄胎妊娠，伴有严重阴道出血和子宫收缩。通过胎盘组织学分析确定为部分性葡萄胎。
产后未经治疗，产妇的β - HCG水平在一个月后降至检测不到的水平。她情况良好，六个月后的随访显示无残留组织或复发迹象。
