Presentation
G3P2 at 24+2/40 with vaginal bleeding for 2 days
Patient Data
A viable, intrauterine fetus with a BPD of 59.4mm and a GA of 24w2d is present, with no obvious gross morphological abnormalities. There is adequate amniotic fluid and the placental morphology appears to be normal.
Intrauterine mass with multiple tiny cystic structures that resembles a snowstorm or a bunch of grapes just distal to the placenta, which appears to be normal. The bulk covered the internal cervical os and filled the anterior lower uterine cavity. The mass had no discernible fetal components, and it clearly separated from the placenta above. By using color Doppler interrogation on the mass, no apparent flow noticed.
Progress
with this ultrasound result, the patient was diagnosed with twin pregnancy, a well developed molar pregnancy, and a normal live fetus.
after being hospitalized for two weeks, the patient experiences pre-eclampsia, ongoing vaginal bleeding, thyrotoxicosis, and lastly IUFD.
fetal portion, placental tissue, and mass were sent for pathology following an elective hysterotomy, and the results revealed
Pathology report
Gross Well-formed fetus measuring CRL=20cm, HC=25cm, and FL=3cm; 15 x 10 cm soft gray brown placental tissue; 18 x 12 cm amniotic membrane centrally placed; 45 cm long umbilical cord. a separated fragments of gray white vesicular membrane tissue mass 20 x 20cm.
C/S: through placenta - soft fleshy gray brown placenta with normal looking cotyledon. through umbilical cord normal positioned three vessels, and through vesicular membrane tissue-soft variable size vesicles.
Microscopy: histologic section through placenta showed mainly early third trimester villi variably composed of unremarkable chorionic villi admixed with scattered chorionic villi reveling mild chorangiosis along with unremarkable fetal fibrous membrane tissue. sections through vesicular tissue showed variable sized hydrophilic villi with cisterna formation and partial trophoblastic proliferation on hemorrhagic background.
DIAGNOSIS
placenta- early third trimester placenta with mild chorangitis
vesicular tissue- Complete hydatiform mole
Case Discussion
It is an uncommon and challenging clinical condition when a molar pregnancy coexists with a live twin fetus. One in 20,000 to 100,000 births result in twins with a healthy fetus and hydatidiform mole.
An increased risk of severe pregnancy problems, including vaginal bleeding, preeclampsia, hyperthyroidism, intrauterine death, and gestational trophoblastic neoplasia, is linked to a hydatidiform mole with a live fetus.