Molar pregnancy with coexisting live intrauterine pregnancy

Case contributed by Anna Khomenko


Patient with known molar pregnancy presented at emergency department with sporadic vaginal bleeding and pelvic pain. The patient denied nausea, vomiting; no fever or chills. Serum HCG test came back positive and the level was over 200,000. Gestational age by LMP was 14 weeks.

Patient Data

Age: 20 years
Gender: Female

There is a live intrauterine pregnancy with biparietal measuring. The placenta demonstrates normal echogenicity and flow on Doppler imaging. Estimated fetal weight approximately 105.15g +/- 15.8g, estimated gestational age at 14 weeks 6 days. Limited fetal survey, including the head, four-chamber views, spine, stomach, cord insertion, bladder, upper extremities, lower extremities were demonstrated and appeal unremarkable. Fetal cardiac activity was detected with a heart rate of 150 bpm. There is abnormal heterogeneous tissue with multiple cystic spaces and small amount of vascularity. This lesion is seen contacting the aforementioned placenta however appears separate. This lesion is also wrapping around the lower uterine segment and covering the internal os. Bilateral adnexa shows thick-walled cystic structure with peripheral vascularity which consistent with corpus luteum cyst.

Case Discussion

Findings as above are highly suggestive of molar pregnancy with coexisting live fetus. Additional less likely differentials would include partially hydropic placenta with placenta previa or placental mesenchymal dysplasia. Imaging findings may represent twin pregnancy with hydatidiform mole and co-existent live fetus.

The patient with this type of pathology and this particular presentation will need a c section and may need additional surgery including a hysterectomy if she continues the pregnancy. The patient has the higher rate of preeclampsia, hyperthyroidism, vaginal bleeding, hemorrhage, preterm labor, and death with continued molar pregnancy. There is a possibility of molar tissue being malignant and it is unable to tell prior to analysis. It is not possible to remove mole while continuing pregnancy.

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