Complete hydatidiform mole with coexistent fetus

Last revised by Reabal Najjar on 3 Feb 2023

Complete hydatidiform mole with coexistent fetus is an extremely rare entity where there is a twin pregnancy with a complete hydatidiform mole and a normal fetus. 

It is seen extremely rarely, with an estimated incidence of 1 in 10,000–100,000 pregnancies 5.

Exaggerated signs and symptoms of pregnancy may be evident. The uterus is larger than the period of gestation and has abnormally high levels of beta-hCG. Clinical presentations include vaginal bleeding, preeclampsia and excessive vomiting.

Sonographic findings of a complete hydatidiform mole, such as a snowstorm appearance are seen with a completely normal fetus with a normal placenta.

These cases are at high risk of complications such as spontaneous abortion, preterm delivery, intrauterine fetal death, bleeding, pre-eclampsia and persistent trophoblastic disease. 

Considering the maternal complication, termination of pregnancy is suggested by a large number of studies. Some suggest that after confirmation of normal karyotype in the coexistent fetus and appropriate patient counseling, continuation of pregnancy can be attempted despite a 30% risk of bleeding and preeclampsia. 

Possible differential considerations include

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