Leila Pourali , Sedigheh Ayati , Fatemeh Vahidroodsari , Manizhe Javanmard , Faezeh Poursadrollah,
Volume 71, Issue 12 (3-2014)
Abstract
Background: Twin pregnancy with a fetus and a diploid complete mole is not rare, but, the cases of twin pregnancy with a partial mole are rare. Nowadays, the prevalence of these cases has been increased due to the high rate of assisted reproductive techniques in reproductive medicine. The importance of twin pregnancy with a fetus and a diploid complete mole is mainly due to systemic complications such as hypertension and maternal hemorrhage and the possibility of trophoblastic tumor following delivery. Different studies have reported some results about similar cases, but limited case reports are presented in our country. The aim of this study is to report a case with incomplete molar pregnancy concomitant with a live fetus.
Case presentation: A 21 yr old woman (G2 ab1) referred to emergency department of Ghaem University Hospital in Mashhad. She complained of scant vaginal bleeding and spotting and a sonography report of a combined molar and normal pregnancy with 15 weeks gestational aged. During hospitalization, the pregnancy complicated with hypertension and proteinuria. Termination of pregnancy was planned at 17th weeks of gestation due to severe preeclampsia. After evacuation of uterus, during follow up visits, -hCG titer raised. Metastasis evaluation was negative. Pathology reports showed patial mole. Then, three doses of methotrexate (50 mg/m2 intra muscular) was administered and finally, according to the monthly follow up, -hCG level was undetectable.
Conclusion: The rate of pregnancy complications such as hypertension, hyperthyroidism, and obstetrics hemorrhage and also the risk of Gestational Trophoblastic Neoplasm (GTN) are increasing in incomplete molar pregnancy. Therefore, early diagnosis and timely treatment of molar pregnancy is very important to reduce maternal morbidity and mortality.
Leila Pourali , Atiyeh Vatanchi, Sedigheh Ayati , Anahita Hamidi , Akram Zarei Abolkheir ,
Volume 76, Issue 1 (4-2018)
Abstract
Background: Complete molar twin pregnancy with coexisting fetus is a rare and important diagnosis in obstetrics. Preeclampsia, preterm labor and life-threatening vaginal bleeding are the serious complications of this type of pregnancy. Gestational trophoblastic neoplasia should be ruled out after termination of pregnancy. In this study we reviewed a molar twin pregnancy with a live coexisting triple x fetus which has not been reported till now.
Case Presentation: Our case was a 22-year-old primigravida woman and 17-18th week of pregnancy, who referred to an University Hospital in Mashhad, Iran with complaint of vaginal bleeding On October 2016. Her first trimester ultrasonography in 13th week of gestational age, reported a live single fetus with an anterior great placenta and cystic formation regarding molar pregnancy. According to above-report, Amniocentesis was done in 15th weeks of pregnancy and its result was triple X. After severe and life-threatening vaginal bleeding, she underwent an emergent hysterotomy. A fetus with no obvious anomaly and a great hydropic and vesicular placenta delivered. Episodic crisis of her blood pressure was best controlled with anti-hypertensive drugs. In our case, chemotherapy with methotrexate was started after poor decline of βHCG titration and definite diagnosis of gestational trophoblastic neoplasia. Remission was completely achieved after four courses of chemotherapy.
Conclusion: Differentiation between complete molar pregnancy with live fetus and partial mole is always challenging in obstetrics. Serious complications as preeclampsia and severe vaginal bleeding may become life-threatening. Coexisting molar pregnancy should be ruled out in a pregnancy associated with frequent and unexpectant vaginal bleeding. Amniocentesis and an expert radiologist can help to differentiate them. Following these patients is very important to reveal any trophoblastic neoplasia.
Soheila Aminimoghaddam , Setare Nassiri , Fatemeh Chegini ,
Volume 77, Issue 7 (10-2019)
Abstract
Background: Abnormal placental invasion in pregnancy is one of the most important dilemmas in gynecology and obstetrics medicine and because of the high potential risk of life-threatening massive bleeding, it has been considered as one of the most important causes of maternal morbidity and even mortality. According to the fact that previous cesarean section is the most highlighted and well-known risk factors for developing these types of abnormal placental invasion, and despite comprehensive recommendations for decreeing of this kind of surgery, the rate of caesarian delivery is raising worldwide, detecting the safer methods of management for optimizing the outcome is mandatory.
Case Presentation: In this report, we are discussing a patient in Firoozgar Hospital, Tehran, Iran, with twin pregnancy accompanying with placenta previa with abnormal invasion, which has got the best possible outcome after performing a multidisciplinary approach without any need to blood transfusion or general anesthesia during cesarean hysterectomy as the standard management of placenta increate. In this case, we have performed magnetic resonance imaging (MRI) before surgery. We found out that we can use the exact site of placental margin and the distance between placental margin and uterovesical junction. So we have done the uterine incision horizontally without damaging to the placenta. Generally, Doppler ultrasonography has enough accuracy for detecting all kinds of placenta creates.
Conclusion: By selecting a safe uterine incision, we can prevent such a sudden and massive bleeding during the operation and also avoid occurring end-organ damage due to hemorrhage for instance, acute tubular necrosis, disseminated intravascular coagulation resulted in maternal morbidity and mortality. In this report, we also discuss the points needed for management and treatment of abnormal placental invasion by reviewing the recent literatures.
