MANAGEMENT OF TWIN PREGNANCIES CONSISTING OF A COMPLETE HYDATIDIFORM MOLE AND NORMAL FETUS

Objective: To report the clinical features, management, and outcome of twin pregnancies consisting of a complete hydatidiform mole and a coe xisting normal fetus. Methods: Between 1966 and 1997, seven women with complete hydatidiform mole and coexisting normal fetus were treated a t the John I. Brewer Trophoblastic Disease Center of Northwestern Univ ersity Medical School. Clinical features, including presenting symptom s, gestational dates, hCG levels, and complications, as well as route of delivery or evacuation, pregnancy outcome, genetic analysis, and ne ed for chemotherapy were assessed. Results: Four women required uterin e evacuation before 20 weeks' gestation because of vaginal bleeding or medical complications, one woman required an emergency hysterotomy be cause of hemorrhage at 24 weeks, and two women delivered normal, viabl e infants at 26 and 34 weeks. The pathologic diagnosis of complete hyd atidiform mole was confirmed in each case and the chromosome complemen t was 46,XX in all molar gestations. Four of seven women required chem otherapy for treatment of nonmetastatic gestational trophoblastic tumo rs, including both women who delivered viable infants and two of the f ive women whose pregnancies were evacuated before 24 weeks' gestation. All four patients were treated with five to seven cycles of a 5-day m ethotrexate regimen and achieved complete remission. Conclusion: Patie nts with a twin pregnancy consisting of a complete mole and a normal f etus are at increased risk for hemorrhage and medical complications, a s well as the development of persistent gestational trophoblastic tumo r. (C) 1998 by The American College of Obstetricians and Gynecologists .