Complete mole coexisting with a normal fetus in a dichorionic diamniotic pregnancy: A case report

Background: Complete hydatidiform mole with a coexisting normal pregnancy is an exceptionally rareoccurrence with a reported incidence of 1 in 22,000-100,000 pregnancies. Management remainscontroversial due to the risk of maternal and fetal complications and limited data on optimalmanagement.Case presentation: A para 1 + 0 presented to the Maternal Fetal Unit at 19 weeks. Ultrasound revealed atwin pregnancy with a single live fetus in one sac and a second sac with multiple cystic lesions and atypical snow-storm appearance consistent with a complete molar pregnancy. The placenta of the molarpregnancy was also low-lying, covering the internal cervical os. She had several episodes of antepartumhemorrhage, which was managed expectantly because she was keen on conception. At 25 weeks, shepresented with copious vaginal bleeding and chills. Speculum examination revealed vesicles withultrasound revealing a single live fetus, but complete molar pregnancy was not observed. Afteradmission, the patient became febrile with tachycardia. Amniocentesis was performed to rule outintraamniotic infection in viable pregnancy. A decision was made to undertake an emergencyhysterotomy because of deteriorating maternal status, placenta previa, and breech presentation.Maternal blood culture was positive for group B Streptococcus, with fetal blood and amniotic fluid culturesbeing sterile. Histopathology of the placenta revealed features consistent with acute chorioamnionitis andperipheral molar pregnancy.Conclusion: This case highlights the difficulty in the management of such cases, as illustrated bymultiple episodes of antepartum hemorrhage and subsequent maternal sepsis. Multidisciplinary care andshared decision making remain integral to management.