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#Grand Rounds

Twin Pregnancy with Complete Hydatidiform Mole: What are The Pregnancy Outcomes?

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BACKGROUND AND PURPOSE:

  • Zilberman Sharon et al. (BJOG, 2020) assessed perinatal and obstetric outcomes when a complete hydatidiform mole (CHM) coexists with a normal fetus and placenta

METHODS:

  • Systematic review and meta-analysis (May 1980 through May 2019)
  • Inclusion criteria
    • Observational cohort studies
    • Included studies needed to assess at least four cases that were confirmed by histopathology and provide data on pregnancy outcomes and GTN
  • Data analysis
    • Two reviewers independently reviewed abstracts and articles

RESULTS:

  • 14 studies | 244 cases
  • Live births: 50% | IUFD was reported in 40.1% of ongoing pregnancies | 78% of births were preterm
  • Incidence of maternal complication in ongoing pregnancies: 80.8%
    • Complications: Vaginal bleeding, hyperthyroidism, and preeclampsia
    • Preeclampsia: 14.3%
  • Total cases diagnosed with GTN: 34%
    • Risk was present regardless of gestational age at the time of termination or delivery  
  • There was significant variability in reporting of complications between studies

CONCLUSION:

  • Twin pregnancies that combine a CHM and a normal fetus are at a high risk of experiencing obstetric complications, including IUFD, pre‐eclampsia and preterm delivery
  • Approximately one third of cases will develop a GTN
  • The authors state that

Our findings emphasise the need for ongoing twin pregnancies including a CHM to be cared for by a multidisciplinary team in a centre with access to neonatal intensive care for very premature newborns and to be offered post‐pregnancy follow up in a centre specialising in the management of GTN

Learn More – Primary Sources:

Obstetric outcomes of twin pregnancies presenting with a complete hydatidiform mole and coexistent normal fetus: a systematic review and meta‐analysis

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