Molar Pregnancy with Co-Existing Viable Fetus Delivered Preterm at 24 Weeks Gestation: A Case Report

It is unusual and challenging to have a molar pregnancy and a viable fetus at the same time. Bleeding per vagina, anemia, hyperemesis gravidarum, hypertension, thyrotoxicosis, and uterine enlargement disproportionate to uterine age are common clinical presentations that should alert the clinician to this uncommon illness. Pregnancy of a hydatidiform mole with a coexistent live fetus in most cases is a complete molar pregnancy. Partial molar pregnancy with fetus is rare and almost always ends in miscarriage due to triploid fetus.

In this case study, we present a 19-year-old woman who presented with acute vaginal bleeding and pelvic discomfort. Transabdominal ultrasound revealed fetal heart rate and identified the fetus at 24 weeks gestation. A large heterogeneous and complex cystic mass was found in the fundus, which was diagnosed as an abnormal placenta with a strong suspicion of molar pregnancy. The cervix was dilated by 4 cm at the time of hospital admission and four hours later, she gave birth to a healthy female fetus. The placenta emerged along with the membrane and abundant grape-like cystic tissue.

A case study showed a coexisting live fetus that was 24 weeks gestational age and had a partial hydatidiform mole, along with severe vaginal bleeding and uterine contraction. A partial mole was identified through histology analysis of the placenta.

Maternal b-HCG levels fell to undetectable levels one month after birth without treatment. She was doing well and a follow-up six months later revealed no evidence of retained tissue or recurrence.