Clinical Analysis Of One Case Of Twin Pregnancy With Partial Hydatidiform Mole Was Found Secondary Choriocarcinoma After Cesarean Section

Background:Pregnancy with hydatidiform mole is relatively rare clinically. It can be divided into two types:Complete hydatidiform mole and partial hydatidiform mole coexisting with fetal, which complete hydatidiform mole coexisting with fetal is the most common and the fetal have a high survival rate, it have a high rate of developing persistent trophoblastic disease; Fetal coexisting with partial hydatidiform mole is usually dead in early trimester of pregnancy, it have a lower rate of developing persistent trophoblastic disease.Objective:To investigate the possible causes, histopathological charcteristics,clinical feature, pregnancy outcome of twin pregnancy with partial hydatidiform mole in one fetus survival and the value of prenatal diagnosis-mainly depends on ultrasound, pathology and karyotype analysis of chromosome in diagnosing partial hydatidiform mole, it will be beneficial for obstetrician to give these patients a thorough assessment of pregnancy and postpartum in clinic and keep maternal and newborn health.Method:The treatment of a patient of twin pregnancy, partial hydatidiform mole in one fetus survival was found secondary choriocarcinoma after cesarean section was analyzed retrospectively in2012(a case) and reported the details of clinical data and follow-up result.Results:The patient gave birth to two normal premature girls by caesarean section because of premature rupture of fetal membranes and fetal distress. Intraoperative findings:There was a contents of uterine cavity, unequal-sized vesicular tissue,, on the posterior uterine wall. The hydatidiform mole tissue was combined with the placental of the oldest daughter. Pathologic diagnosis of placenta was showed partial hydatidiform mole. The HCG increased continuously and Imaging examination showed pulmonary metastasis after operation and the diagnosis was Invasive mole. The patient was transferred from obstetric department to gynecology for treatment. After chemotherapy, HCG dropped to normal, curative effect is relatively satisfactory. After the follow-up year, no obvious abnormality in appearance and intelligence evaluation for the two girls. But the patient had a symptom of menelipsis and HCG increased. The patient was admitted in the hospital again and excluded pregnancy, considered gestational trophoblastic disease relapsed. Finally the patient had a hysterectomy, the pathologic diagnosis was showed choriocarcinoma and the patient was given a chemotherapy. Now the life signs stable and strict follow-up.Conclusion:Pregnancy with partial hydatidiform mole and the fetal can survive is relatively rare clinically. For such patients, prenatal diagnosis-especially ultrasound, pathology and karyotype analysis of chromosome are very important to decide whether to continue the pregnancy or judge prognosis. If the patient have a invasive mole or choriocarcinoma after delivery, it often needs close cooperation of the obstetrician and gynecologist for diagnosis and treatment. Most patients had good result.