BACKGROUND:

The incidence of twin pregnancies with hydatidiform mole is 1 case in 20,000 to 100,000 pregnancies. The complete hydatidiform mole originates from an empty ovum, without maternal genetic material, fertilized by a sperm, which duplicates its genetic material. In the ultrasound a pattern in “snowflakes” is observed. There are two types of care: expectant management or termination of pregnancy, in both situations with prior assessment of potential maternal risks. Any decision must be made in conjunction with the patient and the obstetrician.

CLINICAL CASE:

43-year-old patient, who underwent assisted reproduction techniques to achieve pregnancy, the one achieved was: twin, bichorionic and bi-amniotic. Subsequently, by imaging methods, the diagnosis of twin pregnancy was established, with a hydatidiform mole and a coexisting live fetus. The ultrasound revealed a live fetus, 11.3 weeks old, with a hydatidiform mole. What was observed was corroborated on magnetic resonance imaging and the molar pregnancy was delimited. Methotrexate was applied and manual vacuum aspiration was performed. Histopathology analysis confirmed the diagnosis. Weekly monitoring of the free beta fraction of human chorionic gonadotropin (β-hCG) was carried out until the symptoms had completely disappeared.

CONCLUSIONS:

Since this pregnancy anomaly is extremely rare, the patient must be cared for by a multidisciplinary team that integrates the diagnosis and evaluates the best course of action to follow and prevent the various possible complications. Uterine aspiration is the safest approach for patients with risk factors for gestational trophoblastic neoplasia.

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