완전포상기태와 공존한 생존태아 1예

Abstract

Pregnancies consisting of complete hydatidiform mole with a coexisting fetus are relatively rare and associated with a risk of persistent gestational trophoblastic tumor. Recently, hydatidiform moles with a fetus have become more and more common due to utilization of induction agents for ovulation, and many clinicians have been confronted with the difficulty of determining whether to undergo immediate intervention or expectant management. However, there are limited data to guide the antenatal management of complete hydatidiform mole coexisting with a fetus. We experienced a case of complete hydatidiform mole with a coexistent live fetus, which was diagnosed by ultrasonography at 19 gestational weeks, showing a molar pattern and normal fetal structure, and confirmed normal karyotype of the coexistent fetus. Antenatal management was done with an additional serial check of β-hCG levels and blood pressure. The levels of serum β-hCG in serum level were progressively decreased after 19 gestational weeks and fell within normal range during advancing gestation. Pregnancy was terminated at 30 gestational weeks due to fetal hypoxia resulting from severe pre-eclampsia with a live small for gestational age infant. We report our case with a literature review to provide a guideline of management about complete hydatidiform mole with a coexisting fetus. Our result suggest that the pregnancy of complete mole with a coexisting live fetus may be allowed to continue when the fetal karyotype and development are normal and serum β-hCG titers are falling with advancing gestational age.