Serial hCG and ultrasound measurements for predicting malignant potential in multiple pregnancies associated with complete hydatidiform mole - A report of 2 cases

BACKGROUND: Multiple pregnancy complicated by the presence of a complete hydatidiform mole (CHM) is a rare clinical entity. However, there are enough accumulated data to assist the clinician in the management Of such a patient. CASES: Case 1 presented in the first trimester with a twin pregnancy associated with a CHM. In the absence of other complications, the pregnancy was monitored with serial beta-human chorionic gonadotropin (beta-hCG) and ultrasound measurements. A reduction in molar volume suggested regression of the CHM. The pregnancy was successfully carried to term with no progress of the CHM. beta-hCG levels regressed after delivery. Case 2 had a triplet pregnancy resulting from in vitro fertilization with a CHM detected in the first trimester. Similar measurements were applied. The pregnancy was complicated by episodes of antepartum hemorrhage (APH). Further, the molar volume continued to increase. Because of recurrent APH, delivery was by cesarean section. After delivery, after an initial decline, the beta-hCG level rose, and pulmonary metastases were detected. The patient was treated with single-agent chemotherapy, with complete resolution. CONCLUSION: The combination Of serial ultrasound molar volume measurements with serial beta-hCG estimation may assist the clinician in predicting which of these rare complicated pregnancies will result in the development of trophoblastic neoplasia.