Complete hydatidiform mole with co-existing fetus: Predictors of live birth

Abstract

Multiple gestation consisting of complete hydatidiform mole with co-existing fetus (CHMCF) is unusual. From our institution, we reported two cases with unfavorable obstetric consequences. The recommendation for antenatal management is still not distinctly determined. Therefore, the aim of this article was to review the literature according to the predictors of infant survival and to develop a management guidance for pregnancy with CHMCF. Between January 1, 1993 and May 31, 2016, 12 case series and 89 case reports comprising of 204 pregnant women were identified. The pregnancies successfully delivered 78 live births (37.86%). For clinical symptoms, pregnant women with antenatal complications, including pregnancy-induced hypertension (PIH), hyperthyroidism (HTD) and hyperemesis gravidarum (HG), significantly developed adverse perinatal events. Low hCG blood level was the best predictor of fetal survival (P=0.006). We developed a model using logistic regression analysis which was enhanced by including an hCG cut-off level of 400,000mIU/mL. On the basis of our intensive review, we suggest that the patient with CHMCF without antenatal obstetric problems especially PIH, HTD and HG together with initial serum hCG level less than 400,000mIU/mL is a good candidate for pregnancy continuation and reaching fetal viability.

Keywords: Co-existing fetus; Complete hydatidiform mole; Live birth; Predictor; Twin pregnancy.