Severe, very early onset preeclampsia in a Covid 19-positive woman with a twin pregnancy presenting with a hydatidiform mole and coexisting normal fetus: a case report

Abstract

Cases of hydatidiform moles with a coexisting fetus are sparse and patients are at high risk for severe complications. Patients and physicians often face the dilemma of the wish to continue pregnancy until viability of the fetus while the risk for maternal complications increases. We present an educational case of a twin pregnancy presenting with a hydatidiform mole and coexisting normal fetus with a placenta praevia. The patient developed severe, early onset preeclampsia with beginning HELLP-syndrome and was tested Covid-19 positive in the further course. Termination of pregnancy was conducted via caesarean section at 18 + 6 weeks of pregnancy. Histopathology and genetic analysis confirmed a complete hydatidiform mole next to a normal placenta. Close follow-up examinations were conducted and showed normal findings including ß HCG levels normalizing within 5 months. This case combines several rare, difficult and severe medical conditions and demonstrates how an individualized therapy by an interdisciplinary team covering a highly sensitive topic was developed in a situation where no guidelines exist.

Keywords: case report; complete mole; gestational trophoblastic disease; hydatidiform mole; preeclampsia.

Figure 1

Timeline from amniocentesis to termination of pregnancy due to severe preeclampsia.

Figure 2

Ultrasound images showing the hydatidiform mole presenting as an enlarged placenta with numerous cysts reminding of a bunch of grapes.

Figure 3

Histopathology images of the the normal placenta (A) and of the complete hydatidiform mole (B) using haematoxylin eosin staining. The pictures of the hydatitiform mole show a centrally broadened stroma with scarcely cells and pseudocystic transformation. The stroma is surrounded by a markedly proliferating accumulation of syncytio- and cytotrophoblasts. Magnification x5, x10.

Figure 4

Quantitative Fluorescence PCR illustrates the absence of maternal alleles in DNA originating from hydatidiform mole. In molar DNA, only one (paternally inherited) allele could be detected for each STR- marker.