بارداري دوقلويي مولار كامل به‌همراه جنين زنده تريپل X: گزارش موردي

Molar twin pregnancy with a live coexisting triple X fetus: case report

زمينه و هدف: بارداري دوقلويي مول كامل به‌همراه جنين زنده يك بارداري نادر مي‌باشد. در اين مقاله يك مورد بارداري مولار كامل و جنين زنده با كاريوتايپ تريپل X گزارش شد. معرفي بيمار: بيمار خانم 22 ساله با بارداري 18-17 هفته بود كه در مهر 1395 با شكايت خونريزي واژينال به مركز آموزشي درماني ام‌البنين وابسته به دانشگاه علوم پزشكي مشهد مراجعه كرد. در سونوگرافي 13 هفته، يك جنين زنده نرمال به‌همراه جفت قدامي حجيم به‌نفع مول گزارش شده بود، بنابراين براي بيمار حاملگي مول پارشيل يا حاملگي دوقلويي به‌همراه مول كامل مطرح شد. نتيجه آمنيوسنتز بيمار تريپل X گزارش شد. به‌دنبال خونريزي شديد واژينال تهديد‌كننده حيات براي بيمار هيستروتومي انجام شد و يك جنين بدون آنومالي آشكار همراه با يك جفت هيدروپيك حجيم خارج شد. پس از يك ماه با توجه به تشخيص نئوپلازي تروفوبلاستيك جفتي تحت كموتراپي قرار گرفت. نتيجه‌گيري: افتراق حاملگي دوقلويي مولار كامل و جنين زنده با حاملگي مول پارشيل از موارد چالش‌برانگيز مامايي مي‌باشد كه براي افتراق اين‌دو مي‌توان از راديولوژيست متبحر و آمنيوسنتز كمك گرفت.

Background: Complete molar twin pregnancy with coexisting fetus is a rare and important diagnosis in obstetrics. Preeclampsia, preterm labor and life-threatening vaginal bleeding are the serious complications of this type of pregnancy. Gestational trophoblastic neoplasia should be ruled out after termination of pregnancy. In this study we reviewed a molar twin pregnancy with a live coexisting triple x fetus which has not been reported till now. Case Presentation: Our case was a 22-year-old primigravida woman and 17-18th week of pregnancy, who referred to an University Hospital in Mashhad, Iran with complaint of vaginal bleeding On October 2016. Her first trimester ultrasonography in 13th week of gestational age, reported a live single fetus with an anterior great placenta and cystic formation regarding molar pregnancy. According to above-report, Amniocentesis was done in 15th weeks of pregnancy and its result was triple X. After severe and lifethreatening vaginal bleeding, she underwent an emergent hysterotomy. A fetus with no obvious anomaly and a great hydropic and vesicular placenta delivered. Episodic crisis of her blood pressure was best controlled with anti-hypertensive drugs. In our case, chemotherapy with methotrexate was started after poor decline of βHCG titration and definite diagnosis of gestational trophoblastic neoplasia. Remission was completely achieved after four courses of chemotherapy. Conclusion: Differentiation between complete molar pregnancy with live fetus and partial mole is always challenging in obstetrics. Serious complications as preeclampsia and severe vaginal bleeding may become life-threatening. Coexisting molar pregnancy should be ruled out in a pregnancy associated with frequent and unexpectant vaginal bleeding. Amniocentesis and an expert radiologist can help to differentiate them. Following these patients is very important to reveal any trophoblastic neoplasia.