Twin pregnancy with a living fetus and coexisting complete hydatidiform mole.

CASE REPORT A 26 year-old para 2 presented at 30 weeks' gestation with a small, painless antepartum haemorrhage. When booked at sixteen weeks' amenorrhoea ultrasound scanning confirmed her dates to be correct and no obvious fetal abnormality was seen. The pregnancy was uncomplicated and the patient was well and normotensive throughout. All of her pregnancies were conceived with the aid ofclomiphene citrate and her other children were delivered vaginally at term. On admission the patient's blood pressure was 115/58 mmHg. The fundal height was at the xiphisternum which was greater than expected and the uterus was soft and non-tender. There was a single fetus, the lie was longitudinal, the presentation was breech and the fetal heart was heard. On ultrasound scanning the liquor volume was normal and the placenta was posterior and slightly low-lying. A large mass of multiple sonolucent areas was visualised separate from the superior edge of the placenta. Intravenous access was established and blood was taken for haemoglobin, group and hold (B Rhesus positive) and human chorionic gonadotrophin (HCG) level. Intramuscular steroids were given to the patient to improve fetal lung maturity. Four hours after admission the patient experienced a sudden, substantial, painless haemorrhage. A second intravenous line was inserted, blood was taken for coagulation profile and 500 mls colloid was infused over ten minutes while four units of packed cells were awaited. On examination she was pale but normotensive. The uterus was soft and non-tender, the fetal heart rate was 130 beats per minute and fresh blood was seen trickling from the vagina. Written consent for an emergency caesarean section was obtained from the patient. An emergency lower segment caesarean section was performed under general anaesthetic and a male infant weighing 1410 g was delivered in good condition by breech extraction. A healthy placenta and membranes were delivered, and in addition 1200 ml ofvesicular tissue were removed from the uterus. An infusion of oxytocin was commenced and carboprost 250 ,ug was injected into the myometrium to improve uterine tone and control blood loss. The patient made an uneventful recovery and went home on the fifth postoperative day. The baby remained in the neonatal unit and made very good progress. The BHCG result from admission was 251,478 IU/I and the pathology of the vesicular tissue was reported as a complete mole co-existing with a normal twin fetus and placenta. The patient's details were registered with Charing Cross …