The management and outcome in patients presenting with twin/multiple pregnancies complicated by a complete hydatidiform mole (CHM) and patients presenting with partial hydatidiform mole (PHM)

Patients can present with twin or multiple pregnancies in which one of the conceptions is a CHM and the optimum management of these patients is uncertain. Between 1979 and 1997, 126 women were registered at the Charing Cross Hospital with this type of pregnancy. Histological review confirmed that 73 of these patients had a CHM and a separate twin. 18 (25%) of these pregnancies resulted in a live birth and CHM. Delivery of the pregnancy was normal vaginal delivery 15; Caesarean Section 3. The remaining 55 (75%) of patients resulted in a non-viable foetus/still birth and CHM. 15 (21%) of these patients subsequently required chemotherapy for persistent gestational trophoblastic disease (GTD). Histological diagnosis of PHM can be difficult and between 1990 and 1997 we reviewed 2,976 patients who were diagnosed as having a PHM. PHM was confirmed in 1,887 (63%) of these cases. Diagnoses were revised to either CHM (21%) or non-molar pregnancy (16%). 12 (0.6% of patients developed persistent gestational trophoblastic disease (GTD) requiring chemotherapy. Initially all patients were in the low risk category and were treated with methotrexate and folinic acid. One patient switched treatment to actinomyocin-D and 2 patients required high-risk chemotherapy with the EMA/CO schedule. Ail 12 patients requiring chemotherapy remain in remission. Patients with PHM require the same follow up as patients with CHM.