Complete Hydatidiform Mole With Coexisting Live Fetus: Outcomes After Assisted Reproductive Technology and Natural...

Complete hydatidiform mole with a coexisting live fetus in a twin pregnancy is exceptionally rare and carries major maternal and fetal risks. We describe two such pregnancies to illustrate management options. The first followed frozen-thawed single blastocyst transfer and presented at 13 weeks with a live fetus, a separate molar mass, an intramural fibroid, markedly elevated serum beta-human chorionic gonadotropin, and biochemical hyperthyroidism. Multidisciplinary assessment led to hysterotomy with removal of the fetus, molar tissue, and fibroids, followed by rapid recovery and no gestational trophoblastic neoplasia. The second was a spontaneously conceived twin pregnancy with a live 9-week fetus and multicystic molar tissue that was evacuated by suction curettage. An initial decline in beta-human chorionic gonadotropin was followed by a low-level plateau that resolved after a single low-dose methotrexate cycle. These cases highlight the need for individualized, multidisciplinary care and close biochemical follow-up.