[Multiple (quadruple) pregnancy involving complete hydatidiform mole and 3 fetuses]

The rate of hydatidiform mole in our country oscillates from 1:144 to 1:552 pregnancies. We report the second case of hydatidiform mole coexisting with a spontaneous multiple pregnancy (three fetuses and one hydatidiform mole). The patient was a 34 year old woman. She had not received hormonal therapy for anovulation. At 13th weeks of gestation she presented vaginal spotting and hyperemesis. An ultrasonographic examination revealed three living fetuses and the multiple cystic echo typical of an hydatidiform mole. At 14 weeks of pregnancy she was diagnosed to have clinical symptoms of severe preeclampsia. We did not have an adequate response to the antihypertensive drugs and the patient underwent therapeutic termination of the pregnancy. The thyroid hormones were in normal levels. The serum beta-hCG was up to 500,000 mU/ml. Two fetuses were female weighing 55 g. each one. One fetus was male weighing 50 g. All of them had a normal karyotype. The patient development a gestational trophoblastic disease. These have been only three reports of complete hydatidiform mole in triplet pregnancy with two fetuses. These cases were pregnancies occurring after ovulation inducing therapy. We analyzed the clinical aspects and treatment of hydatidiform mole coexisting with multiple pregnancy.