A Rare Case of a Molar Pregnancy Coexisting with a Live Foetus in a Patient with Prior Exposure to M-2 Tone in First Trimester in Eastern Uganda: A Case Report.
Although gestational trophoblastic diseases (GTD) is common, its coexistence with a viable twin pregnancy is a rare phenomenon. The occurrence of such a pregnancy, with reports of prior exposure to M2-tone in early pregnancy, has not been documented before. To the best of our knowledge, this is the first of such a case in Uganda.
A 30 years old, black African Ugandan, gravida 3para 1+1 at 19+4 weeks of amenorrhoea (WOA) presented at Mbale RegionalReferral Hospital (MRRH) in September 2024. She had had a viable term vaginal delivery 5 years ago, that was followed by secondary infertility, for which, no treatment was sought. She subsequently had two natural conceptions. The second pregnancy was lost at 3 months of amenorrhoea following a spontaneous abortion. During the current pregnancy, she was put on M-2 tone (Ayurveda tablets) for 2 months and oral progesterone 10 mg daily till 12 weeks of amenorrhoea. During her fourth antenatal care (ANC) contact, it was noticed that she had gained excessive weight for the WOA. Further assessment revealed exaggerated symphysio-fundal height (SFH). The obstetric scan requested for showed features of viable foetus coexisting with a molar pregnancy. Three prior ultrasound scans had apparently reported a normal pregnancy. Serum beta human chorionic gonadotrophin hormone was very high for WOA. During the pregnancy and peripartum period, she developed obstetric complications but delivered a viable foetus, with a placenta that showed clinical evidence of molar pregnancy. Follow up has revealed resolution of symptoms and no gestational trophoblastic neoplasia (GTN) sequelae.
Molar twin pregnancy with a viable foetus is associated with various maternal and perinatal adverse outcomes and presents management challenges. Whether early pregnancy exposure to M2-tone is a risk factor cannot be elucidated. Close antenatal and postnatal surveillance should be instituted to rule out GTN sequelae.
A 30 years old, black African Ugandan, gravida 3para 1+1 at 19+4 weeks of amenorrhoea (WOA) presented at Mbale RegionalReferral Hospital (MRRH) in September 2024. She had had a viable term vaginal delivery 5 years ago, that was followed by secondary infertility, for which, no treatment was sought. She subsequently had two natural conceptions. The second pregnancy was lost at 3 months of amenorrhoea following a spontaneous abortion. During the current pregnancy, she was put on M-2 tone (Ayurveda tablets) for 2 months and oral progesterone 10 mg daily till 12 weeks of amenorrhoea. During her fourth antenatal care (ANC) contact, it was noticed that she had gained excessive weight for the WOA. Further assessment revealed exaggerated symphysio-fundal height (SFH). The obstetric scan requested for showed features of viable foetus coexisting with a molar pregnancy. Three prior ultrasound scans had apparently reported a normal pregnancy. Serum beta human chorionic gonadotrophin hormone was very high for WOA. During the pregnancy and peripartum period, she developed obstetric complications but delivered a viable foetus, with a placenta that showed clinical evidence of molar pregnancy. Follow up has revealed resolution of symptoms and no gestational trophoblastic neoplasia (GTN) sequelae.
Molar twin pregnancy with a viable foetus is associated with various maternal and perinatal adverse outcomes and presents management challenges. Whether early pregnancy exposure to M2-tone is a risk factor cannot be elucidated. Close antenatal and postnatal surveillance should be instituted to rule out GTN sequelae.