ADIPS Poster Presentation Australasian Diabetes in Pregnancy Society and Society of Obstetric Medicine Australia and New Zealand Joint Scientific Meeting 2025

A rare case of severe early preeclampsia in the context of a partial molar pregnancy  (#129)

Ikanyeng T Sengwaketse 1
  1. Obstetric Medicine, Cairns Hospital, Cairns, QLD, Australia

Introduction: 

Preeclampsia is hypertension usually arising after 20 weeks of gestation with maternal organ or uteroplacental dysfunction, and affects 3-5% of pregnancies.1,2 Gestational trophoblastic disease is a group of premalignant and malignant disorders arising from trophoblastic cells, usually divided into partial and complete molar pregnancies based on histopathology. 3,4 

Case summary: 

A 30-year-old, G1P0, presented with 1 week of preeclampsia symptoms at 16-weeks-of-gestation on background of Factor-V Leiden heterozygous. Blood pressure was 172/128, with pitting oedema up to mid tibia bilaterally. Her systemic examination was unremarkable. 

She was managed with intravenous Hydralazine, magnesium-sulphate infusion and oral Labetalol with good effect. 

Ultrasound revealed a very large placenta with placental lakes. The foetus was 1 week behind in biometry with large cystic spaces in the brain, consistent with a partial molar pregnancy and had triploidy. 

There was significant transaminitis, with a normal full blood count, a urine protein-creatinine ratio of 1500g/mol, B-HCG of 2,144,660 IU/L and SFLT-1/PLGF ratio was 1,154. 

She had medical termination of pregnancy. Post-partum, she required escalating doses of anti-hypertensives and required suction, dilatation and curettage for retained products of conception, with good effect on her blood pressure. Histopathology showed a partial hydatidiform mole. 

Conclusion: 

Partial molar pregnancies arise from dispermic fertilisation of an ovum and result in triploidy.3 The relationship between trophoblastic disease and early onset of preeclampsia is established.2 Patients with molar pregnancies get preeclampsia before 20 weeks and should be managed aggressively as trophoblastic disease is associated with severe morbidity and significant risk of mortality.  

  1. Fox, R., Kitt, J., Leeson, P., Aye, C. Y. L., & Lewandowski, A. J. (2019). Preeclampsia: Risk Factors, Diagnosis, Management, and the Cardiovascular Impact on the Offspring. Journal of clinical medicine, 8(10), 1625.
  2. Core, D., Vervaeke, H., Leethy, K., Cooper, D., & Zoorob, D. (2024). Eclampsia, HELLP and PRES in a 16-week partial molar pregnancy. BMJ case reports, 17(6), e258188.
  3. Garner, E. I., Goldstein, D. P., Feltmate, C. M., & Berkowitz, R. S. (2007). Gestational trophoblastic disease. Clinical obstetrics and gynecology, 50(1), 112–122.
  4. Ning, F., Hou, H., Morse, A. N., & Lash, G. E. (2019). Understanding and management of gestational trophoblastic disease. F1000Research, 8, F1000 Faculty Rev-428.