Abstract
Twin pregnancy with complete hydatidiform mole (CHM) management is challenging and remains unguided up to this date. This report presents the case of a 20-year-old woman that was diagnosed with CHM coexisting with a healthy fetus at 18 week of gestation, following presentation with an episode of vaginal bleeding. After rigorous counseling about the significantly high risks of obstetrical complications and gestational trophoblastic neoplasia (GTN), the patient declined termination. Luckily, pregnancy was uncomplicated and successfully brought up to 34 weeks of gestation with serial follow-ups, leading to an uncomplicated delivery via cesarean section. This condition presents unique diagnostic and management challenges, as clinicians must balance the potential for fetal survival against significant maternal risks.