[Twin pregnancy with a complete hydatiform mole and a viable co-twin]. / Gravidez gemelar com uma mola hidatiforme completa e um co-gémeo viável.

A complete hydatiform mole coexisting with a live, viable twin is a rare event. The diagnosis is challenging, and is normally achieved only at second trimester. It may be associated with thyrotoxicosis, vaginal bleeding, preeclampsia, fetal death or persistent throphoblastic disease. The authors describe the case of a pregnant woman presenting with first trimester bleeding. Ultrasound revealed a twin pregnancy with a viable twin and another placenta apparently detached. At 16 gestational weeks ultrasound revealed a live fetus with a normal placenta and a separate vacuolated and vascularized mass. Facing the hypothesis of gestational trophoblastic disease, the couple chose pregnancy interruption. Given the rarity of this situation, a high index of suspicion is needed to achieve the diagnosis. Despite the existence of case reports with good fetal and maternal outcome, the decision of pregnancy continuation should be made by the informed parents.

A existência de uma gravidez gemelar bicoriónica com uma mola hidatiforme completa e um co-gémeo viável é um evento raro, sendo o diagnóstico habitualmente realizado no segundo trimestre. Pode associar-se a tirotoxicose, pré-eclâmpsia, hemorragia vaginal, doença persistente do trofoblasto e morte fetal. Os autores descrevem o caso de uma grávida com hemorragia do primeiro trimestre. As imagens ecográficas foram interpretadas como uma gravidez gemelar bicoriónica com um embrião vivo e outra placenta com imagem de descolamento. Às 16 semanas visualizou-se um feto vivo com placenta posterior e uma massa vacuolada anterior, vascularizada. Perante a hipótese de doença do trofoblasto o casal optou pela interrupção da gravidez. O exame anatomo-patológico confirmou o diagnóstico. Perante a raridade desta entidade clínica, é necessário um elevado índice de suspeição para estabelecer oseu diagnóstico ecográfico. Apesar de estarem descritos casos com um bom desfecho materno e neonatal, a decisão de continuação da gravidez deve ser tomada pelos progenitores.

Ureterocele: antenatal diagnosis and management.

Ureteroceles are cystic dilations of the intravesical submucosal ureter. Most cases are associated with complete ureteral and renal duplication, and association with ureterohydronephrosis is frequent. The authors describe the 4 cases of fetal ureterocele diagnosed from March 2008 to March 2012. Mean gestational age at diagnosis was 23 weeks (16-34 weeks). One of 4 cases progressed to severe hydronephrosis with megacystis and was referred to a Fetal Medicine Center for fetoscopy and laser ureterocelotomy. The remaining 3 cases did not need fetal therapy. Mean gestational age at delivery was 37 weeks. One case abandoned follow-up; 2 children were submitted to cystoscopic ureterocele incision and the child submitted to fetal therapy needed heminephrectomy due to recurrent urinary tract infections. In those 3 cases renal function was preserved. When a fetal ureterocele is diagnosed, close sonographic surveillance should be offered to monitor the possible urinary tract obstruction and assess the need for prenatal intervention. Fetal diagnosis is important to program the timing of delivery and postnatal care.

Ultrasonographic diagnosis of fetal ovarian cysts: five cases in five years.

OBJECTIVE: To evaluate the outcome of ultrasonographically diagnosed fetal ovarian cysts within a 5-year period. METHODS: This was a retrospective evaluation of the prenatal and postnatal medical records of the five cases of fetal ovarian cyst diagnosed at our institution from January 2002 to December 2006. RESULTS: The mean gestational age at diagnosis was 31.6 weeks. One of the patients had type I diabetes and another had chronic hypertension and preeclampsia. The mean cyst diameter at diagnosis was 38.3 mm (range 29-60 mm). When diagnosed, four of the cysts were simple and the other was septated. During pregnancy, the septated cyst and two of the simple cysts became hemorrhagic. Postnatally the septated cyst and two of the simple cysts underwent spontaneous remission; the other two cases, corresponding to hemorrhagic cysts, were surgically removed after birth. CONCLUSIONS: The best clinical approach to a fetal ovarian cyst is controversial. In this small series, three of the five cysts regressed spontaneously, including a hemorrhagic one. Once a fetal ovarian cyst is diagnosed, ultrasonographic monitoring should be provided in order to identify complications and define the best therapeutic approach.