Twin molar pregnancies, characterized by a rare chromosomal anomaly in one of the fraternal twins leading to complex challenges, have been a source of intrigue within the medical community. The condition presents along with early pregnancy symptoms, such as severe vomiting, and dangerous endocrinologic disorders, and has a high risk of developing into invasive cancer.
Ruofan Yao, MD, an OBGYN and Maternal-Fetal Medicine Specialist at Loma Linda University Children's Hospital, defines twin molar pregnancies as an occurrence where one twin develops normally while the other turns into a mole. The molar portion can grow rapidly, occupying a significant part of the uterus, leading to preterm deliveries, cancer development, or severe hemorrhaging during birth.
Yao says the challenges of decision-making in such complex cases highlight the delicate balance between the risk of prematurity for the normal twin and potential maternal health concerns.
"The biggest concern that we have is maternal risk of developing cancer and hemorrhaging during birth," says Yao. In addition, moms are also dealing with balancing the risks of having a premature baby. It's a very complicated decision-making process."
Yao explains that monitoring hCG levels, the pregnancy hormone, is critical to make sure cancer doesn't develop.
"For normal pregnancies, the hCG level will rise to around 100,000 during the 12-14 week range, and then it falls between 10,000 and 20,000 for the remainder of pregnancy," says Yao. "A molar pregnancy can go up to a million or more. This pregnancy hormone stimulates the thyroid gland into overdrive and causes an invasive type of cancer called gestational trophoblastic neoplasia."
In 2020, Rosa Gutierrez, who had struggled with infertility for four years and was diagnosed with endometriosis, faced a unique set of challenges during her pregnancy. Her first ultrasound in Monterey Park revealed a rare occurrence—one in 100,000 pregnancies—twin molar pregnancy. Doctors recommended terminating the pregnancy due to potentially life-threatening complications. Seeking a second opinion at Loma Linda University Health, Gutierrez met Dr. Yao, who, along with her faith, guided her through the rare condition. Despite initial fears, Gutierrez and her husband Miguel Gallegos chose to trust the process, developing a plan for potential complications.
"There were times when I'd be cooking, and I would start getting anxious because I was worried what would happen if I started to bleed and bleed out? What if there's traffic? What if I don't make it to the hospital? But whenever I panicked and got scared, my husband always reassured me that everything would be okay," says Gutierrez.
The mole continued to grow, but through weekly scans and careful monitoring, the pregnancy progressed successfully.
"Dr. Yao said our goal was to reach at least 24 weeks. I made it to 37 weeks when Dr. Yao said it was time for a c-section. The oncology team was also there to remove the molar tissue, and I gave birth to a 100% healthy baby."
The pathology report revealed the molar tissue was non-cancerous, and she expressed overwhelming gratitude for the successful outcome. Gutierrez had a baby boy, whom she and her husband Miguel Gallegos named Mattias.
Mattias is now two and a half years old, and Gutierrez and her husband are expecting another child.
Yao explains a need for continued research and case reporting for twin molar pregnancies and notes that LLUCH has encountered six instances in the last three years, a high occurrence in the Inland Empire for such a rare condition.
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