Recurrent Complete Hydatidiform Mole with Increased Myometrial Vascularity: A Case Report

Abstract

Background: Recurrent complete hydatidiform mole is uncommon, and marked myometrial vascularity may complicate uterine evacuation because of haemorrhage risk. Case Presentation: A 28-year-old multiparous woman (P1+2, L1) presented following a previous pregnancy evacuation in Nepal, persistent amenorrhoea, vomiting, and abnormal ultrasonographic findings. Imaging demonstrated a markedly enlarged uterus containing a heterogeneous echogenic mass with multiple irregular cystic areas, together with markedly increased myometrial vascularity and arteriovenous malformations predominantly in the fundoposterior region. Serum β-hCG was 1154 mIU/mL and haemoglobin was 11.0 g/dL. The patient was stabilised, blood was cross-matched, and suction dilatation and evacuation was performed under ultrasound guidance. She subsequently received one 8-day methotrexate–leucovorin cycle. Histopathological examination demonstrated diffuse hydropic swelling of chorionic villi with circumferential trophoblastic proliferation and absence of fetal tissue; p57 immunostaining was negative, confirming complete hydatidiform mole. Following evacuation, vomiting and systemic symptoms resolved within 48 hours and haemodynamic stability was maintained. Serial β-hCG monitoring showed a decline from 1154 mIU/mL to 150 mIU/mL at 8 weeks, with continued downward progression. Conclusion: This case highlights the importance of recognising recurrent molar pregnancy, evaluating marked uterine vascularity before intervention, obtaining histopathological confirmation, and maintaining structured β-hCG surveillance after treatment. Careful follow-up remained necessary throughout the documented post-treatment surveillance period.