多胎妊娠中伴有完全葡萄胎和正常胎儿易于发生严重的产科并发症以及出生后的恶性转化。对于这种罕见类型的妊娠滋养细胞瘤病，预后信息有限。本研究旨在确定伴有完全葡萄胎和伴存正常胎儿的多胎妊娠的产科结局和滋养细胞瘤肿瘤发生的风险，并确定不良产科和肿瘤学结局的风险因素，以改进患者信息和管理。这是一项回顾性的国家队列研究，收集了2001年1月至2022年1月法国滋养细胞瘤疾病国家中心的11411份记录。在11411例葡萄胎妊娠中，有141例经组织学确诊为伴有完全葡萄胎和伴存正常胎儿的多胎妊娠。大约四分之一的妇女（23％，33/141）因预计预后不良或自主选择而决定终止妊娠。在继续妊娠的77％的妇女（108/141）中，16％的妊娠（17/108）因母亲并发症终止，37％（40/108）在24周孕龄前自然流产。剩下的47％妊娠（51/108）的中位分娩年龄是32周孕龄。在排除选择性终止妊娠后，第8天的整体新生儿存活率为36％（39/108；95％CI：27-46）。与游离β-hCG水平> 10倍中位数（MoM）的妇女相比，游离β-hCG水平< 10 MoM的妇女更有可能达到24周孕龄（OR，7.0；95％CI，1.3-36.5；p = 0.022）。较低的游离β-hCG水平还与更好的早期新生儿存活率相关（活儿子在第8天的中位数游离β-hCG水平是9.4 MoM，而死儿子为20.0 MoM；p = 0.02）。在伴有完全葡萄胎和正常胎儿的多胎妊娠之后，滋养细胞瘤肿瘤的总体发生率为26％（35/136，95％CI：19-34）。所有35例患者的FIGO低风险评分，治愈率为100％。基于患者要求的妊娠终止与滋养细胞瘤肿瘤风险降低无关。如子痫前期和产后出血等孕妇并发症也与滋养细胞瘤肿瘤的风险增加无关，高hCG水平或第8天新生儿的存活率也不再高。伴有完全葡萄胎和正常胎儿的多胎妊娠具有高风险的产科并发症。在继续妊娠的患者中，约三分之一的新生儿在第8天存活，并且大约四分之一的患者发展为滋养细胞瘤肿瘤。因此，相比单个完全葡萄胎，恶性转化的风险似乎更高。低游离β-hCG水平可能提示早期新生儿的更好存活，这个关系需要进一步研究。© 2023 Elsevier Inc. 保留所有权利。

Multiple pregnancy with a complete hydatidiform mole and a normal fetus is prone to severe obstetrical complications and malignant transformation after birth. Prognostic information is limited for this rare form of gestational trophoblastic disease.This study aimed to determine obstetrical outcomes and the risk of gestational trophoblastic neoplasia in women with multiple pregnancy with complete hydatidiform mole and coexisting normal fetus, and identify risk factors for poor obstetrical and oncological outcomes to improve patient information and management.This was a retrospective national cohort study of 11411 records from the French National Center for Trophoblastic Disease registered between January 2001 and January 2022.Among 11411 molar pregnancies, 141 involved histologically confirmed multiple pregnancy with complete hydatidiform mole and coexisting normal fetus. Roughly a quarter of women (23%, 33/141) decided to terminate pregnancy because of presumed poor prognosis or by choice. Among the 77% of women (108/141) who continued their pregnancy, 16% of pregnancies (17/108) were terminated because of maternal complications, and 37% (40/108) ended in spontaneous miscarriage before 24 Weeks' Gestational Age (Weeks' GA). The median delivery age in the remaining 47% of pregnancies (51/108) was 32 Weeks' GA. The overall neonatal survival rate at day 8 was 36% (39/108; 95%CI: 27-46) after excluding elective pregnancy terminations. Patients with free beta hCG levels < 10 multiples of the median (MoM) were significantly more likely to reach 24 Weeks' GA than those with free beta hCG levels > 10 MoM (OR, 7.0; 95% CI, 1.3-36.5; p = 0.022). A lower free beta hCG level was also associated with better early neonatal survival (the median free beta hCG level was 9.4 MoM in patients whose child was alive at day 8 vs 20.0 MoM in those whose child was deceased; p = 0.02). The overall rate of gestational trophoblastic neoplasia after a multiple pregnancy with complete hydatidiform mole and a normal fetus was 26% (35/136, 95% CI: 19-34). All 35 patients had low-risk FIGO scores and the cure rate was 100%. Termination of pregnancy on patient request was not associated with a lower risk of gestational trophoblastic neoplasia. Maternal complications such as preeclampsia and postpartum hemorrhage were not associated with a higher risk of gestational trophoblastic neoplasia, and neither were having high hCG levels or newborn survival at day 8.Multiple pregnancy with complete hydatidiform mole and coexisting fetus carries a high risk of obstetrical complications. In patients who continued their pregnancy, about one third of neonates were alive at day 8 and roughly one in four patients developed gestational trophoblastic neoplasia. The risk of malignant transformation therefore appears to be higher than after singleton complete mole. Low levels of free beta hCG may be indicative of better early neonatal survival and this relationship warrants further study.Copyright © 2023 Elsevier Inc. All rights reserved.