Anesthetic management of a patient with complete molar pregnancy in twin gestation: A case report

The coexistence of a complete hydatidiform mole with a healthy fetus is a rare and high-risk clinical condition that presents significant anesthetic challenges. We present the case of a 38-year-old pregnant woman with a twin pregnancy consisting of a mole and a coexisting fetus, who was admitted with metrorrhagia, early-onset preeclampsia, severe anemia and dyspnea secondary to pulmonary metastases. General anesthesia was planned, including invasive monitoring, large-bore venous access, and the availability of massive transfusion. During uterine evacuation, an estimated blood loss of 3.5 liters was recorded, managed with the transfusion of four units of packed red blood cells and tranexamic acid. In the immediate postoperative period, the patient developed acute pulmonary edema and respiratory failure, requiring high-flow oxygen therapy, bilateral pleural drainage, and intensive care management. This case highlights the importance of anticipatory anesthetic planning and multidisciplinary management to reduce maternal morbidity and mortality associated with this uncommon condition.