{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T16:51:49Z","timestamp":1791564709662,"version":"4.3.4"},"reference-count":50,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:00:00Z","timestamp":1759968000000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"},{"start":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T00:00:00Z","timestamp":1759968000000},"content-version":"tdm","delay-in-days":0,"URL":"http:\/\/doi.wiley.com\/10.1002\/tdm_license_1.1"}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Ultrasound in Obstet &amp;amp; Gyne"],"published-print":{"date-parts":[[2026,3]]},"abstract":"<jats:title>ABSTRACT<\/jats:title>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>Complete hydatidiform mole and coexisting normal fetus (CHMCF) is a rare condition for which there is significant heterogeneity in diagnosis, counseling and management of complications. The objective of this study was to summarize the prevalence of clinical outcomes in reported cases of CHMCF.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>\n                      A systematic literature search was conducted in PubMed, Embase and Scopus databases from inception until 1 October 2024. Case series and cohort studies including at least three cases of histologically confirmed CHMCF were included. A random\u2010effects model was used for meta\u2010analysis of proportions and heterogeneity was estimated using Higgins'\n                      <jats:italic>I<\/jats:italic>\n                      <jats:sup>2<\/jats:sup>\n                      index. The Newcastle\u2013Ottawa scale and the Joanna Briggs Institute critical appraisal checklist were used to assess study quality, while certainty of evidence was assessed using Grading of Recommendations Assessment, Development and Evaluation (GRADE) methodology. The study was registered in the PROSPERO database (CRD42023431734).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Quantitative synthesis included 19 studies and 417 cases of CHMCF. Diagnosis was made using ultrasound in 76.0% (95%\u2009CI, 58.5\u201390.6%) of cases and occurred in the first trimester in 52.7% (95%\u2009CI, 34.0\u201371.0%). Symptoms at diagnosis were present in 80.5% (95%\u2009CI, 66.1\u201392.3%) of cases, with vaginal bleeding being the most common symptom both at diagnosis and later in pregnancy. The pooled proportion of elective pregnancy termination was 48.8% (95%\u2009CI, 32.7\u201365.1%), with 6.2% (95%\u2009CI, 1.0\u201313.9%) due to maternal complications. The pooled proportion of live births was 46.5% (95%\u2009CI, 36.1\u201357.1%), with most being delivered by Cesarean section (71.2% (95%\u2009CI, 42.4\u201394.4%)). Preterm birth (&lt;\u200937\u2009weeks) occurred in 67.8% (95%\u2009CI, 44.7\u201388.1%) of cases, very preterm birth (&lt;\u200932\u2009weeks) in 12.4% (95%\u2009CI, 0.2\u201333.9%) and miscarriage (fetal death &lt;\u200924\u2009weeks) in 32.7% (95%\u2009CI, 26.1\u201339.6%). Pre\u2010eclampsia was present in 17.8% (95%\u2009CI, 5.9\u201332.7%) of cases and postpartum hemorrhage occurred in 42.7% (95%\u2009CI, 5.1\u201384.8%). A small\u2010for\u2010gestational\u2010age neonate\u00a0(birth weight &lt;\u200910\n                      <jats:sup>th<\/jats:sup>\n                      percentile) was delivered in 40.6% (95%\u2009CI, 12.9\u201370.8%) of cases. Rates of neonatal and maternal mortality were negligible. The pooled proportion of gestational trophoblastic neoplasia was 33.8% (95%\u2009CI, 25.6\u201342.5%); among elective terminations, continued pregnancies and live births, the rates were 14.1% (95%\u2009CI, 5.4\u201324.9%), 20.3% (95%\u2009CI, 12.0\u201329.9%) and 5.9% (95%\u2009CI, 1.9\u201311.2%), respectively. The evidence level according to GRADE was low to very low.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>\n                      Pregnancies with CHMCF present a high risk of maternal, obstetric and neonatal complications, including miscarriage, pre\u2010eclampsia, small\u2010for\u2010gestational age, postpartum hemorrhage and preterm birth. The risk of developing gestational trophoblastic neoplasia was not clearly mitigated by early pregnancy termination. Early diagnosis, referral to a maternal\u2013fetal medicine unit with expertise in trophoblastic disorders and extensive implementation of screening protocols for preterm birth and pre\u2010eclampsia are recommended to facilitate timely intervention aimed at outcome improvement. \u00a9 2025 The Author(s).\n                      <jats:italic>Ultrasound in Obstetrics &amp; Gynecology<\/jats:italic>\n                      published by John Wiley &amp; Sons Ltd on behalf of International Society of Ultrasound in Obstetrics and Gynecology.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1002\/uog.70104","type":"journal-article","created":{"date-parts":[[2025,10,10]],"date-time":"2025-10-10T01:10:09Z","timestamp":1760058609000},"page":"272-282","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":4,"title":["Multiple pregnancy with complete hydatidiform mole and coexisting normal fetus: systematic review and meta\u2010analysis of clinical outcomes from non\u2010randomized studies"],"prefix":"10.1002","volume":"67","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-3239-3799","authenticated-orcid":false,"given":"N.","family":"Salmeri","sequence":"first","affiliation":[{"name":"Obstetrics and Gynecology Unit IRCCS San Raffaele Scientific Institute  Milan Italy"},{"name":"School of Medicine Vita\u2010Salute San Raffaele University  Milan Italy"},{"name":"Department of Clinical Sciences and Community Health Universit\u00e0 degli Studi di Milano  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"A.","family":"Pizzetti","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Unit IRCCS San Raffaele Scientific Institute  Milan Italy"},{"name":"School of Medicine Vita\u2010Salute San Raffaele University  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"E.","family":"Grassi","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Unit IRCCS San Raffaele Scientific Institute  Milan Italy"},{"name":"School of Medicine Vita\u2010Salute San Raffaele University  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4370-8271","authenticated-orcid":false,"given":"R.","family":"Cioffi","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Unit IRCCS San Raffaele Scientific Institute  Milan Italy"},{"name":"School of Medicine Vita\u2010Salute San Raffaele University  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8451-429X","authenticated-orcid":false,"given":"G.","family":"Mangili","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Unit IRCCS San Raffaele Scientific Institute  Milan Italy"},{"name":"School of Medicine Vita\u2010Salute San Raffaele University  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Seckl","sequence":"additional","affiliation":[{"name":"Gestational Trophoblastic Disease Centre Charing Cross Hospital Campus of Imperial College London  London UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-0876-5596","authenticated-orcid":false,"given":"A.","family":"Sotiriadis","sequence":"additional","affiliation":[{"name":"Second Department of Obstetrics and Gynecology, Faculty of Medicine, School of Health Sciences Aristotle University of Thessaloniki  Thessaloniki Greece"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M.","family":"Candiani","sequence":"additional","affiliation":[{"name":"Obstetrics and Gynecology Unit IRCCS San Raffaele Scientific Institute  Milan Italy"},{"name":"School of Medicine Vita\u2010Salute San Raffaele University  Milan Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8097-366X","authenticated-orcid":false,"given":"P. 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