title: The clinical characteristics and early detection of postpartum choriocarcinoma.
abstract: OBJECTIVE
  This study aimed to identify the clinical and demographic characteristics and prognosis of patients with conditions diagnosed with postpartum choriocarcinoma based on the International Federation of Gynecology and Obstetrics 2000 prognosis scoring system or based on pathologically confirmed choriocarcinoma and to analyze the patients' clinical symptoms for early detection of this disease.
  
  
  METHODS
  Between January 1983 and August 2013, 24 consecutive women with postpartum choriocarcinoma were treated at 2 hospitals. Data on clinical and demographic characteristics, including initial presenting symptoms, type of antecedent pregnancy, fetal complications, and prognosis of these patients, were analyzed. According to the time interval between the previous delivery and the onset of disease, patients were divided into 2 groups: the short and long interval groups.
  
  
  RESULTS
  The most common symptom among the 24 patients with postpartum choriocarcinoma was irregular vaginal bleeding (14/24); in some cases, bleeding was caused by metastatic foci (7/24). Massive genital bleeding causing emergency hysterectomy and several obstetric complications, such as unknown severe fetal anemia and fetal growth retardation, was only observed in the short interval group. The overall primary remission rate was 91.7%.
  
  
  CONCLUSIONS
  The most common symptom of patients with postpartum choriocarcinoma in the short and long interval groups was genital bleeding, and the overall prognosis may be improved by introduction of an appropriate chemotherapy regimen. Careful pathological examination of the placenta is needed in cases of fetomaternal hemorrhage, unknown fetal anemia, and abnormal obstetric events, including premature delivery, still birth, and infantile growth retardation, for the early detection of intraplacental choriocarcinoma.
authors.affiliation: *Department of Obstetrics and Gynecology, Tokyo Women's Medical University, Tokyo; and †Department of Reproductive Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
authors.forename: Noriko
authors.initials: N
authors.lastname: Ryu
authors.forename: Masaki
authors.initials: M
authors.lastname: Ogawa
authors.forename: Hideo
authors.initials: H
authors.lastname: Matsui
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Usui
authors.forename: Makio
authors.initials: M
authors.lastname: Shozu
mesh_terms: D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D002822:Choriocarcinoma / Q000175:diagnosis* / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007044:Hysterectomy; D008875:Middle Aged; D009367:Neoplasm Staging; D049590:Postpartum Period; D011247:Pregnancy; D011379:Prognosis; D012189:Retrospective Studies; D014594:Uterine Neoplasms / Q000175:diagnosis* / Q000628:therapy*