title: Term pregnancy with choriocarcinoma presenting as severe fetal anemia and postpartum hemorrhage.
abstract: OBJECTIVE
  Term pregnancy with choriocarcinoma is a rare condition that can be a serious health threat to both the mother and the fetus. We present a rare case of term pregnancy with choriocarcinoma presenting as severe fetal anemia and postpartum hemorrhage.
  
  
  METHODS
  A 34-year-old woman, gravida 3 para 2, was admitted for profuse vaginal bleeding 2 weeks after cesarean delivery of a full-term anemic baby. Transvaginal sonography revealed a 4.7-cm×10.6-cm heterogenous lesion in the endometrial cavity. Dilatation and curettage was done and a pathologic report revealed choriocarcinoma. Metastatic workup showed lung metastasis. The patient achieved remission after eight cycles of chemotherapy in the form of etoposide, methotrexate, actinomycin D, cyclophosphamide, and vincristine. There was no evidence of recurrence in the subsequent 3 years of regular follow up.
  
  
  CONCLUSIONS
  Although fetomaternal hemorrhage is a rare form of presentation of choriocarcinoma, its presence should alert the physician to investigate the cause further. This chemotherapy regimen was effective in our case and the patient needed to be followed up carefully.
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Kueishan, Taoyuan, Taiwan.
authors.forename: Hsiu-Huei
authors.initials: HH
authors.lastname: Peng
authors.affiliation: Department of Obstetrics and Gynaecology, Ten-Chen General Hospital, Yang-Mei, Tao-Yuan, Taiwan.
authors.forename: Zooi-Ping
authors.initials: ZP
authors.lastname: Ng
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Kueishan, Taoyuan, Taiwan.
authors.forename: Yun-Hsin
authors.initials: YH
authors.lastname: Tang
authors.affiliation: Department of Obstetrics and Gynecology, St. Luke's Medical Center Global City, Taguig City, Philippines; Department of Obstetrics and Gynecology, St. Luke's Medical Center Quezon City, Quezon City, Philippines.
authors.forename: Angelica Anne A
authors.initials: AA
authors.lastname: Chua
authors.affiliation: Department of Obstetrics and Gynecology, Chang Gung Memorial Hospital at Linkou and Chang Gung University College of Medicine, Kueishan, Taoyuan, Taiwan. Electronic address: kghuang@ms57.hinet.net.
authors.forename: Kuan-Gen
authors.initials: KG
authors.lastname: Huang
mesh_terms: D000328:Adult; D000740:Anemia / Q000209:etiology; D000971:Antineoplastic Combined Chemotherapy Protocols; D002822:Choriocarcinoma / Q000150:complications* / Q000188:drug therapy / Q000556:secondary; D005260:Female; D005315:Fetal Diseases / Q000209:etiology; D006801:Humans; D008175:Lung Neoplasms / Q000188:drug therapy / Q000556:secondary*; D006473:Postpartum Hemorrhage / Q000209:etiology*; D049590:Postpartum Period; D011247:Pregnancy; D011252:Pregnancy Complications, Neoplastic / Q000188:drug therapy / Q000209:etiology*; D014463:Ultrasonography; D014594:Uterine Neoplasms / Q000150:complications* / Q000188:drug therapy / Q000473:pathology
keywords: fetal anemia; postpartum hemorrhage; term pregnancy with choriocarcinoma