title: The use of middle cerebral artery Doppler ultrasonography to guide delivery of a viable pregnancy complicated by metastatic gestational chroriocarinoma.
abstract: Background: Choriocarcinoma is a rare, aggressive subtype of gestational trophoblastic neoplasia. The diagnosis of metastatic choriocarcinoma in the setting of a viable intrauterine pregnancy is exceedingly rare and often associated with feto-maternal hemorrhage.Case: An otherwise healthy Gravida 1 Para 0 at 34 weeks gestational age presented with metastatic choriocarcinoma and a viable fetus. Measured Doppler peak systolic velocity of the middle cerebral artery was used to detect fetal anemia, thus optimising the timing of delivery.Conclusion: This is the first case report to our knowledge using Doppler ultrasonography to detect fetal anemia in an effort to guide delivery in a case of choriocarcinoma diagnosed during pregnancy. If choriocarcinoma is diagnosed during pregnancy, middle cerebral artery Doppler ultrasonography may serve as a critical tool to help detect anemia, allowing pregnancy prolongation to promote fetal maturity while screening for the development of feto-maternal hemorrhage.
authors.affiliation: Naval Medical Center Portsmouth Department of Obstetrics and Gynecology Portsmouth VA USA.
authors.forename: Andrew S
authors.initials: AS
authors.lastname: Thagard
authors.affiliation: Naval Medical Center PortsmouthDepartment of Obstetrics and GynecologyPortsmouth VAUSA; Department of Obstetrics and GynecologyPortsmouth VAUSA.
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Dubil
authors.affiliation: Naval Medical Center PortsmouthResidency in Obstetrics and GynecologyPortsmouth VAUSA; Department of Obstetrics and GynecologyPortsmouth VAUSA.
authors.forename: Amy
authors.initials: A
authors.lastname: Lee
authors.affiliation: Naval Medical Center PortsmouthDepartment of Obstetrics and GynecologyDivision of Gynecologic OncologyPortsmouth VAUSA; Department of Obstetrics and GynecologyPortsmouth VAUSA.
authors.forename: Jay
authors.initials: J
authors.lastname: Allard
authors.affiliation: Naval Medical Center PortsmouthDepartment of Obstetrics and GynecologyPortsmouth VAUSA; Department of Obstetrics and GynecologyPortsmouth VAUSA.
authors.forename: Craig M
authors.initials: CM
authors.lastname: Zelig
keywords: MCA‐PSV Doppler; choriocarcinoma; feto‐maternal hemorrhage