Intraplacental choriocarcinoma and fetomaternal haemorrhage and maternal disseminated intravascular coagulopathy in a term pregnancy: A case report

Background Intraplacental choriocarcinoma (ICC) is a rare form of gestational trophoblastic disease that has been documented as complicating near-term pregnancies with massive fetomaternal haemorrhage (FMH), intrauterine fetal demise, neonatal anaemia, and disseminated disease of both mother and child. Case A 31-year-old woman at 38 weeks of gestation underwent caesarean section due to reduced fetal movements. The caesarean section was complicated by disseminated intravascular coagulopathy (DIC). Massive FMH and choriocarcinoma were diagnosed after delivery. Discussion Review of the literature demonstrated this to be the first published case of DIC associated with choriocarcinoma, a rare complication. The literature suggests post-partum serial measurement of beta human chorionic gonadotropin (β-HCG) in women with unexplained massive FMH. This case demonstrates the potential to reduce morbidity and mortality by earlier diagnosis of choriocarcinoma by means of surveillance of serial β-HCG levels in patient and child. Outcome The patient underwent 4-agent chemotherapy after methotrexate alone failed to achieve remission. β-HCG levels were undetectable at the time of publishing this case report and the child is healthy with no complications.
Highlights • Unexplained massive FMH may be secondary to ICC. • ICC are typically small lesions and may be missed on histopathology. • Serial BHCG surveillance may aid in diagnosis of unexplained massive FMH.