Postpartum Choriocarcinoma: Delay in Diagnosis and Lessons L
Pregnancy-related causes must always be ruled out in women with irregular vaginal bleeding in the reproductive age group even if she is postpartum and lactating. Ultrasound diagnosis of presumed incomplete miscarriage should be followed up with histology or clinically to rule out gestational trophoblastic neoplasia.

Published in the Journal of Obstetrics and Gynecology of India, the authors describe a woman who was treated with progestogens for irregular vaginal bleeding and eventually she was diagnosed to have stage IV choriocarcinoma.

A 23-year-old para 1 attended the accident and emergency department for irregular vaginal bleeding of one and half month’s duration. She was on progestogen pills for more than a month for the same symptoms from a private physician. She had delivered about 4 months ago and was breast feeding her infant. There was no history of fever, abdominal pain, nausea, or vomiting. She was not using any contraception. There was no history of passing clots.

General examination was unremarkable and abdominal examination was normal. The uterus was normal size on bimanual examination with a closed cervical os. There was no tenderness on cervical movements or in the adnexa. Urine pregnancy test was positive and serum beta human chorionic gonadotropin (β-hcg) was 850 IU.

A transvaginal ultrasound scan revealed an endometrial thickness of 22 mm and normal ovaries. A provisional diagnosis of incomplete miscarriage was made based on her symptoms and ultrasound findings and three options were discussed with her-expectant management with observation, vaginal misoprostol and surgical evacuation of the uterus.

The patient opted for vaginal misoprostol and she returned after a week with moderate vaginal bleeding when the general and pelvic examination was unchanged but on transvaginal scanning some cystic changes were noted in a thick endometrium and the ovaries were normal.

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