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Presentation and management of choriocarcinoma after nonmolar pregnancy
Author(s) -
Tidy John A.,
Rustin Gordon J. S.,
Newlands Edward S.,
Foskett Marianne,
Fuller Sandra,
Short Delia,
Rowden Philippa
Publication year - 1995
Publication title -
bjog: an international journal of obstetrics and gynaecology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 2.157
H-Index - 164
eISSN - 1471-0528
pISSN - 1470-0328
DOI - 10.1111/j.1471-0528.1995.tb11429.x
Subject(s) - choriocarcinoma , medicine , obstetrics , pregnancy , live birth , vaginal bleeding , abortion , gestational trophoblastic disease , molar pregnancy , gynecology , retrospective cohort study , gestation , surgery , genetics , biology
Objective To ascertain the mode of presentation and treatment outcome for women with choriocarcinoma after a nonmolar pregnancy. Design Retrospective analysis of case records between 1985 and 1994. Setting A referral centre for trophoblastic disease. Subjects One hundred women with choriocarcinoma: 62 after a live birth, six after a live birth preceded by a molar pregnancy and 32 after a nonmolar abortion. Results Choriocarcinoma after nonmolar pregnancies represent 17% of the total gestational trophoblastic tumours requiring treatment. Vaginal bleeding was the commonest symptom in all groups, but symptoms from metastatic disease were important in the group presenting after a live birth. Metastatic disease was present in 31% of cases after live birth and 43% post‐abortion. The median interval between the antecedent pregnancy and choriocarcinoma was five and six months, respectively. High risk multi‐agent chemotherapy was required in 82% and 60% of cases, respectively. The mortality rate was significantly higher after a live birth than a nonmolar abortion (21% vs 6%). Conclusions Treatment of choriocarcinoma after a live birth is associated with an unacceptably high mortality rate. Vaginal bleeding is an important early symptom and a pregnancy test should be performed if it persists after usual medical treatment.