Two cesarean deliveries after hemi-hysterectomy due to gestational trophoblastic neoplasia.

Abstract

OBJECTIVE:

Although uterine didelphys per se is not associated with an impaired ability to conceive, the association between uterine anomalies and gestational trophoblastic neoplasia (GTN) remains unclear. The management of chemotherapy-resistant GTN in women with uterine didelphys raises a new issue regarding whether to perform a hemi-hysterectomy.

CASE REPORT:

A 23-year-old, gravida 1, para 0 Japanese woman was referred with a failed intermittent cervical dilatation for hematometra. Four years previously, she developed a GTN Stage III, score 5. As two cycles of chemotherapy with methotrexate (MTX) and one cycle of EMA-CO (etoposide, MTX, actinomycin D, cyclophosphamide and vincristine) did not result in remission, we performed an abdominal hemi-hysterectomy. After a canalization procedure and cervicoplasty were performed, the patient conceived naturally and prematurely delivered by cesarean section twice.

CONCLUSION:

A hemi-hysterectomy should be considered for fertility preservation when GTN develops on either side of a didelphic uterus and adjuvant chemotherapy does not result in remission.

• Authors: Kentaro Kai, Yasushi Kawano, Mitsutake Yano, Mamiko Okamoto, Eiichi Hori, Kaei Nasu, Hisashi Narahara
• Journal: Taiwanese journal of obstetrics & gynecology (Taiwan J Obstet Gynecol) Vol. 57 Issue 2 Pg. 315-318 (Apr 2018) ISSN: 1875-6263 [Electronic] China (Republic : 1949- )
• PMID: 29673680 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2018. Published by Elsevier B.V.

Topics

• Adult
• Cesarean Section
• Chemotherapy, Adjuvant
• Female
• Gestational Age
• Gestational Trophoblastic Disease (drug therapy, pathology, surgery)
• Humans
• Hysterectomy (methods)
• Male
• Pregnancy
• Premature Birth
• Uterus (abnormalities, surgery)