A rare cause of postpartum vaginal bleeding

Oğuzhan Tokur,Erdem Fatihoğlu,Fatma Dilek Gökharman,Sonay Aydın

doi:10.1186/s43055-021-00666-z

Abstract

BackgroundInvasive mole is a trophoblastic disease (GTD) caused by trophoblast cells invading the myometrium during pregnancy. The GTD range also includes mole hydatidiform, choriocarcinoma, and placental site trophoblastic tumor (PSTT). Invasive moles are most common following molar pregnancies; however, they can even rarely occur after a full-term birth. Despite the fact that pathology is the only way to make a clear diagnosis, clinic and radiologic evaluation can be helpful. We wanted to highlight a rare incidence of invasive mole following a healthy full-term delivery in this case.Case presentationA 28-year-old female patient presented with intermittent prolonged severe vaginal bleeding for 2 weeks after a term healthy vaginal delivery. In workup, beta human chorionic gonadotropin levels (b-hCG) value was 7540 mIU/ml. After suspicion of gestational trophoblastic neoplasm (GTN), the patient was sent to ultrasonography (US) and magnetic resonance imaging (MRI). GTN was confirmed by radiological and clinical findings, and a conclusive diagnosis of an invasive mole was made histopathologically.ConclusionInvasive mole should be considered in the differential diagnosis in patients with postpartum bleeding and a persistently high b-hCG level after a healthy term delivery.

Highlights

Invasive mole is a trophoblastic disease (GTD) caused by trophoblast cells invading the myometrium during pregnancy
Invasive mole should be considered in the differential diagnosis in patients with postpartum bleeding and a persistently high beta human chorionic gonadotropin levels (b-hCG) level after a healthy term delivery
Gestational trophoblastic disease (GTD) is a set of diseases caused by aberrant trophoblast growth, which can lead to gestational trophoblastic neoplasia (GTN)

Summary

Background

Gestational trophoblastic disease (GTD) is a set of diseases caused by aberrant trophoblast growth, which can lead to gestational trophoblastic neoplasia (GTN). Invasive mole is caused by abnormal trophoblastic cells invading the body It most usually occurs after a postmolar pregnancy; it can occur after a full-term delivery. Definitive diagnosis is made by pathology, but GTN is diagnosed based on clinic and radiologic findings This case was presented since invasive moles are uncommon after full-term delivery. Case presentation A 28-year-old woman was admitted to the hospital after having intermittent prolonged severe vaginal bleeding for 2 weeks following a healthy term vaginal delivery Based on laboratory test results, hemoglobin levels were low (7 gr/dl) and beta human chorionic gonadotropin levels (b-hCG) were high (7.540mIU/ml) According to these findings, the patient was referred to the radiology department with an initial diagnosis of GTN. The patient was diagnosed with invasive mole based on clinical, radiological, and pathologic findings

Discussion

Conclusion