Purpose: To report the rare case of post-partum choriocarcinoma following a term live birth and to highlight the importance of prompt diagnosis and chemotherapy.

Design: Case Report

Case Report: A 36-year-old Para 3+1 day 40 post uneventful vaginal delivery presented to emergency department complaining of profuse per-vaginal bleeding for 1 day with lethargy. Her lochia had stopped 2 weeks ago and she was fully breastfeeding her newborn. Vaginal examination was normal. Trans-vaginal ultrasound showed a thin endometrial thickness. Her UPT was positive and 0-hour serum β-hCG was markedly raised. Her CT TAP showed lung metastasis, uterus was bulky with hyperdensities seen within. She was diagnosed as post-partum choriocarcinoma with FIGO staging GTN stage III and her WHO prognostic scoring for GTN was 5.

She was started on first line chemotherapy and responded well. She completed a total of 5 cycles chemotherapy and her subsequent follow-up with serial β-hCG in our gynaecology clinic were all normal.

Discussion: Post-partum choriocarcinoma is very aggressive and can lead to mortality if there is any delay in diagnosis. The diagnosis of post-partum choriocarcinoma is established based on the presenting symptoms, serum β-hCG level and CT scan findings. Despite its rarity, clinician must always be vigilant when confronted with ambiguous symptoms. In conclusion, vaginal bleeding is the common presenting symptom of choriocarcinoma. Irregular or vaginal bleeding in post-partum women warrant thorough investigation. Product of conception must be sent for histology examination if available.