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Uterine Rupture on Invasive Molar Pregnancy Revealing a Choriocarcinoma: Case Report from a Low-Income Country
Rakotomalala Nivoarimelina Zoly1, Refeno Valéry2, Ramarokoto Malalafinaritra Patrick Marco1
1Mother-Child Complex, Professor Zafisaona Gabriel University Hospital, Mahajanga, Boeny Region, Madagascar.
Introduction:
Gestational trophoblastic diseases are rare entities encompassing a wide spectrum of benign and malignant placental pathologies. Uterine rupture is primarily related to a uterine scar and, exceptionally, following an invasive mole or gestational choriocarcinoma. Our objective is to report a rare case of uterine rupture following an invasive mole revealing gestational choriocarcinoma.
Case Presentation:
A 23-year-old pregnant woman was admitted for genital bleeding complicated by hypovolemic shock. She presented with symptoms suggestive of a ruptured ectopic pregnancy. However, her hCG levels were markedly elevated, raising suspicion of gestational trophoblastic disease. A subtotal hysterectomy with bilateral salpingo-oophorectomy and bladder repair was performed. Due to the lack of histopathology, the diagnosis of choriocarcinoma was clinically and biochemically inferred. Exclusive chemotherapy using the methotrexate-folinic acid protocol was initiated. The patient was lost to follow-up after the first course.
Conclusion:
The reported case is generally consistent with data from the literature. The practitioner must emphasize the highly curable nature of the disease to optimize patient adherence until the end of the treatment plan. Early diagnosis must be optimized to allow for conservative treatment.
