Successful term vaginal delivery following remission from ultra-high-risk metastatic choriocarcinoma: a rare case of preserved fertility and favourable obstetric outcome

Abstract

Metastatic choriocarcinoma represents one of the most aggressive forms of gestational trophoblastic neoplasia (GTN), particularly when associated with distant spread such as pulmonary and central nervous system involvement. Advances in multi-agent chemotherapy have significantly improved survival; however, data regarding fertility and pregnancy outcomes following treatment for ultra-high-risk disease remain limited. We reported a young woman diagnosed with metastatic choriocarcinoma following a medical termination of pregnancy, who achieved complete remission after EP/EMA chemotherapy and subsequently conceived spontaneously. Serial β-hCG levels showed a rapid decline from 443,096 IU/l to normal values, confirming treatment response. The interval between completion of chemotherapy and conception was approximately two years. Her antenatal course was clinically stable. She presented in labour at term and progressed to vaginal delivery despite meconium-stained liquor, with reassuring fetal status throughout. Both mother and neonate had an uncomplicated postpartum course. This case highlights the possibility of preserved reproductive function and favourable obstetric outcomes even after treatment for ultra-high-risk metastatic GTN.