Cervical foley tamponade as a bridge to chemotherapy for hemorrhagic postpartum choriocarcinoma.

BACKGROUND

Postpartum choriocarcinoma is highly chemosensitive but may cause life-threatening uterine hemorrhage requiring urgent hemostatic intervention. Uterine artery embolization or hysterectomy may be necessary when bleeding is uncontrolled. We report a patient in whom cervical Foley catheter tamponade reduced massive uterine bleeding sufficiently to permit prompt chemotherapy while preserving the uterus.

CASE PRESENTATION: A 24-year-old primiparous woman developed recurrent massive uterine bleeding after term vaginal delivery. Histopathologic examination of tissue obtained during repeat uterine evacuation was consistent with choriocarcinoma. At referral, transvaginal ultrasonography showed a 12-mm hypervascular myometrial lesion, chest computed tomography revealed multiple pulmonary metastases, and serum human chorionic gonadotropin was 143,249 mIU/mL. Three days later, she was admitted emergently with recurrent massive bleeding; the lesion had enlarged to 33 mm and serum human chorionic gonadotropin had increased to 317,589 mIU/mL. A 16-French Foley catheter was placed within the cervical canal, reducing the bleeding to a clinically manageable level. Combination chemotherapy with methotrexate, etoposide, and actinomycin D (MEA) was initiated the following day. Although bleeding did not cease completely, uterine artery embolization and hysterectomy were avoided. The patient completed 16 cycles of MEA chemotherapy, including consolidation therapy, achieved complete remission, and retained her uterus.

CONCLUSION

Cervical Foley catheter tamponade may provide a simple and rapidly available temporizing option for severe uterine bleeding in selected patients with postpartum choriocarcinoma. It may serve as a bridge to definitive chemotherapy while avoiding more invasive hemostatic procedures.