ABSTRACT:
Background: Pregnancy after treatment for high-risk gestational trophoblastic neoplasia (GTN) is generally considered feasible with appropriate timing and surveillance. Data are limited for patients who experienced significant chemotherapy hypersensitivity and who declined consolidation chemotherapy. Case Presentation: A 27-year-old with two previous normal vaginal deliveries with prior pre-eclampsia (2020) and postpartum haemorrhage from uterine atony (2022), was diagnosed in 2023 with FIGO stage III: 9 choriocarcinoma with right-lung metastasis. Brain MRI showed no intracranial disease. She commenced EMA-CO chemotherapy. Intravenous etoposide caused Grade 2–3 infusion reactions requiring interruption, premedication, slower re-challenge, and eventual transition to oral etoposide. She declined consolidation chemotherapy and entered surveillance. Approximately one year later, she conceived and had uncomplicated antenatal care. At 37 + 1 weeks, she had a spontaneous vaginal delivery of a healthy female infant. Postpartum issues included intermittent uterine atony responsive to uterotonics, hypokalaemia to 2.5 mmol/L requiring intravenous replacement, and pre-eclampsia (urine protein–creatinine ratio 0.3 g/g) without severe features. Upon discharge plans for early obstetric oncology follow-up and immediate ß-hCG reassessment were made. Conclusions: A favourable term pregnancy outcome can occur after high-risk metastatic GTN treated with EMA-CO despite clinically significant etoposide hypersensitivity and without consolidation therapy. Vigilant surveillance coordinated peripartum care, and early postpartum ß-hCG monitoring are essential to exclude disease recurrence.