L19 Placenta and Trophoblastic disease

Hydatidiform mole diagnosis Uterine evacuation

(for definite diagnosis and treatment): histopathological examination of evacuated uterine specimen (also see "Treatment" below)

ß-hCG

- Beta subunit - Homology with TSH, LH and FSH

placental abnormalities 4. Placenta variants 5. Chronic intervillositis

- Diffuse infiltration of mononuclear cells of maternal origin into the intervillous space within the placenta

Placental development respiration and excretion

- Glucose, oxygen, AA exchange

Placental development immunological barrier?

- Lymphoid cells, phagocytes

ß-hCG maintains? then is produce where at 12 wks?

- Maintains Corpus Luteum, until placenta takes over around week 12 - Levels rise quickly then plateau - Clinical uses

Anatomy of the cord Wharton's jelly function

- Protects and insulates - Macrophages · LOW LYING PLACENTA- C section advised · C section- inc risk of placenta implanting in wrong place

Placental development hormone production?

- hCG, hPL, Progesterone

Physiological changes of pregnancy renal

-60% inc blood flow -50% inc GFR -low creatinine, urea -glycosuria norm -proteinuria <30mg norm

Amniotic fluid What conditions may be dec?

-IUGR, renal pathologies, rupture membranes -norm reduces to term

placenta chorion composed of?

-composed of trophoblasts (cells make up outer layer of blastocyst)- during implantation, trophoblasts multiply in number and extend into uterine wall

placental abnormalities 4. Placenta variants 4.. Succenturiate placenta

-condition in which one or more accessory lobes develop in the membranes apart from the main placental body to which vessels of fetal origin usually connect them. It is a smaller variant of a bilobed placenta. -The vessels are supported only by communicating membranes.

Physiological changes of pregnancy GI

-delayed gut motility -constipation -inc Alkaline Phosphatase

Amniotic fluid What conditions may be inc?

-diabetes, macrosomia, foetal pathologies

placental abnormalities 3. Vasa Praevia

-fetal blood vessels cross or run near the internal opening of uterus; vessels are at risk of rupture when the supporting membranes rupture; as unsupported by umbilical cord or placental tissue

placenta chorion trophoblasts form?

-form finger-like structures called chorionic villi (finger-liked structures of the placenta composed of embryo- derived trophoblasts

Physiological changes of pregnancy respiratory

-inc tidal vol -inc resp rate -mild resp akalosis -red max inspiratory vol in 3rd trimester

placental abnormalities 4. Placenta variants 7. Placental chorioangioma

-non-trophoblastic benign tumor of the placenta that is characteristically vascular and originates from primitive chorionic tissue. -rare and occurs in less than 1% of all pregnancies

Physiological changes of pregnancy skeletal

-osteopenia -inc osteoblast activity

placental abnormalities 4. Placenta variants 2. Circumvallate placenta

-placental morphological abnormalitiy, a subtype of placenta extrachorialis in which the fetal membranes (chorion and amnion) "double back" on the fetal side around the edge of the placenta. -After delivery, a circumvallate placenta has a thick ring of membranes on its fetal surface

placental abnormalities 4. Placenta variants 3. Placenta membranacea

-rare placental disorder characterised by presence of fetal membranes (complete or partially) covered by chorionic villi

placental abnormalities 4. Placenta variants 8. Gestational trophoblastic disease

-term used for a group of pregnancy-related tumours. These tumours are rare, and they appear when cells in the womb start to proliferate uncontrollably

Anatomy of placenta MALIMPLANTATIONS 1. · Velamentous cord insertion

-umbilical cord inserts into the fetal membranes (choriamniotic membranes), NOT THE PLACENTA, then travels within the membranes to the placenta (between the amnion and the chorion). -baby's blood vessels then stretched along the membrane between the insertion point and the placenta -The exposed vessels are not protected by Wharton's jelly and hence are vulnerable to rupture. -can lead to serious pregnancy complications such as vasa previa

placental abnormalities 4. Placenta variants 6. Placental mesenchymal dysplasia

-uncommon vascular anomaly of the placenta characterized by placentomegaly with multicystic placental lesion on ultrasonography and mesenchymal stem villous hyperplasia on histopathology

placental abnormalities 4. Placenta variants 1. Bilobed placenta

-variation in normal shape of placenta; placenta separate into 2 1/2 ; not associated with inc risk of foetal anomalies but there is inc risk of vaginal bleeding during and after preg

Anatomy of the cord how many fetal veins? function?

1 - Transfer oxygenated blood from the placenta to the fetus

Anatomy of placenta 2 membranes?

1. AMNION- FETAL SIDE 2.CHORION-MATERNAL SIDE

placenta 3 main functions

1. Attach the fetus to the uterine wall 2. Provide nutrients to the fetus 3. Allow the fetus to transfer waste products to the mother's blood

Choriocarcinoma pathophysiology

1. Destructive growth into myometrium without chorionic villi 2. risk of hemorrhage and early metastasis (lung, vagina, brain, liver)

Hydatidiform mole pathophysiology

1. Hydropic degeneration of chorionic villi with concomitant proliferation of cytotrophoblasts and syncytiotrophoblasts 2. death of the embryo

placental abnormalities

1. Placenta Accreta 2. Placenta Praevia 3. Vasa Praevia 4. Placenta variants

Choriocarcinoma cause?

1. after molar preg (50%) 2. normal preg (20-30%) 3. after miscarriage (20%)

placenta formation chorionic villi function

1. contain fetal blood vessels embedded in mesencyhmal tissue 2. extend into the lacunae of the endometrium, where they are bathed in maternal blood. -This blood is found within the lacunae of the decidua basalis , which is derived from the stratum functionalis of the endometrium.

Hydatidiform mole pathophysiology INVASIVE MOLE

1. trophoblasts invade the myometrium 2. increased risk of bleeding and hematogenous spread

Amniotic fluid foetal skin impermeable from wk?

16

Anatomy of the cord how many fetal arteries? function?

2 Transfer deoxygenated blood and waste products from the fetus to the placenta

Placental development terminal villi formed by wks?

20

Complete mole

46 chromosomes, 2 sperm from dad enter egg and empty maternal egg. No fetal tissue, completely edematous and has a slight risk for choriocarcinoma.

Hydatidiform mole etiology complete mole fetal karyotypes?

46XX: more common (∼ 90% of cases) 46XY: less common (∼ 10% of cases)

placenta formation at first, there are how many layers separating fetal and maternal blood? NAME

5 1. the syncytiotrophoblast layer 2. its basement membrane 3. cytotrophoblast cells 4. the endothelial cell basement membrane 5. the endothelial cells lining the fetal capillaries

Amniotic fluid made of?

90% water with foetal waste ie cells

Hydatidiform mole diagnosis Laboratory tests: β-HCG level measurement

: β-HCG level measurement (initial test of choice), which should reveal β-HCG that is markedly elevated (higher than expected for the gestational age)

Umbilical cord Wharton's jelly

A gelatinous tissue that remains when the embryonic body stalk blends with the yolk sac within the umbilical cord.

placental abnormalities 1. Placenta Accreta 3 grades?

Accreta - chorionic villi attach to the myometrium, rather than being restricted within the decidua basalis. Increta - chorionic villi invade into the myometrium. Percreta - chorionic villi invade through the perimetrium (uterine serosa).

Hydatidiform mole etiology partial mole caused by?

Caused by fertilization of an egg containing a haploid set of chromosomes with two sperms (each of them containing a haploid set of chromosomes as well)

Hydatidiform mole etiology complete mole caused by?

Caused by fertilization of an empty egg that does not carry any chromosomes → The (physiological) haploid chromosome set contributed by the sperm is subsequently duplicated.

Choriocarcinoma etiology

Choriocarcinoma only develops after fertilization and implantation of the egg. Most cases of choriocarcinoma are preceded by a hydatidiform mole: 50% hydatidiform mole 25% miscarriages or ectopic pregnancy 25% normal pregnancy

Hydatidiform mole

Classified as complete or partial moles Benign trophoblastic disease Proliferates within the uterus without myometrial infiltration or hematogenic dissemination

Hydatidiform mole etiology complete mole result of? partial mole due to?

Complete mole is the result of paternal disomy! Partial mole is the result of triploidy!

Hydatidiform mole etiology partial mole

Contains fetal or embryonic parts in addition to trophoblastic tissue

Choriocarcinoma prognosis

Cure rate of 95-100%; worse prognosis in the case of advanced-stage disease

Implantation and placenta development trophoblast invades endometrium changing it to?

DECIDUA

Hydatidiform mole etiology complete mole

Does not contain any fetal or embryonic parts

Hydatidiform mole etiology partial mole fetal karyotypes?

Fetal karyotypes: 69XXX, 69XXY, 69XYY

Hydatidiform mole diagnosis Transvaginal ultrasound 2. partial hydatidiform mole

Fetal parts may be visualized. Fetal heart tones may be detectable. Amniotic fluid is present. Increased placental thickness

diff between GTD (hydatidiform mole) and GTN (choriocarcinoma)?

GTD - hydatidiform mole Trophoblast Excess paternal genes Complete or partial Usually benign but can be pre- malignant GTN - choriocarcinoma • Trophoblast • Malignant

Choriocarcinoma

Highly aggressive, malignant tumor consisting of trophoblastic tissue Exhibits histological signs of malignancy and a tendency to metastasize early

Choriocarcinoma diagnosis Uterine dilation and curettage (D&C)

Histopathologic examination shows cytotrophoblasts and syncytiotrophoblasts without chorionic villi Both diagnostic and therapeutic (but only limited diagnostic value)

Choriocarcinoma diagnosis Staging

If malignancy is suspected Chest x-ray: multiple nodules in lung metastasis" -Cannon ball" metastases

Choriocarcinoma diagnosis

Laboratory tests Pelvic ultrasound Uterine dilation and curettage (D&C) Staging

Hydatidiform mole diagnosis

Laboratory tests: β-HCG level measurement Transvaginal ultrasound Uterine evacuation Chest x-ray:

Hydatidiform mole clinical features partial mole

Less severe symptoms due to β-HCG levels that are lower than in complete moles Vaginal bleeding Pelvic tenderness

most common type of GTD?

MOLAR PREG

Anatomy of placenta umbilical cord inserts into which side of placenta?

Maternal side- umbilical cord comes out of this side

Hydatidiform mole prognosis

Most patients achieve normal reproductive function after recovery.

Placental site trophoblastic tumours (PSTT) same as womb cancer?

NO . In womb cancer the cancer develops from the cells of the womb lining (the endometrium). In PSTT the tumour develops from the cells that grow to form the placenta. The cells are called trophoblast cells.

Molar Pregnancy COMPLETE Is there an embryo?

NO EMBRYO

Hydatidiform mole INVASIVE MOLE

No histologic signs of malignancy in the primary tumor Trophoblasts infiltrate the myometrium and gain access to the vascular system. Hematogenic dissemination leads to metastatic growth in different organs (brain, lungs, liver).

placental abnormalities 2. Placenta Praevia

Normally, the position of the placenta will move as the womb grows and stretches, so that eventually, by the last three months of pregnancy, it should be near the top of the womb. -in some cases; placenta stays in the lower portion (part) of the womb, and either partially or completely covers the cervix (neck of the womb). This is known as placenta praevia.

Umbilical cord umbilical vein transports?

OXYGENATED blood to the fetal heart

placental abnormalities 1. Placenta Accreta occurs when?

Placenta accreta occurs when all or part of the placenta attaches abnormally to the myometrium (the muscular layer of the uterine wall).

placental abnormalities 2. Placenta Praevia 4 grades

Placenta praevia occurs in four grades, ranging from minor to major: Grade 1 - (minor) the placenta is mainly in the upper part of the womb, but some extends to the lower part. Grade 2 - (marginal) the placenta reaches the cervix, but doesn't cover it. Grade 3 - (major) the placenta partially covers the cervix. Grade 4 - (major) the placenta completely covers the cervix (most serious type of placenta praevia)

Choriocarcinoma clinical features

Postpartum vaginal bleeding and inadequate uterine regression after delivery Theca lutein cysts Additional symptoms depend on the site of metastasis (e.g., seizures from metastases in the brain; dyspnea or hemoptysis from metastases in the lungs)

Hydatidiform mole etiology risk factors

Prior molar pregnancy History of miscarriage Patients ≤ 15 and ≥ 35 years

ß-hCG made by?

Syncytiotrophoblast

Hydatidiform mole diagnosis Transvaginal ultrasound 1. complete hyatidiform mole

Theca lutein cysts Echogenic mass interspersed with many hypoechogenic cystic spaces that represent hydropic villi (referred to as "swiss cheese," "bunch of grapes," or "snowstorm") No amniotic fluid Lack of fetal heart tones

Choriocarcinoma treatment

Treatment of choice: chemotherapy Surgical treatment (e.g., hysterectomy): may be indicated to stop bleeding from cancerous lesions or to excise distant metastases Monitor β-HCG levels for at least 12 months.

Amniotic fluid measurable on?

USS

Hydatidiform mole TREATMENT

Uterine evacuation by dilation and suction curettage: Complete moles have a 20% risk of becoming invasive and a 2% risk of developing into choriocarcinoma. Therefore, complete evacuation of the uterine cavity is the mainstay of treatment. Monitor β-HCG levels until in reference range (usually 8-12 weeks) Chemotherapy (usually methotrexate) if unresolved, as indicated by any of the following: 1. β-HCG values do not decrease. 2.Histological features of malignant GTD are present. 3.If metastases are present on chest x-ray.

Hydatidiform mole clinical features complete mole

Vaginal bleeding during the first trimester Uterus size greater than normal for gestational age Passage of vesicles that may resemble a bunch of grapes through the vagina Endocrine symptoms -Preeclampsia (before the 20th week of gestation) -Hyperemesis gravidarum -Ovarian theca lutein cysts: bilateral, large, cystic, adnexal masses that are tender to the touch -Hyperthyroidism

Persistent trophoblastic disease (PTD) symptoms

Vaginal bleeding is the most common symptom.

Umbilical cord

a tube containing the blood vessels connecting the fetus and placenta

Molar Pregnancy PARTIAL what can develop?

abnormal embryo can develop -TRIPLOIDY

placental abnormalities 1. Placenta Accreta

abnormal trophoblast invasion of part or all of the placenta into the myometrium of the uterine wall -when all or part of placenta attaches abnormally to the myometrium (muscular layer of uterine wall)

placenta chorionic villi upper capillary involves 3 traversing layers, these are? lower capillaries involves 5 layers, these are?

because the basement membranes of the syncytiotrophoblast and capillary are fused. The layers are 1. syncytiotrophoblast 2. basement membrane 3. endothelial cell. The lower capillaries would involve 5 layers: 1. the syncytiotrophoblast layer 2. its basement membrane 3. cytotrophoblast cells 4. the endothelial cell basement membrane 5. the endothelial cells lining the fetal capillaries.

placenta composed of?

both maternal tissue and tissue derived from embryo

Gestational trophoblastic diseases (GTD)

cells or tumours that start in the womb from cells that would normally develop into the placenta.

placenta formation synctiotrophoblast layer forms?

chorionic villi

Molar Pregnancy PARTIAL appearance

clusters of 'grapes' are more scattered trophoblastic hyperplasia

Umbilical cord contains?

contains two umbilical arteries and one umbilical vein embedded in a connective tissue known as Wharton's jelly

Anatomy of placenta as placenta matures, what becomes thinner to aid diffusion?

cytotrophoblast

Implantation and placenta development blastocyst implants into endometrium what day?

day 5

Implantation and placenta development lacunae from day?

day 7

Umbilical cord umbilical arteries transports?

deoxygenated blood away from fetal heart to the placenta

placenta what is the chorion?

embryonic-derived portion of placenta

partial mole

embyro present, 69XXY, rare transformation into choriocarcinoma

Molar Pregnancy COMPLETE cause?

empty egg fertilsied by: 1. one sperm that duplicates its DNA (90%) OR BY 2 SPERM (10%) 2. 46 XX or 46XY DIPLOIDY

Blood flow and nutrients in the placenta maternal and fetal blood flow in the placenta separated by?

fetal trophoblasts and endothelial cells.

placenta formation squamous synctiotrophoblast layer develops?

finger-like projections into the endometrium

Blood flow and nutrients in the placenta fetal blood flow?

flows from the fetus into two main arteries in the umbilical cord, through the capillary network of the chorionic villi and is returned to the fetus by the umbilical vein.

Hydatidiform mole etiology complete mole in rare cases, formation of?

formation of a complete mole may also result from simultaneous fertilization of an empty egg by two sperms.

placenta formation squamous synctiotrophoblast layer formed by? therefor it is? contains no?

fused cytotrophoblasts therefore multinucleate and contains no internal cell membrane boundaries

Hydatidiform mole in some cases may not produce any?

hCG

placenta formation squamous synctiotrophoblast layer secretes?

hCG, estrogen, and progesterone.

Choriocarcinoma what is it?

highly malignant trophoblast tumour

hCG

human chorionic gonadotropin- placental hormone

Gestational trophoblastic diseases (GTD) include?

hydatidiform moles (both complete and partial invasive moles choriocarcinoma.

Hydatidiform mole diagnosis Chest x-ray

in case of dyspnea or chest pain

Blood flow and nutrients in the placenta does the maternal and fetal blood mix in the placenta?

in the placenta, the maternal and fetal blood does not mix. The two blood supplies remain separated by the fetal trophoblasts and endothelial cells.

Hydatidiform mole may develop malignant traits and become?

invasive mole

Choriocarcinoma is?

malignant tumor of the placenta

Choriocarcinoma diagnosis Pelvic ultrasound

mass of varying appearance (suggestive of hemorrhage and necrosis); hypervascular on color Doppler

placenta histology · Decidua basalis derived from?

maternal endometrial lining

Blood flow and nutrients in the placenta if fertilisation and implantation occurs, what phase of uterine cycle not initiated? instead what happens?

menstrual phase Instead, the placenta develops at the site of implantation.

Gestational trophoblastic diseases (GTD) includes what?

molar pregnancy, persistent trophoblastic disease (PTD), choriocarcinoma, the very rare placental site trophoblastic tumour (PSTT)

placenta formation cytotrophoblast layer contains? their role?

mononuclear cuboidal cells -supportive role

Molar Pregnancy COMPLETE no what type of genes at all?

no maternal genes at all

Molar Pregnancy PARTIAL cause?

normal egg fertilised by: 1. one sperm that duplicates its DNA 2.two sperm 3. 69 XXY or 92 XXXY

Blood flow and nutrients in the placenta fetal blood that flows through the capillaries of the chorionic villi is? causes?

nutrient and oxygen poor. Because of this disparity in the nutrient and oxygen concentration between the fetal blood in the villi and the maternal blood in the intervillous space, nutrients and oxygen diffuse from the maternal blood, into the villi and into the fetal blood.

Blood flow and nutrients in the placenta maternal blood that enters placenta is rich in?

nutrient and oxygen rich.

placenta intervillous space

part of placenta that surrounds chorionic villi and contains maternal blood

Umbilical cord connects?

placenta to the developing fetus

Molar Pregnancy COMPLETE appearance

placental villi become swollen and form vesicles- bunch of grapes trophoblastic hyperplasia

placenta chorion chorionic villi surrounded by?

surrounded by maternal blood which comes intro direct contact with embryonic trophoblast cells

hcg initially sec from?

syncitiotrophoblasts cells

placenta formation Over time, what regresses, forming 3 layers?

the cytotrophoblast layer regresses and the basement membrane of the syncytiotrophoblast may fuse with that of the fetal blood vessels. three layers separating the maternal and fetal blood: 1. the syncytiotrophoblast layer 2. fused basement membrane 3. the endothelial cells of the fetal capillaries.

placenta formation the 2 fetal cell types that contribute to the placenta both derive from?

trophoblast

Blood flow and nutrients in the placenta blood returned from placenta to fetus by?

umbilical vein

Choriocarcinoma rare?

v rare

Choriocarcinoma diagnosis Laboratory tests

very high β-HCG (initial test of choice)

Implantation and placenta development cytotrophoblast forms?

villous tree with multiple branching

Implantation and placenta development true circulation not until week?

week 6

Blood flow and nutrients in the placenta diffusion of oxygen, nutrients and waste products in fetal and maternal blood in the placenta?

· A growing fetus requires lots of nutrients and oxygen that it cannot provide for itself, so the fetal blood that flows through the capillaries of the chorionic villi is nutrient and oxygen poor. Because of this disparity in the nutrient and oxygen concentration between the fetal blood in the villi and the maternal blood in the intervillous space, nutrients and oxygen diffuse from the maternal blood, into the villi and into the fetal blood. · Conversely, the fetal blood contains high concentrations of carbon dioxide and other waste products, while the material blood in the intervillous space contains low concentrations of these waste products. · As a result, carbon dioxide and other waste products diffuse out of the fetal blood, across the trophoblasts of the chorionic villi and into the maternal blood that surrounds the villi. · The mother's lungs, kidneys and liver will easily remove these waste products from her blood.

placenta histology

· Composed of both maternal and fetal tissues · Decidua basalis- derived from maternal endometrial lining · Chorionic villi-emerge from the chorion that surrounds embryo · Villi invade decidua's blood-filled lacunae to facilitate exchange between fetus and mother · Nutrients, gases and waste products + macromolecules- transderred between maternal blood in lacunae and tiny vessels in villi

placenta

· Composite structure of embryonic and maternal tissues that supplies nutrients to the developing embryo · Placenta- found only in mammals- allows mother to provide large amount nutrients to offspring for extended period of time

functions of placenta

· Facilitates the physiologic exchange between maternal and fetal circulations. · Serves as a selective filter for nutrients and maternal macromolecules like IgG. · Provides a site for gas exchange. · Serves as an endocrine organ secreting a number of hormones, which include hCG and progesterone.

placenta chorionic villi found where?

· Found within capillaries

Persistent trophoblastic disease (PTD)

· In most molar pregnancies, any remaining abnormal tissue in the womb usually dies off. · But in a small proportion of women, the tissue can remain and grow further into the lining of the womb and, like a cancer, spread to other areas of the body. This is known as persistent trophoblastic disease

Placental site trophoblastic tumours (PSTT) can spread beyond?

· In some women PSTT can spread beyond the womb. It is most likely to spread to the lungs or to the body structures surrounding the womb.

Amniotic fluid LEVELS?

· Inc to peak of 800ml at 30 wks before reducing to about 400 ml at 42/40

Blood flow and nutrients in the placenta maternal blood flow?

· Maternal blood flows from mother's circulatory system through intervillous space + re-enters mother's blood vessels

Umbilical cord mostly made up of?

· Mostly made up of connective tissue known as 'Wharton's jelly'- relatively few cells · The cord has one large umbilical vein + 2 umbilical arteries

Placental site trophoblastic tumours (PSTT) HAPPEN AFTER?

· Placental site trophoblastic tumours (PSTTs) happen after pregnancy. They can happen after any type of pregnancy, including molar pregnancy, miscarriage, abortion, or a full term normal pregnancy. They can occur several months, or even years, afterwards.

Amniotic fluid produced by?

· Produced by foetal urine, swallowed and bathes lungs

Choriocarcinoma prognosis

· Risk scored with FIGO scoring system · Management determined by high or low risk · Prognosis norm v good

placenta chorionic villi what layer still present, which layer is mostly gone?

· Syncytiotrophoblast layer still present but cytotrophoblasts mostly gone

Placental site trophoblastic tumours (PSTT) develop where?

· These tumours develop in the area where the placenta joined the lining of the womb (uterus). They can grow into the muscle layer of the womb. They are slow growing and are usually curable.

Umbilical cord contains vessels that?

· These vessels transport blood to and from placenta- exchange between mother and fetus occurs

Placental site trophoblastic tumours (PSTT)

· Very rare and unique form of GTD · Tumour represents a neoplastic transformation of intermediate trophoblastic cells that normally play critical role in implantation

Molar preg types

· can be complete or partial

Gestational trophoblastic diseases (GTD) rare?

· extremely rare but can happen during or after pregnancy.

Molar Pregnancy PARTIAL What may be formed and see within the molar tissue?

· foetal tissue might be seen within the molar tissue.

Molar Pregnancy COMPLETE due to?

· happens when a sperm from the father fertilises an empty egg that contains no genes from the mother.

Molar Pregnancy

· happens when fertilisation of egg by sperm goes wrong- leads to growth of abnormal cells or clusters of water filled sacs inside womb

hCG production and preg?

· initially secreted by syncitiotrophoblasts cells · produced by pituitary in menopause women · in early preg- hCG rescues corpus luteum + MAINTAINS progesterone production until placental steroidogenesis established

Molar Pregnancy most are benign or malignant?

· most are benign (not cancerous)

Molar Pregnancy PARTIAL remove?

· need surgery to remove the molar tissue.

Molar Pregnancy COMPLETE no parts of? only what in the womb?

· no parts of a baby (foetal tissue) form. · only molar tissue in the womb.

Molar Pregnancy COMPLETE how remove the molar tissue?

· surgery to remove the molar tissue.

Molar Pregnancy PARTIAL can baby form?

· the foetal tissue cannot develop into a baby, although on an ultrasound scan it may look like a foetus

Choriocarcinoma management

• Urine hCG • Regional Referral - Edinburgh, Sheffield, London • Chemotherapy • Monitoring - Long term follow-up - Vaginal bleeding, pregnancy, lung symptoms