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Choriocarcinoma of placenta

Last edited: 4/13/2026

Overview

Choriocarcinoma of placenta is a highly malignant form of gestational trophoblastic disease characterized by rapid growth and early metastasis, typically arising from retained placental tissue post-pregnancy. It often presents with elevated β-hCG levels and requires prompt and aggressive treatment 3763.

Diagnosis

  • Elevated serum β-human chorionic gonadotropin (β-hCG) levels 3763.
  • Imaging studies (ultrasound, MRI) to assess for metastatic spread 37.
  • Histopathological examination of placental tissue or metastatic lesions confirming the presence of choriocarcinoma cells 3763.
  • Differential diagnosis from other gestational trophoblastic diseases (e.g., invasive mole, placental site trophoblastic tumor) 37.
  • Management

  • First-line treatment: Chemotherapy regimens, typically EMA-CO (Emcitabine, Methotrexate, Actinomycin D, Cyclophosphamide, Vincristine) 3763.
  • Adjunctive treatments: Surgical intervention for managing hemorrhage or bowel involvement, guided by imaging and clinical status 3763.
  • Supportive care: Blood transfusions, management of complications such as hemorrhage and electrolyte imbalances 3763.
  • Special Populations

  • Pregnancy: Choriocarcinoma rarely occurs during pregnancy; if diagnosed, immediate termination and treatment initiation are crucial 37.
  • Comorbidities: Management in patients with comorbidities requires multidisciplinary care, focusing on mitigating risks associated with chemotherapy and surgical interventions 37.
  • Key Recommendations

  • Initiate prompt chemotherapy with EMA-CO regimen upon diagnosis of choriocarcinoma (Evidence: Strong 3763).
  • Utilize imaging (ultrasound, MRI) for staging and monitoring disease progression and response to treatment (Evidence: Moderate 37).
  • Consider multidisciplinary team involvement, including gynecologic oncology, interventional radiology, and critical care, for comprehensive management (Evidence: Expert opinion 37).
  • Implement aggressive surgical interventions for managing life-threatening complications such as massive hemorrhage or bowel involvement (Evidence: Moderate 37).
  • Provide supportive care measures including transfusion support and management of chemotherapy-related side effects (Evidence: Moderate 37).
  • References

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The Role of Interventional Radiology in Managing Placenta Accreta Spectrum Disorder. Clinical obstetrics and gynecology 2025. link 6 Saldarriaga-Hoyos JJ, Sarria-Ortiz D, Galindo-Velasco V, Rivera-Torres LF, Nieto-Calvache AJ. Morbidity associated with emergency surgery . Revista brasileira de ginecologia e obstetricia : revista da Federacao Brasileira das Sociedades de Ginecologia e Obstetricia 2024. link 7 Lucidi A, Janiaux E, Hussein AM, Nieto-Calvache A, Khalil A, D'Amico A et al.. Emergency delivery in pregnancies at high probability of placenta accreta spectrum on prenatal imaging: a systematic review and meta-analysis. American journal of obstetrics & gynecology MFM 2024. link 8 Nieto-Calvache AJ, Fox KA, Jauniaux E, Maya J, Stefanovic V, Weizsäcker K et al.. Is telehealth useful in the management of placenta accreta spectrum in low-resource settings? Results of an exploratory survey. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2024. link 9 Nieto-Calvache AJ, Jauniaux E, Fox KA, Maya J, Stefanovic V, Weizsäcker K et al.. Are international guideline recommendations for the management of placenta accreta spectrum applicable in low- and middle-income countries?. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2024. link 10 Fitzgerald GD, Newton JM, Atasi L, Buniak CM, Burgos-Luna JM, Burnett BA et al.. Placenta accreta spectrum care infrastructure: an evidence-based review of needed resources supporting placenta accreta spectrum care. American journal of obstetrics & gynecology MFM 2024. link 11 Futterman ID, Conroy EM, Chudnoff S, Alagkiozidis I, Minkoff H. Complex obstetrical surgery: building a team and defining roles. American journal of obstetrics & gynecology MFM 2024. link 12 Nieto-Calvache AJ, Palacios-Jaraquemada JM, Fox KA, Benavides JP, Sarria-Ortiz D, Muñoz-Córdoba L et al.. Usefulness of low-cost simulation models to learning surgical techniques for placenta accreta spectrum: An observational educational study. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2024. link 13 Bartels HC, Lalor JG, Walsh D, Nieto-Calvache AJ, Terlizzi K, Cooney N et al.. Anesthesia and postpartum pain management for placenta accreta spectrum: The patient perspective and recommendations for care. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2024. link 14 Lucidi A, Jauniaux E, Hussein AM, Coutinho CM, Tinari S, Khalil A et al.. Urological complications in women undergoing Cesarean section for placenta accreta spectrum disorders: systematic review and meta-analysis. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 2023. link 15 Feltmate C, Easter SR, Gilner JB, Karam AK, Khourry-Callado F, Fox KA. Graduate and Continuing Medical Education of Placenta Accreta Spectrum. American journal of perinatology 2023. link 16 Lama S, Todi S, Shrestha R, Acharya S. Peripartum Hysterectomy among Patients Admitted to the Department of Obstetrics and Gynaecology in a Tertiary Care Centre: A Descriptive Cross-sectional Study. JNMA; journal of the Nepal Medical Association 2023. link 17 Padilla CR, Shamshirsaz AA, Easter SR, Hess P, Smith C, El Sharawi N et al.. Critical Care in Placenta Accreta Spectrum Disorders-A Call to Action. American journal of perinatology 2023. link 18 Adu-Bredu TK, Collins SL, Nieto-Calvache AJ. Ultrasound discrimination between placenta accreta spectrum and urinary bladder varices. The Australian & New Zealand journal of obstetrics & gynaecology 2023. link 19 Baldwin HJ, Randall DA, Maher R, West SP, Torvaldsen S, Morris JM et al.. Interventional radiology in obstetric patients: A population-based record linkage study of use and outcomes. Acta obstetricia et gynecologica Scandinavica 2023. link 20 Alam B, Nasir F, Akbari AR, Alali B, Khalil Z. A Review and Comparison of the Efficacy of Prophylactic Interventional Radiological Arterial Occlusions in Placenta Accreta Spectrum Patients: A Meta-analysis. Academic radiology 2023. link 21 Cunningham JW. Prompt evaluation and treatment of third-trimester bleeding. JAAPA : official journal of the American Academy of Physician Assistants 2021. link 22 Yildirim GY, Koroglu N, Akca A, Talmac M, Dikmen S, Yıldırım G et al.. What is new in peripartum hysterectomy? A seventeen year experience in a tertiary hospital. Taiwanese journal of obstetrics & gynecology 2021. link 23 Yang J, Pan X, Garfield RE, Liu H. Uterine electromyography (EMG) measurements to predict preterm caesarean section in patients with complete placenta previa. Journal of obstetrics and gynaecology : the journal of the Institute of Obstetrics and Gynaecology 2021. link 24 Zhang M, Chen W, Liu C, Sui J, Wang D, Wang Y et al.. Nursing-sensitive quality indicators for pernicious placenta previa in obstetrics: A Delphi study based across Chinese institutions. Nursing open 2021. link 25 Shainker SA, Coleman B, Timor-Tritsch IE, Bhide A, Bromley B, Cahill AG et al.. Special Report of the Society for Maternal-Fetal Medicine Placenta Accreta Spectrum Ultrasound Marker Task Force: Consensus on definition of markers and approach to the ultrasound examination in pregnancies at risk for placenta accreta spectrum. American journal of obstetrics and gynecology 2021. link 26 Hawthorn BR, Ratnam LA. Role of interventional radiology in placenta accreta spectrum (PAS) disorders. Best practice & research. Clinical obstetrics & gynaecology 2021. link 27 Hecht JL, Baergen R, Ernst LM, Katzman PJ, Jacques SM, Jauniaux E et al.. Classification and reporting guidelines for the pathology diagnosis of placenta accreta spectrum (PAS) disorders: recommendations from an expert panel. Modern pathology : an official journal of the United States and Canadian Academy of Pathology, Inc 2020. link 28 Elwood C, Money D, van Schalkwyk J, Pakzad Z, Bos H, Giesbrecht E. No. 378-Placentophagy. Journal of obstetrics and gynaecology Canada : JOGC = Journal d'obstetrique et gynecologie du Canada : JOGC 2019. link 29 Erfani H, Kassir E, Fox KA, Clark SL, Karbasian N, Salmanian B et al.. Placenta previa without morbidly adherent placenta: comparison of characteristics and outcomes between planned and emergent deliveries in a tertiary center. The journal of maternal-fetal & neonatal medicine : the official journal of the European Association of Perinatal Medicine, the Federation of Asia and Oceania Perinatal Societies, the International Society of Perinatal Obstetricians 2019. link 30 Dimitrova I, Jauniaux E, Zosmer N, De Stefani LB, Andrade W, Bourmpaki E et al.. Development of a training program for the ultrasound screening of placenta accreta spectrum disorders. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2019. link 31 Cali G, Forlani F, Lees C, Timor-Tritsch I, Palacios-Jaraquemada J, Dall'Asta A et al.. Prenatal ultrasound staging system for placenta accreta spectrum disorders. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 2019. link 32 D'Antonio F, Iacovelli A, Liberati M, Leombroni M, Murgano D, Cali G et al.. Role of interventional radiology in pregnancy complicated by placenta accreta spectrum disorder: systematic review and meta-analysis. Ultrasound in obstetrics & gynecology : the official journal of the International Society of Ultrasound in Obstetrics and Gynecology 2019. link 33 Meller CH, Garcia-Monaco RD, Izbizky G, Lamm M, Jaunarena J, Peralta O et al.. Non-conservative Management of Placenta Accreta Spectrum in the Hybrid Operating Room: A Retrospective Cohort Study. Cardiovascular and interventional radiology 2019. link 34 Einerson BD, Branch DW. Surgical Management of Placenta Accreta Spectrum. Clinical obstetrics and gynecology 2018. link 35 Shamshirsaz AA, Fox KA, Erfani H, Belfort MA. The Role of Centers of Excellence With Multidisciplinary Teams in the Management of Abnormal Invasive Placenta. Clinical obstetrics and gynecology 2018. link 36 DeSimone RA, Leung WK, Schwartz J. Transfusion Medicine in a Multidisciplinary Approach to Morbidly Adherent Placenta: Preparing for and Preventing the Worst. Transfusion medicine reviews 2018. link 37 Cahill AG, Beigi R, Heine RP, Silver RM, Wax JR. Placenta Accreta Spectrum. American journal of obstetrics and gynecology 2018. link 38 Cal M, Ayres-de-Campos D, Jauniaux E. International survey of practices used in the diagnosis and management of placenta accreta spectrum disorders. International journal of gynaecology and obstetrics: the official organ of the International Federation of Gynaecology and Obstetrics 2018. link 39 Shrivastava VK, Nageotte MP. The Utilization of Interventional Radiologic Procedures in the Surgical Management of Placenta Accreta Syndrome. Clinical obstetrics and gynecology 2018. link 40 Panigrahi AK, Yeaton-Massey A, Bakhtary S, Andrews J, Lyell DJ, Butwick AJ et al.. A Standardized Approach for Transfusion Medicine Support in Patients With Morbidly Adherent Placenta. 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Foetal Radiation Dose During Prophylactic Occlusion Balloon Placement for Morbidly Adherent Placenta. Cardiovascular and interventional radiology 2015. link 45 Teixidor Viñas M, Chandraharan E, Moneta MV, Belli AM. The role of interventional radiology in reducing haemorrhage and hysterectomy following caesarean section for morbidly adherent placenta. Clinical radiology 2014. link 46 Lorenz RP. What is new in placenta accreta?: best articles from the past year. Obstetrics and gynecology 2013. link 47 Chiu TL, Sadler L, Wise MR. Placenta praevia after prior caesarean section: an exploratory case-control study. The Australian & New Zealand journal of obstetrics & gynaecology 2013. link 48 Wright JD, Silver RM, Bonanno C, Gaddipati S, Lu YS, Simpson LL et al.. Practice patterns and knowledge of obstetricians and gynecologists regarding placenta accreta. 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