Gestational choriocarcinoma diagnosed on retained products two weeks post partum following massive fetomaternal haemorrhage at term

A 36-year-old woman presented at 38 weeks gestation with a two week history of reduced fetal movements. The cardiotocogram was abnormal and the infant delivered by caesarian section, weighing 3360 grams. baby required full resuscitation. blood count showed haemoglobin 39 g/L. Kleihauer-Betke test positive estimated to be 113 mls packed red blood. placenta bulky pale trimmed fresh weight 914.5 vessels appeared empty. Microscopically, there focal area necrosis. Two post-partum, mother hospital large post-partum haemorrhage. Histology retained products choriocarcinoma. CT an irregular uterine lesion measuring 53x52x44 mm no evidence metastasis. Massive fetomaternal is recognised but rare complication gestational Malignancy may not macroscopically on placental examination it important look for any atypia in trophoblast which alert pathologist diagnosis.