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Chorionic villi are microscopic projections that line the chorion, the outermost layer of the embryonic sac. Surgeons sample these projections for genetic testing because they contain the same genetic material as a fetus.

If you are at risk for delivering a baby with genetic abnormalities, your health-care provider may recommend this prenatal test, which is performed at 10 to 12 weeks gestation to find out a fetus' genetic makeup.

To take a chorionic villus sample, your surgeon either enters the uterus through the cervix (transcervical procedure) or through the abdomen (transabdominal procedure). The fetus' position in the uterus determines which procedure the surgeon uses.

If your surgeon uses a transcervical procedure, he opens your vagina with a speculum and eases a thin catheter through it and your cervix.

Your surgeon then moves the catheter to the chorionic villi with the guidance of an ultrasound. He checks the fetus' position on the ultrasound screen so he can maneuver the catheter within the uterus without harming the fetus.

If your surgeon uses the transabdominal procedure, it will be very similar to amniocentesis. He inserts a needle through your abdomen and uterus to the chorionic villi. As with the transcervical procedure, your surgeon uses ultrasound to determine the fetus' position to help guide the needle safely to the chorionic villi.

Once the catheter or needle reaches the chorionic villi, your surgeon withdraws a small sample and carefully removes it from the uterus.

You should receive Rh immune globulin (RHIG) at the time of CVS if you are an Rh-negative unsensitized patient.

The sample is sent to a laboratory. How the lab technicians handle the sample depends on the genetic abnormalities they are looking for and the type of technology they use. They will extract chromosomes from the sample's cells to find out if your fetus is carrying any genetic abnormalities.

In most cases, your health-care provider will have your test results back within two weeks. The results can help you and your partner decide whether to carry the pregnancy to term, or how to prepare for the baby you will deliver.

Review Date: 06/05/2010

Linda J. Vorvick, MD, Medical Director, MEDEX Northwest Division of Physician Assistant Studies, University of Washington, School of Medicine; Susan Storck, MD, FACOG, Chief, Eastside Department of Obstetrics and Gynecology, Group Health Cooperative of Puget Sound, Redmond, Washington; Clinical Teaching Faculty, Department of Obstetrics and Gynecology, University of Washington School of Medicine. Also reviewed by David Zieve, MD, MHA, Medical Director, A.D.A.M., Inc.

Choriocarcinoma is a quick-growing form of cancer that occurs in a woman's uterus (womb). The abnormal cells start in the tissue that would normally become the placenta, the organ that develops during pregnancy to feed the fetus.

Choriocarcinoma is a type of gestational trophoblastic disease.

See also:

• Gestational trophoblastic disease
• Hydatiform mole

Chorioblastoma; Trophoblastic tumor; Chorioepithelioma; Gestational trophoblastic neoplasia

Choriocarcinoma is an uncommon, but very often curable cancer associated with pregnancy. A baby may or may not develop in these types of pregnancy.

The cancer may develop after a normal pregnancy; however, it is most often associated with a complete hydatidiform mole. The abnormal tissue from the mole can continue to grow even after it is removed and can turn into cancer. About half of all women with a choriocarcinoma had a hydatidiform mole, or molar pregnancy.

Choriocarcinomas may also occur after an abortion, ectopic pregnancy, or genital tumor.

A possible symptom is continued vaginal bleeding in a woman with a recent history of hydatidiform mole, abortion, or pregnancy.

Additional symptoms may include:

• Irregular vaginal bleeding
• Ovarian cysts
• Uneven swelling of the uterus
• Pain

A pregnancy test will be positive even when you are not pregnant. Pregnancy hormone (HCG) levels will be persistently high.

A pelvic examination may reveal continued uterine swelling or a tumor.

Blood tests that may be done include:

• Quantitative serum HCG
• Complete blood count
• Kidney function tests
• Liver function tests

Imaging tests that may be done include:

• CT scan
• MRI

After an initial diagnosis, a careful history and examination are done to make sure the cancer has not spread to other organs. Chemotherapy is the main type of treatment.

A hysterectomyand radiation therapy are rarely needed.

For additional information, see cancer resources.

Most women whose cancer has not spread can be cured and will maintain reproductive function.

The condition is harder to cure if the cancer has spread and one of more of the following events occur:

• Disease has spread to the liver or brain
• Pregnancy hormone (HCG) level is greater than 40,000 mIU/mL at the time treatment begins
• Cancer returns after having chemotherapy in the past
• Symptoms or pregnancy occurred for more than 4 months before treatment began
• Choriocarcinoma occurred after a pregnancy that resulted in the birth of a child

Many women (about 70%) who initially have a poor outlook go into remission (a disease-free state).

A choriocarcinoma may come back after treatment, usually within several months but possibly as late as 3 years. Complications associated with chemotherapy can also occur.

Call for an appointment with your health care provider if symptoms arise within 1 year after hydatidiform mole, abortion (including miscarriage), or term pregnancy.

Careful monitoring after the removal of hydatidiform mole or termination of pregnancy can lead to early diagnosis of a choriocarcinoma, which improves outcome.

Goldstein DP, Berkowitz RS. Gestational trophoblastic disease. In: Abeloff MD, Armitage JO, Niederhuber JE, Kastan MB, McKenna WG, eds. Abeloff's Clinical Oncology. 4th ed. Philadelphia, Pa: Elsevier Churchill Livingstone; 2008:chap 94.

Kavanagh JJ, Gershenson DM. Gestational trophoblastic disease: hydatidiform mole, nonmetastatic and metastatic gestational trophoblastic tumor: diagnosis and management. In: Katz VL, Lentz GM, Lobo RA, Gershenson DM. Comprehensive Gynecology. 5th ed. Philadelphia, Pa: Mosby Elsevier; 2007:chap 35.

Soper J, Creasman JT. Gestational trophoblastic disease. In: Disaia PJ, Creasman WT, eds. Clinical Gynecologic Oncology. 7th ed. Philadelphia, Pa: Saunders Elsevier; 2007:chap 7.

Chorionic villus sampling (CVS) is the removal of a small piece of placenta tissue (chorionic villi) from the uterus during early pregnancy to screen the baby for genetic defects.

CVS can be done through the cervix (transcervical) or through the abdomen (transabdominal). The techniques are equally safe when done by a provider with experience, although miscarriage rates are slightly higher when done through the cervix. The health care provider will use ultrasound to pick the safest approach and as a guide during sampling.

An abdominal ultrasound is performed to determine the position of the uterus, the size of the gestational sac, and the position of the placenta within the uterus. Your vulva, vagina, cervix, and abdomen are cleaned with an antiseptic.

The transcervical procedure is performed by inserting a thin plastic tube through the vagina and cervix to reach the placenta. The provider uses ultrasound images to help guide the tube into the appropriate area and then removes a small sample of chorionic villus tissue.

The transabdominal procedure is performed by inserting a needle through the abdomen and uterus and into the placenta. Ultrasound is used to help guide the needle, and a small amount of tissue is drawn into the syringe.

The sample is placed in a dish and evaluated in a laboratory.

Your health care provider will explain the procedure, its risks, and alternative procedures such as amniocentesis. Genetic counseling is recommended prior to the procedure. This will allow you to make an unhurried, informed decision regarding options for prenatal diagnosis.

You will be asked to sign a consent form before this procedure, and you may be asked to wear a hospital gown.

The morning of the procedure you may be asked to drink fluids and refrain from urinating to fill your bladder, which allows adequate visualization so the sample may be taken.

Tell your health care provider if you are allergic to iodine or shellfish, or if you have any other allergies.

The ultrasound doesn't hurt. A clear, water-based conducting gel is applied to the skin to help with the transmission of the sound waves. A handheld probe called a transducer is then moved over the area. In addition, your health care provider may apply pressure on your abdomen to find the position of your uterus.

The antiseptic cleansing solution will feel cold at first and may irritate your skin if not washed off after the procedure.

Some women say the vaginal approach feels like a Pap smear with some discomfort and a feeling of pressure. There may be a small amount of vaginal bleeding following the procedure.

An obstetrician can perform this procedure in about 5 minutes, after the preparation.

The test is a way of detecting genetic disorders. The sample is used to study the DNA , chromosomes, and certain signs (called chemical markers) of disease in the developing baby. It can be done sooner than amniocentesis, about 10 to 12 weeks after your last menstrual period. Test results take about 2 weeks.

Chorionic villus sampling does not detect neural tube defects. If neural tube defects or Rh incompatibility are a concern, an amniocentesis will be performed.

This test can usually not diagnose congenital defects, which are problems in the way the baby's body forms.

A normal result means there are no signs of any genetic defects. However the test could miss some genetic defects.

Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.

An abnormal result may be a sign of more than 200 disorders, including:

• Down syndrome
• Hemoglobinopathies
• Tay-Sachs disease

The risks of CVS are only slightly higher than those of an amniocentesis.

Possible complications include:

• Bleeding
• Infection
• Miscarriage
• Rh incompatibility in the mother
• Rupture of membranes

Signs of complications include:

• Excessive bleeding
• Excessive vaginal discharge
• Fever

Report any signs of complications to your health care provider.

CVS was previously thought to cause limb problems in the developing baby. When CVS is performed after 9 weeks gestational age, this risk appears to be very low (6 per 10,000), and is no more frequent than in pregnancies without this testing.

If your blood is Rh negative, you may receive RhoGAM to prevent Rh incompatibility.

You will receive a follow-up ultrasound 2 to 4 days after the procedure to make sure the pregnancy is proceeding normally.

Simpson JL, Otano L. Prenatal genetic diagnosis. In: Gabbe SG, Niebyl JR, Simpson JL. Obstetrics: Normal and Problem Pregnancies. 5th ed. New York, NY: Churchill Livingstone; 2007:chap. 7.

American College of Obstetricians and Gynecologists (ACOG). Invasive prenatal testing for aneuploidy. Washington (DC): American College of Obstetricians and Gynecologists (ACOG); 2007 Dec. 9 p.

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Hope this helps

USA

Xenia, Ohio

Xenia, Illinois

ASIA

Xian, China.

Xiamen, China

Xenicus Peak, New Zealand

EUROPE

Xanthi, Greece

Xifias, Greece

Xilokeratea, Greece

Xinovryssi, Greece

Xero Chorio, Greece

Xilokastro, Greece

Xino Nero, Greece

Xiropigado, Greece

Neither rats nor mice are poisonous. They are both very dirty and carry many diseases, and so do the fleas that are on them. As to which is more of a disease factory, I don't know. If I had to guess it would be rats.

Neither Rats or Mice are in essence poisonous. Neither secrete venom. However what i think the question is is "Do rats or Mice carry more diseases?" In which case there is some debate as to which would carry more diseases. Rats are known to carry the oriental rat flea which does carry Yersinia pestis, the organism responsible for bubonic plague. however mice carry other diseases which are equally lethal, and often harder to diagnose.