Placental Chorioangioma Research Articles

Safety of vaginal delivery in women with placental chorioangiomas diagnosed by prenatal ultrasound: A retrospective cohort study.

This study aimed to examine the maternal and neonatal outcomes in different mode of delivery in pregnant women with placental chorioangiomas, in order to determine the safety of vaginal delivery.We conducted a retrospective study of 54 women with placental chorioangioma diagnosed by prenatal ultrasound and subsequently proven histologically, excluding those who underwent cesarean section for obstetric indications. The mode of delivery was divided into a vaginal delivery group (23 women) and a cesarean section group (31 women). The indication of cesarean section group was only for placental chorioangioma, no other obstetric indications. The maternal characteristics, pregnancy outcomes and the color doppler imaging characteristics of placental chorioangioma of the 2 groups were compared, and the clinical characteristics of women in the vaginal delivery group were described in detail.The incidence of placental chorioangioma was nearly 0.43‰ in our study. There was no significant difference in the maternal characteristics and pregnancy outcomes between the 2 groups. 82.6% (19/23) of the women successfully delivered vaginally and 4 failed who turned to cesarean section in the vaginal delivery group; among them, 17 women had giant chorioangiomas (>4 cm in diameter). The direct cause of vaginal delivery failure was fetal distress, persistent occiput posterior fetal position and cephalopelvic disproportion.Pregnant women with placental chorioangiomas and no other obstetric indications for cesarean section may attempt a vaginal delivery, even with giant chorioangiomas. If there are risk factors of vaginal delivery failure, the progress of labor needs to be closely monitored.

Risk Factors for Short Stature in Children Born Small for Gestational Age at Full-Term.

ObjectiveThis study aims to identify the risk factors associated with short stature in children born small for gestational age (SGA) at full-term.MethodsThis was a retrospective study. The subjects were full-term SGA infants who were followed up until the age of 2 years. The risk factors for short stature were identified with univariate and multivariate analyses.ResultsOf 456 full-term SGA children enrolled in this study, 28 cases had short stature at 2 years of age. A significant decrease in placental perfusion was found in the short children group with intravoxel incoherent motion (IVIM) technology, which was an advanced bi-exponential diffusion-weighted imaging (DWI) model of magnetic resonance imaging (MRI) (p = 0.012). Compared to non-short children born SGA at full-term, the short children group underwent an incomplete catch-up growth. Mothers who suffered from systemic lupus erythematosus were more likely to have a short child born SGA (p = 0.023). The morbidity of giant placental chorioangioma was higher in the short children group. The pulsatility index (PI), resistivity index (RI), and systolic-diastolic (S/D) ratio of umbilical artery were higher in the short children group than in the non-short control group (p = 0.042, 0.041, and 0.043). Multivariate analysis demonstrated that decrease of perfusion fraction (fp) in IVIM of placental MRI, chromosomal abnormalities, short parental height, and absence of catch-up growth were associated with a higher risk of short stature in children born SGA at full-term.ConclusionRisk factors for short stature in full-term SGA children at 2 years of age included a decrease of perfusion fraction fp in IVIM of placental MRI, chromosomal abnormalities, and short parental height.

MANAGEMENT OF FETAL ANEMIA AND THROMBOCYTOPENIA WITH INTRAUTERINE BLOOD TRANSFUSION

Fetal anemia and fetal thrombocytopenia are two of the most unsmiling complications in pregnant women, and they can lead to perinatal mortality and morbidity. After long years of study with intravascular intrauterine blood transfusion, a number of varieties of implications have been described. Intrauterine Blood Transfusion (IUBT) is considered the best method in the case of fetal anemia because it is caused by red cell alloimmunization. Not only for red blood cell transfusion, this method can also be used for the transfusion of platelets to thrombocytopenic fetuses in pregnant women. It is generally detected after a child is born who is symptomatic and shows signs of bleeding in the brain and skin. The biggest milestone for the clinician is to give preventive treatment in next pregnancy. Pregnancies at risk require serial monitoring, and Fetal Middle Cerebral arterial (MCA) Doppler is the non-invasive test that is now proving to be the choice for monitoring. IVIG (Intravenous immunoglobulin) is used to manage severe Rh-immunization and is now showing promising effects. Indications like Parvovirus B19, Fetomaternal hemorrhage (FMH), Fetal SacrococcygealTeratoma (SCT), Twin-twin transfusion syndrome, placental chorioangioma diseases, or other infections can be treated with this method. This review covers fetal transfusion techniques and explores current management of fetal anemia and thrombocytopenia.

PLACENTAL CHORANGIOMA AND ITS CLICOPATHOLOGICAL SPECTRUM: A CASE SERIES

Introduction:Chorangioma is a rare primary vascular tumour of placenta with an incidence of about 1% in carefully examined term placenta. Chorangiomas in the past have been described as hemangiomas. Chorangioma is a benign, vascular, non-trophoblastic tumor of plancenta that is potentially threatening and can lead to hazardous feto-maternal catastrophy. Objectives: To analyse clinicopathological characteristics, diagnosis, differential diagnoses, treatment, and prognoses of placental chorioangioma (PCA). Results: Mean age of the patients was 38 years. 2 patients were below 30 years and 2 were above 30 years. Only 1 patient was primigravida, rest 3 were multigravida. Mean gestational age was 31.8 weeks. 3 out of 4 cases were term gestations. Out of 4 patients, 3 had an emergency LSCS and 1 had normal labor. 1 out of the 4 patients delivered a dead fetus. Grossly, all the specimens werecomplete placenta. All lesions were extraplacental, solitary and all were >5cm. The mean tumor size was 7.3 cm (range: 6-8.5cm). All the tumowere nodular, well circumscribed, solid masses. On cut-section, lesions were reddish-brown to tan-off-white, solid, firm, hemorrhagic masses as depicted in the pictures. Microscopically, the lesions were composed of network of proliferating capillaries lined by benign endothelium in enlarged villi covered by trophoblastic epithelium. Focal hyalinized areas were seen in one of the cases as depicted in the pictures. Conclusion: Giant chorangiomas are relatively rare, however, their diagnosis and management pose a big challenge owing to serious antenatal feto-maternal complications they lead to. Careful radiological and histopathological examination are thus of utmost importance.

Clinicopathological characteristics of placental chorioangioma: A clinicopathological study of 77 cases

ObjectiveTo explore clinicopathological characteristics, diagnosis, differential diagnoses, treatment, and prognoses of placental chorioangioma (PCA). MethodsPlacenta of 77 cases of PCA firmly diagnosed by pathology from 2009 through 2019 were collected, and clinicopathological characteristics of the patients were retrospectively analyzed. ResultsSeventy-seven patients were 20–41 (mean age, 28.8) years old at onset. Thirty patients showed pregnancy comorbidity. In one patient with the largest tumor (diameter, 16 cm), intrauterine fetal demise occurred at 33 weeks of gestation. Tumors were macroscopically manifested. The placental fetal surface showed a raised dark red to a pale pink nodule, quasi-round, with a maximum diameter of 0.2–16 cm. Microscopically, the tumors had a lot of capillaries and some interstitial loose connective tissue. One case was of atypical cellular chorioangioma. Immunophenotypically, CD34 (+) and Ki-67 proliferation indexes were less than 10%. ConclusionsLarge PCA often accompanies pregnancy comorbidity. Atypical cellular chorangioma is rare and may be misdiagnosed as a malignant tumor. Therefore, improvement of understanding of such tumors can provide a basis for clinical diagnosis and intervention.

Giant placenta chorioangioma with postpartum bleeding and uterine atony

Chorioangioma is the most commonly occurring vascular, non-malignant placental tumor in pregnancy, with a reported incidence of 1% in all examined placentas. Nonetheless, real tumor incidence remains unknown because of small specimen sizes, which contributes to a lack of detection throughout the entire gestational period. Prenatal detection and diagnosis may be possible with ultrasound screening; however, most placental chorioangioma diagnoses are postnatal, based upon histopathological studies. This article report the case of postnatal diagnosis and associated complications in a 35-year-old patient with a 6 cm × 4 cm × 4 cm placental chorioangioma.

VP13.13: Giant placental chorioangioma as the cause of Mirror syndrome

VP13.13: Giant placental chorioangioma as the cause of Mirror syndrome

Three-dimensional color Doppler acquisition of a highly vascular giant placental chorioangioma

A 25-year-old primigravida, on scan at 27 weeks, was diagnosed with a large vascular placental chorioangioma (Figure 1). The different intrauterine treatment options such as ablation of vessels by laser or glue embolization seemed difficult, as there were multiple feeders inside the tumor draining into a large feeding vessel (Figure 2); moreover, it was in close proximity to the umbilical cord, subjecting it to a higher risk of fetal demise. We managed the pregnancy conservatively with serial scans.

Recurrent placental chorioangioma in the setting of Fontan circulation: A case report

Recurrent placental chorioangioma in the setting of Fontan circulation: A case report

Placental chorioangioma – An infrequent cause for polyhydramnios

Placental chorioangioma is the commonest tumour of the placenta arising from the vascular tissue. It is benign in nature. It is reported in about 0.5–1% of deliveries. Chorioangiomas, if large can affect both the mother and the fetus. We report a case where the mother presented with polyhydramnios with a chorioangioma arising from the placenta. Caesarean section was done for fetal distress. Many a times, placental chorioangioma is detected by routine antenatal scan before other clinical features sets in. In some situations, similar to ours, it may be detected only postnatally. Hence, antenatal ultrasound should mention the placental composition apart from the placental location. This would help in identifying chorioangioma enabling regular monitoring, timely intervention and delivery of such cases.

Corioangioma placentario: reporte de un caso en la Unidad de Patología del Hospital San Juan de Dios E.S.E. Rionegro-Antioquia

Dentro de las neoplasias no trofoblásticas gestacionales de tipo vascular, el corioangioma es la más común. Se caracteriza por presentar una proliferación exagerada de estructuras vasculares, con células endoteliales y vellosidades coriónicas que generan una alteración de los vasos sanguíneos tanto arteriales como venosos. Tiene una incidencia menor al 1%, con tasas de mortalidad perinatal aproximadas entre 18% a 40%. Se presenta el caso de un corioangioma placentario diagnosticado a las 26 semanas de gestación en una paciente de 21 años de edad sin controles prenatales previos, el cual generó un lóbulo accesorio de 7 cm con tinción positiva en el análisis inmunohistoquímico para anticuerpos antimúsculo liso y CD34, y negativa para Ki67. El corioangioma desencadenó complicaciones en el embarazo, con parto pretérmino, hidropesía fetal y retardo en el crecimiento intrauterino, que llevaron a la muerte fetal. La falta de control prenatal en nuestra paciente impidió que se detectaran las anomalías placentarias oportunamente, con un desenlace fatal para el feto. Un control prenatal adecuado con seguimiento ecográfico puede evitar eventos fatales como el presentado. El análisis macroscópico y microscópico de la placenta puede favorecer la identificación de los casos y el aporte a las estadísticas de incidencia y mortalidad.

Perinatal outcome of pregnancies complicated by placental chorioangioma: systematic review and meta-analysis.

To report the perinatal outcome of singleton pregnancies complicated by placental chorioangioma diagnosed on prenatal ultrasound. MEDLINE, EMBASE, CINAHL and ClinicalTrials.gov databases were searched for studies reporting the outcome of pregnancies complicated by placental chorioangioma. Inclusion criteria were singleton pregnancy diagnosed with placental chorioangioma on prenatal ultrasound, with no other associated structural anomaly. The primary outcome was perinatal mortality. Secondary outcomes included associated non-structural anomalies detected on prenatal ultrasound (including fetal hydrops, anemia, polyhydramnios, signs of hyperdynamic circulation and small-for-gestational-age (SGA) fetus), SGA at birth, composite neonatal morbidity and preterm birth. Outcome was assessed separately in pregnancies undergoing and those not undergoing fetal therapy. Subanalyses were performed according to the presence of hydrops and the size of the tumor in all pregnancies diagnosed with chorioangioma. Random-effects meta-analyses of proportions were used to analyze the data. Twenty-eight studies (161 pregnancies) were included. In pregnancies complicated by chorioangioma that did not undergo intervention, intrauterine death occurred in 8.2% (95% CI, 3.8-15.0%), while neonatal death and perinatal death occurred in 3.8% (95% CI, 1.0-8.1%) and 11.1% (95% CI, 5.0-19.4%), respectively. SGA at birth was present in 24.0% (95% CI, 13.5-36.5%) of cases, while preterm birth < 37 weeks complicated 34.1% (95% CI, 21.1-48.3%) of pregnancies. Composite neonatal morbidity occurred in 12.0% (95% CI, 4.5-22.3%) of cases. On ultrasound, signs of fetal hyperdynamic circulation were present in 21.0% (95% CI, 9.6-35.3%) of cases, while peak systolic velocity in the fetal middle cerebral artery was increased in 20.6% (95% CI, 10.9-32.3%). Subanalysis according to the size of chorioangioma, including both pregnancies that did and those that did not undergo intervention, showed a progressive increase in the occurrence of most of the outcomes explored with increasing size of the tumor. Furthermore, the prevalence of adverse perinatal outcome was high in pregnancies complicated by chorioangioma presenting with fetal hydrops. There was no randomized controlled trial comparing intervention vs expectant management in pregnancies complicated by chorioangioma with signs of fetal compromise (hydrops or hyperdynamic circulation). Overall, perinatal mortality occurred in 31.2% (95% CI, 18.1-46.1%) of fetuses undergoing in-utero therapy, and 57.3% (95% CI, 39.2-74.4%) had resolution of hydrops or hyperdynamic circulation after treatment. Placental chorioangioma is associated with adverse perinatal outcome. The size of the mass and presence of fetal hydrops are likely to be the main determinants of perinatal outcome in affected pregnancies. Copyright © 2019 ISUOG. Published by John Wiley & Sons Ltd.

A rare case of intra-uterine blood transfusion for fetal anemia caused by a giant placental chorioangioma

AbstractObjectivesChorioangiomas (CAs) are the most frequent tumor-like-lesions of the placenta. Giant CAs (more than 4–5 cm in diameter) is rare and may result in severe maternal fetal complications.Case presentationA 38-year-old multigravida presented at 31 weeks’ gestation with contractions. Upon evaluation, contractions were spontaneously ceased, and the cervix was closed. Ultrasound examination revealed a single viable fetus, polyhydramnios and a 75 x 48 x 82 mm vascular lesion located on the placental surface near the cord insertion. Doppler assessment was suggestive of fetal anemia with middle cerebral artery-peak systolic velocity (MCA-PSV) 1.8 MoM’s. Fetal heart rate monitoring and biophysical scores were reassuring. Following betamethasone fetal cord sampling that revealed fetal hemoglobin level of 8.8 g/dL, 57 cc of blood was transfused resulting in final hemoglobin level of 14.3 g/dL measured prior to needle extraction. MCA-PSV was normalized immediately after the procedure, however aggravated at the following day with MCA-PSV 65 cm/s (1.46 MoM’s). No other intervention was taken and MCA-PSV continued to fluctuate from slight to severe anemia spontaneously over a period of two weeks. At 34 gestational weeks, the women delivered a healthy baby. Fetal hemoglobin level at delivery was 21 g/dL.ConclusionsFetal blood transfusion is a reasonable treatment for fetal anemia in cases of giant chorioangiomas. Following transfusion, MCA-PSV may act unexpectedly reflecting various mechanisms affecting the flow.

A patient with a giant placental chorioangioma in whom measurement of the middle cerebral artery peak systolic velocity was useful for determining the timing of delivery

A patient with a giant placental chorioangioma in whom measurement of the middle cerebral artery peak systolic velocity was useful for determining the timing of delivery

Neonatal outcome of a giant placental chorioangioma in a late preterm newborn

Chorioangioma, the most common benign placental tumor, is found in 1% of placental pathology. Tumors greater than 4 cm are classified as giant and associated with multiple maternal and fetal complications. Authors are presenting a case report of a rare 16 cm giant chorioangioma, discovered at time of delivery, complicated with pregnancy induced hypertension and presenting with minimal fetal complication. This patient exhibited eventually a satisfactory perinatal outcome, complicated by severe anemia and thrombocytopenia requiring transfusion of blood products and bilateral, self-resolved spontaneous cephalohematomas. Chorioangiomas should be considered in the differential diagnosis of any newborn that presents with anemia.

Neonatal non-immune hydrops due to large placental chorioangioma -a treatable cause of hydrops

The term non-immunologic hydrops fetalis (NIHF) defines an edematous fetus with fluid collections in some usually two or all serous cavities that does not have erythroblastosis fetalis from isoimmunization. Ballantyne described the first case of non-immune hydrops. In 1943 Dr Edith Potter published the first description of NIHF. Hydrops Fetalis is considered as a prenatal form of cardiac failure. Hydrops may present as a stiffness of one limb due to edema (present case) to severe generalized anasarca with bilateral pleural effusion. Usually non-immune hydrops associated with severe morbidity and mortality. NIHF not only caused by fatal fetal causes like Chromosomal, alpha thalassemia, infections and cardiac causes but also caused by placental causes like twin to twin transfusion syndrome and placental tumours like placental chorioangioma, among these last entity usually have good prognosis if we managed properly in utero or at the time of delivery and early postnatal days. Some cases of non-immune hydrops amenable to treatment and will have better prognosis like chylothorax, CCAM, Supra Ventricular Tachycardia (SVT), bladder obstruction and hydrothorax.

P12.10: Perinatal outcome of pregnancies complicated by placental chorioangioma: a systematic review and meta‐analysis

P12.10: Perinatal outcome of pregnancies complicated by placental chorioangioma: a systematic review and meta‐analysis

Large placental chorioangioma: a potential effective in-utero treatment modality for radio frequency ablation

Abstract Background Placenta chorioangiomas are common benign placental tumours. While microscopic chorioangiomas are frequent, macroscopic chorioangiomas of more than 5 cm are rare and often associated with fetal complications such as high output cardiac failure, fetal anaemia and stillbirth. Close monitoring and in-utero treatment are sometimes necessary to prevent adverse pregnancy outcome. Case presentation We present two cases of large placenta chorioangiomas with one case requiring surgical therapy with radiofrequency ablation (RFA) of tumour vessels, which resulted in a successful outcome of a live birth at term. Conclusion We conclude that RFA is an effective alternative treatment modality to fetoscopic laser therapy in utero for cases at risk of fetal cardiac failure and intrauterine demise in the presence of large chorioangiomas.

Corioangioma placentario gigante: a propósito del primer caso sometido a fetoscopia y fotocoagulación láser en el Perú

El corioangioma placentario es una tumoración benigna no trofoblástica de muy rara presentación. Se asocia a complicaciones del embarazo cuando tiene dimensiones mayores a 4 cm. Se presenta el caso de una gestante adolescente de 25 semanas referida a nuestro servicio para manejo prenatal de un corioangioma placentario gigante que complicó el embarazo con polihidramnios y anemia fetal severa. Se realizó por primera vez en el Perú la ablación láser del vaso nutricio principal de la tumoración por fetoscopia, lo que logró revertir las complicaciones y mejorar el pronóstico fetal.

Pregnancy complications and adverse outcomes in placental chorioangioma: a retrospective cohort analysis

Objective: To measure the relative risk of pregnancy complications and adverse outcomes in women with placental chorioangioma, and postnatal developmental deficiencies in their offspring.Methods: We designed a retrospective cohort study using records from 140,387 pregnancies at our hospital between 1 January, 2008 and 1 July, 2017. Follow-up of children in the placental chorioangioma group was conducted by phone interview.Results: Placental chorioangioma was diagnosed in 56 patients (incidence = 0.04%). Fifty-one cases were detected during routine prenatal ultrasound. Placental chorioangioma patients were at increased risk for fetal loss or induced abortion (RR = 9.93, 95% CI [4.66, 21.20]), preterm birth (n = 13, RR = 2.45, 95% CI [1.52, 3.95]), birth by cesarean section (n = 45, RR = 1.62, 95% CI [1.42, 1.84]), and polyhydramnios (n = 9, RR = 9.98, 95% CI [5.48, 18.18]), but not fetal distress (n = 5, RR = 0.49, 95% CI [0.22, 1.15]) or preeclampsia (n = 5, RR = 1.61, 95% CI [0.70, 3.73]), although there was an increased risk for preeclampsia after controlling for preterm birth (n = 3, RR = 3.6, 95% CI [1.33, 9.74]). No developmental complications were reported in offspring.Conclusion: Placental chorioangioma increases the risk of fetal demise, pregnancy complications and adverse outcomes. In cases with mild complications or when early cesarean termination of pregnancy is feasible, the prognosis is excellent.