A rare giant placental chorioangioma with favorable outcome: A case report and review of the literature

A rare case of giant placental chorioangioma causing polyhydramnios and fetal hydrops: A case report and literature review

BACKGROUND

Placental chorioangioma is a benign tumour of the placenta. In most cases, chorioangiomas are small and do not result in maternal or fetal complications. This report presents a case with a large placental chorioangioma, which was associated with an intrapartum event leading to significant maternal and perinatal morbidity.

CASE PRESENTATION

A case of placental chorioangioma was diagnosed at 29 + 1 weeks of gestation. As the tumour enlarged progressively with polyhydramnios, further ultrasound examination indicated signs of fetal hydrops. Following multi-disciplinary team discussion, caesarean section was performed with delivery of a female infant. Pathological examination of the placenta confirmed an infarcted chorioangioma.

CONCLUSIONS

Placental chorioangiomas are benign, non-trophoblastic vascular neoplasms. While often asymptomatic, they can occasionally have unfavourable outcomes. Ultrasound examination plays a critical role in their diagnosis and monitoring. These neoplasms exhibit a wide range of clinical manifestations, leading to their classification as a spectrum of symptoms rather than a distinct syndrome. Early diagnosis, vigilant prenatal surveillance, and timely intervention are essential to minimize fetal morbidity and mortality.

Giant Chorioangioma of the Placenta as a Cause of Maternal, Foetal, and Neonatal Complications

Chorioangioma is a benign placental neoplasm seen in about one percent of all pregnancies. The larger neoplasms generally cause severe foeto-maternal complications. We are reporting a case of a 33-year-old gravida three para two female who was incidentally diagnosed with chorioangioma at her routine 28-week antenatal follow-up. She delivered a preterm small-for-gestational-age female baby at 34 weeks with complications. Therefore, an early diagnosis warrants a close follow-up and timely intervention for a better outcome of the pregnancy.

A giant early second-trimester placental chorioangioma associated with isolated proteinuria and histopathologically confirmed placental insufficiency, a novel association: A case report

We present a case of giant chorioangioma at 18 weeks of gestation leading to fetal hypertrophic cardiomyopathy without other evidences of fetal volume overload and late-onset isolated proteinuria. Oligohydramnios developed at term and placental insufficiency was confirmed on histopathological examination and a nonanemic nonthrombocytopenic normal weight healthy baby was delivered.

Non-invasive fetal electrocardiography ameliorates fetal outcome in chorioangioma: A case report

 Chorioangioma is a rare vascular placental tumour. Large chorioangiomas are known to have many maternal and perinatal complications. The case of placental chorioangioma detected via ultrasound is presented. This paper is focused on non-invasive fetal electrocardiography (NI-FECG) clinical use for diagnosing fetal anemia in chorioangioma.A 22-year-old primigravida was admitted to the department of fetomaternal medicine at 30 weeks of gestation. She had threatened preterm labour, polyhydramnios, and breech presentation. The large echogenic mass of 77 mm×66 mm×83 mm, located in the uterine bottom, protruded into the amniotic cavity, and connected to the marginal sinus of the placenta was determined via ultrasound. The sinusoidal pattern of beat-to-beat variations was diagnosed via NI-FECG in spite of normal blood flow velocity in the fetal middle cerebral artery. Therefore, NI-FECG was superior in the detection of fetal anemia. The female baby weighing 1500 g and measuring 42 cm in length, with a head circumference of 30 cm and Apgar score 3⟶5, was delivered by caesarean section. The baby had severe anemia and respiratory distress syndrome.NI-FECG was a good option for the clinician for the timely and accurate diagnosis of fetal anemia and fetal compromise in placental chorioangioma.

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

Objectives

Chorioangiomas (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 presentation

A 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.

Conclusions

Fetal 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 rare case of a giant placental chorioangioma with favorable outcome

Chorioangioma is the most common type of placental tumor. A primigravida woman was noted on routine scan at 21 weeks of gestation to have a placental mass measuring 1.8 x 2.2cm. A detailed ultrasound scan revealed a well circumscribed, hypoechoic lesion protruding into the amniotic cavity; hence a preliminary diagnosis of placental chorioangioma was made and close prenatal surveillance was scheduled. At 34 weeks of gestation, the mass was measuring 6.27 x 5.38cm. The patient experienced reduced fetal movements at 37 weeks gestation. A small-for-gestational age but normal female neonate was delivered by caesarean section. Histopathological analysis of the placenta confirmed the diagnosis. According to our case, a giant placental chorioangioma may have a favorable outcome without any medical intervention.

Value of ultrasound scoring system for assessing risk of pernicious placenta previa with accreta spectrum disorders and poor pregnancy outcomes

PURPOSE

To evaluate a system for assessing the risk of pernicious placenta previa (PPP) with placenta accreta spectrum (PAS) disorders and poor pregnancy outcomes.

METHODS

This prospective study focused on PPP women at ≥ 28 weeks' pregnancy. Transabdominal or transvaginal ultrasonography was used to assess PAS and poor pregnancy outcomes with a system involving uteroplacental demarcation, number and size of lacunae, bladder line, and placental basal and lacunae flow. Every item was assigned 0-2 points, and the sum yielded the final score. Diagnosis of PAS was based on surgery or pathology. One or more of postpartum hemorrhage (PPH) ≥ 1000 ml, hysterectomy, and organ invasion were regarded as a poor pregnancy outcome. Receiver operating characteristic (ROC) curves were generated.

RESULTS

Fifty-one PPP women were included, with 70.6% having PAS and 75.0% of PAS women having a poor pregnancy outcome. The incidence of PAS diagnosis was 36.4% for those with a score < 5 points, with 0% having a poor outcome; 76.5% for those with a score ≥ 5 to < 8 points, with 61.5% having a poor outcome; and 100% for those with a score ≥ 8 points, with 100% having a poor pregnancy outcome.

CONCLUSION

The system for predicting PPP with PAS and poor pregnancy outcomes was of high accuracy.

Multimodality imaging of placental masses: a pictorial review

Placental masses are uncommonly identified at the time of obstetric ultrasound evaluation. Understanding the pathologies presenting as placental masses is key for providing a differential diagnosis and guiding subsequent management, which may include additional imaging with magnetic resonance (MR) imaging. Potential benign entities include chorioangiomas and teratomas. Larger chorioangiomas can cause fetal cardiovascular issues from volume overload. Placental mesenchymal dysplasia has an association with fetal anomalies and detailed fetal evaluation should be performed when it is suspected. Identifying other cystic masses such as partial and complete moles is crucial to prevent erroneous pregnancy termination. This review addresses normal imaging appearance of the placenta on ultrasound and MR imaging and describes various trophoblastic and nontrophoblastic placental masses. Potential placental mass mimics including uterine contractions and thrombo-hematomas are also presented.

Unusual complications of placental chorioangioma: consumption coagulopathy and hypertension in a preterm newborn

We report a case of a preterm neonate born to a mother with giant placental chorioangioma. The baby had microangiopathic haemolytic anaemia, thrombocytopenia and cardiac failure at birth. In addition, she had a disseminated intravascular coagulation-like picture and had bleeding from multiple sites, which was treated with transfusion of multiple blood products. She also developed transient hypertension and required antihypertensive drugs for 3 weeks. The baby was successfully managed and discharged home, though with signs of neurosensory impairment.