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Placental Abnormalities
Published in Amar Bhide, Asma Khalil, Aris T Papageorghiou, Susana Pereira, Shanthi Sairam, Basky Thilaganathan, Problem-Based Obstetric Ultrasound, 2019
Amar Bhide, Asma Khalil, Aris T Papageorghiou, Susana Pereira, Shanthi Sairam, Basky Thilaganathan
Although chorioangioma is the most common tumor of the placenta, it is rare—occurring in about 1:5,000–10,000 pregnancies. It is a vascular malformation, usually seen as a circumscribed solid mass that may protrude from the fetal surface of the placenta. Intraplacental tumors are more difficult to recognize, and targeted ultrasound using color Doppler can help in identifying chorioangiomas in cases with a high index of suspicion, for example in unexplained polyhydramnios or hydrops with evidence of hyperdynamic fetal blood flow. Pregnancies complicated by placental chorioangioma are at increased risk of polyhydramnios and associated pre-term delivery. In more severe cases, fetal hydrops can occur, and Doppler investigation of the middle cerebral artery can show high peak velocity blood flow indistinguishable from fetal anemia. Such pregnancies are at high risk of fetal demise, and treatment with amniodrainage in order to prevent pre-term delivery or interstitial laser ablation may be successful in improving perinatal outcome. Apart from the effects of a hyperdynamic circulation, associations with chorioangioma include fetal growth restriction, placental abruption, and umbilical artery thrombosis.
Placenta, Umbilical Cord, and Amniotic Membranes
Published in Asim Kurjak, CRC Handbook of Ultrasound in Obstetrics and Gynecology, 2019
Primary nontrophoblastic tumors of the placenta are the relatively common hemangioma and the very rare teratoma.66 Placental hemangioma (known as “chorangioma and chorioan-gioma”) is found in approximately 1% of pregnancies. Usually it is single, but occasionally multiple, with wide variations in size (from a few millimeters in diameter to 780 g) and location.66 Large hemangiomas are seen most commonly as bulging protuberances of the fetal surface of the placenta, but a substantial minority occur on the maternal surface, where they may appear to replace the whole lobe or a part of it. They can be situated entirely within the membranes, but many of them are not visible on the external placental surface.
Chorioangiomas in pregnancy – case report
Published in Journal of Obstetrics and Gynaecology, 2019
Manolis Nikolopoulos, Chineze Otigbah, Madhavi Kalidindi
The pathophysiology of maternal and foetal complications is not well understood. The theories for polyhydramnios include an increased urine production due to foetal hyperdynamic circulation (Wu and Hu 2016), transudation of fluid caused by a mechanical obstruction of blood flow by the tumour near the cord insertion and the functional insufficiency of the placenta secondary to bypassing foetal circulation via the arteriovenous shunting mechanism in the tumour vascular bed. Fetal cardiomegaly and congestive heart failure is also a potential complication and is thought to occur secondary to high cardiac output from arteriovenous shunting, or chronic hypoxia from unoxygenated blood that bypasses maternal circulation through the tumour vascular bed (Kirkpatrick et al. 2007). Growth restriction, uteroplacental insufficiency and foetal distress are also potential outcomes. Fetal non-immune hydrops is an extremely rare complication but can be caused by all of the above factors, including anaemia (Wu and Hu 2016). Around 50% of large chorioangioma cases develop foetal and maternal complications which require either elective delivery or intervention for tumour-related effects (Garcia-Diaz et al. 2012). In case of extreme prematurity, the following techniques have been described: amnioreduction in cases with symptomatic polyhydramnios, intrauterine transfusion if there is an ultrasound evidence of foetal anaemia and though rare, platelet transfusion may also be necessary. Ultrasound-guided interstitial laser therapy, in utero endoscopic devascularisation with use of suture ligation or bipolar cautery of the feeding vessels via fetoscopy, microcoil embolisation and alcohol injection (Acharya 2004; Garcia-Diaz et al. 2012).
A rare giant placental chorioangioma with favourable outcome: a case report
Published in Journal of Obstetrics and Gynaecology, 2022
Ling Hong, Lingling Hua, Peijun Yao, Li Zhang
Chorioangioma is the most common benign tumour of the placenta, occurring in approximately 1% of pregnancies (Lim et al. 2015). Most chorioangiomas are of no significant clinical importance. Giant chorioangiomas are defined as those which are 4−5 cm in diameter (Zanardini et al. 2010). They are rarer and associated with adverse perinatal complications (Demiriz et al. 1997; Batukan et al. 2001; Abdalla et al. 2014). Herein, we report a case of a pregnant patient who presented with a rare giant placental chorioangioma with a favourable outcome upon close surveillance.