17th World Congress in Fetal Medicine

Chorioangiomas in – case report Nikolopoulos M, Otigbah C, Kalidindi M Queens Hospital, Romford, United Kingdom

Objective Chorioangiomas are the most common non-trophoblastic tumors of the placenta with an incidence of approximately 1%. Although majority of these tumors are small, asymptomatic and found incidentally, the large chorioangiomas are often associated with maternal and fetal complications. Fetal , fetal hydrops, , intrauterine fetal growth restriction, preeclampsia, maternal mirror syndrome, HELLP syndrome, preterm labour and placental abruption have been described in the literature. We present two cases of chorioangiomas with good outcome.

Methods This is a report of two cases of chorioangioma in pregnancy.

Results A 32-year-old woman with three previous vaginal deliveries was having serial growth scans in her fourth pregnancy due to previous small for gestational age baby. Ultrasound at 32 weeks gestation showed a large, vascular tumour with mixed echogenicity measuring 6. 9x6. 8x6. 4cm in the placenta. The fetal growth was maintained with the estimated fetal weight on the 10th centile of the customized growth chart with normal amniotic fluid index (AFI 14 cm) and umbilical artery Dopplers. Middle cerebral artery Dopplers (MCA) and peak systolic velocity (Vmax 53. 3 cm/s) were normal. She was referred to the fetal medicine unit, where a diagnosis of chorioangioma was made and a plan to manage expectantly with serial weekly follow up scans. At 34 weeks gestation, polyhydramnios was evident (AFI 28. 2cm and deepest pool 9. 9cm) with tailing off the growth (EFW below the 10th centile on the customized growth chart) and MCA dopplers were noted to be abnormal with high peak systolic velocity (Vmax 69. 5cm/s) indicative of fetal anaemia. There was no evidence of fetal cardiac failure, cardiomegaly, ascites or hydrops. The baby was delivered in good condition with no need for immediate resuscitation by a planned caesarean section after steroid administration for fetal lung maturity. The baby was admitted to the neonatal unit for observation and was given one unit of group specific blood transfusion as the fetal haemoglobin at birth was 100 gm/l. A smooth blackish-brown solid mass was delivered separately along with the placenta, and the histopathological examination confirmed the prenatal diagnosis of chorioangioma with areas of haemorrhagic necrosis, enclosed by placental membranes and weighing 236 grams. In our second case, multiple small firm nodular masses attached to the placenta were noted after a kiwi delivery in a 26-year-old primiparous, low risk woman induced for postdates. The baby was born in good condition and required no further interventions. Two separate firm whitish grey nodular masses measuring 55 x 32 x 20mm and 35 x 32 x 20mm, together weighing 37 grams were examined histologically and the diagnosis of chorioangioma was confirmed. Retrospective review of the scan images of the placenta at a later gestation revealed multiple, small round areas of hyperechogenicity, that were not noted prenatally.

Conclusion Management of chorioangioma is usually conservative with careful monitoring via serial ultrasound examinations to predict complications early. Based on the gestational age at which the complications develop, either delivery or a variety of interventional techniques should be considered on an individualized case to case basis to improve the maternal and fetal outcomes and minimise the related morbidity and mortality. In our first case, delivery by caesarean section after steroid maturity was preferred due to the late onset of complications at 34 weeks gestation, when polyhydramnios and hyperdynamic circulation were evident.