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Tonni G, Lituania M, Cecchi A, Carboni E, Grisolia G, Bonasoni MP, Rizzo G, Ruano R, Júnior EA, Werner H, Sepulveda W. Placental and umbilical cord anomalies detected by ultrasound as clinical risk factors of adverse perinatal outcome: Case series review of selected conditions. Part 1: Placental abnormalities. JOURNAL OF CLINICAL ULTRASOUND : JCU 2024. [PMID: 39165051 DOI: 10.1002/jcu.23773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 07/16/2024] [Accepted: 07/18/2024] [Indexed: 08/22/2024]
Abstract
BACKGROUND The aim of this extended review of multicenter case series is to describe the prenatal ultrasound features and pathogenetic mechanisms underlying placental and umbilical cord anomalies and their relationship with adverse perinatal outcome. From an educational point of view, the case series has been divided in three parts; Part 1 is dedicated to placental abnormalities. METHODS Multicenter case series of women undergoing routine and extended prenatal ultrasound and perinatal obstetric care. RESULTS Prenatal ultrasound findings, perinatal care, and pathology documentation in cases of placental pathology are presented. CONCLUSIONS Our case series review and that of the medical literature confirms the ethiopathogenetic role and involvement of placenta abnormalities in a wide variety of obstetrics diseases that may jeopardize the fetal well-being. Some of these specific pathologies are strongly associated with a high risk of poor perinatal outcome.
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Affiliation(s)
- Gabriele Tonni
- Department of Obstetrics and Neonatology, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Mario Lituania
- Preconceptional and Prenatal Pathophysiology, Department of Obstetrics and Gynecology, E.O. Ospedali Galliera, Genoa, Italy
| | - Alessandro Cecchi
- Department of Obstetrics and Gynecology, Regional Prenatal Diagnostic 2 Level Center, ASUR, Loreto Hospital, Loreto, Italy
| | - Elisa Carboni
- Department of Obstetrics and Gynecology, Regional Prenatal Diagnostic 2 Level Center, ASUR, Loreto Hospital, Loreto, Italy
| | - Gianpaolo Grisolia
- Department of Obstetrics and Gynecology, Carlo Poma Hospital, AST, Mantova, Mantua, Italy
| | - Maria Paola Bonasoni
- Department of Pathology, Santa Maria Nuova Hospital, Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS), AUSL Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppe Rizzo
- Department of Maternal and Child Health, Urological Sciences, Policlinc Hospital Umberto I, University "La Sapienza", Rome, Italy
| | - Rodrigo Ruano
- Division of Maternal-Fetal Medicine, Department of Obstetrics, Gynecology & Reproductive Sciences, University of Miami Leonard M. Miller School of Medicine, Miami, Florida, USA
| | - Edward Araujo Júnior
- Department of Obstetrics, Paulista School of Medicine-Federal University of São Paulo (EPM-UNIFESP), São Paulo, Brazil
| | - Heron Werner
- Department of Fetal Medicine, Biodesign Laboratory DASA/PUC, Rio de Janeiro, Brazil
| | - Waldo Sepulveda
- FETALMED-Maternal-Fetal Diagnostic Center, Fetal Imaging Unit, Santiago, Chile
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Mendoza RP, Doytcheva K, Ud Dean M, Jorgenson KM, Choi D, Segal J, Wang P, Lastra RR. Whole exome sequencing of placental chorangioma. Placenta 2024; 149:13-17. [PMID: 38484495 DOI: 10.1016/j.placenta.2024.03.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/12/2023] [Revised: 03/06/2024] [Accepted: 03/07/2024] [Indexed: 04/07/2024]
Abstract
INTRODUCTION Placental chorangioma is a benign non-trophoblastic vascular proliferation of the placental chorion favored to represent hamartoma-like or hyperplastic capillary lesions. As the exact pathophysiology has not been established, we investigated the molecular characteristics of placental chorangiomas using exploratory whole exome sequencing. METHODS Three cases were retrospectively selected and whole exome sequencing was performed on macrodissected lesions. DNA extraction, DNA quantification, library preparation and sequencing were performed with IDT xGen™ Exome Hybridization Panel v2 for library capture. Sequencing data was analyzed with an in-house bioinformatics pipeline for single-nucleotide variants and insertions/deletions. RESULTS All neonates were delivered at term and had birth weights ranging from 11th-35th percentile for gestational age. All mothers presented with hypertensive disorder during pregnancy. Chorangiomas ranged from 0.7 cm to 5.1 cm and were well-circumscribed near the fetal surface. Case 1 showed a background of chorangiosis and acute subchorionitis, while case 2 had foci of chronic lymphocytic villitis. Whole exome sequencing did not reveal any significant pathologic variants. DISCUSSIONS The absence of molecular alteration in placental chorangioma is likely indicative of the reactive/non-neoplastic nature of this lesion. The presence of compromised blood flow in the form of hypertensive disorders in our cases may be one of its underlying pathophysiologic mechanisms.
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Affiliation(s)
- Rachelle P Mendoza
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Kristina Doytcheva
- Department of Pathology, University of Chicago Medical Center, Chicago, IL, 60637, USA
| | - Minhaz Ud Dean
- Department of Pathology, University of Chicago Medical Center, Chicago, IL, 60637, USA
| | - Kyla M Jorgenson
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Donghyuk Choi
- Department of Pathology, University of Rochester Medical Center, Rochester, NY, 14642, USA
| | - Jeremy Segal
- Department of Pathology, University of Chicago Medical Center, Chicago, IL, 60637, USA
| | - Peng Wang
- Department of Pathology, University of Chicago Medical Center, Chicago, IL, 60637, USA
| | - Ricardo R Lastra
- Department of Pathology, University of Chicago Medical Center, Chicago, IL, 60637, USA.
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Agarwal N, Papanna R, Bergh EP, Hernandez-Andrade E, Backley S, Salazar A, Johnson A, Espinoza J. Management of large placental chorioangioma: two-port laser approach for fetal intervention. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2023; 62:882-890. [PMID: 37448172 DOI: 10.1002/uog.26307] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/04/2023] [Revised: 06/09/2023] [Accepted: 05/12/2023] [Indexed: 07/15/2023]
Abstract
OBJECTIVES There is a paucity of literature providing evidence-based guidelines for the management of large placental chorioangioma (≥ 4 cm in diameter). The objectives of this study were to compare outcomes between patients managed expectantly and those undergoing in-utero intervention and to describe the different in-utero techniques used for cessation of blood flow to the tumor and the associated outcome. METHODS This was a retrospective cohort study of 34 patients referred for the management of large placental chorioangioma in a single center between January 2011 and December 2022, who were managed expectantly or underwent in-utero intervention. In-utero intervention was performed when the fetus developed any signs of impending compromise, including high combined cardiac output (CCO), worsening polyhydramnios or abnormal fetal Doppler velocimetry findings. Interventions included radiofrequency ablation (RFA), interstitial laser ablation (ILA) and single-port or two-port fetoscopic laser photocoagulation (FLP). Treatment selection was dependent on the proximity of the tumor to the umbilical cord insertion (UCI) and placental location. The two-port technique was performed in patients with a chorioangioma with large feeding vessels (≥ 3 mm) located in the posterior placenta, in which one port was used for occlusion using bipolar forceps and the other port was used for laser photocoagulation of the feeding vessels downstream. The single-port technique was used for chorioangioma with small feeding vessels (< 3 mm) located in the posterior placenta. ILA or RFA was performed in cases with an anterior placenta. Supportive treatments, including amnioreduction and intrauterine transfusion (IUT), were performed for worsening polyhydramnios and suspected fetal anemia based on middle cerebral artery Doppler flow studies, respectively. Comparative statistical analysis between cases undergoing expectant management vs in-utero intervention was performed. Descriptive details were provided for patients who underwent in-utero intervention. RESULTS Thirty-four cases of large chorioangioma were evaluated, of which 25 (73.5%) were managed expectantly and nine (26.5%) underwent intervention. The frequency of polyhydramnios was significantly higher in the intervention group compared with the expectant-management group (66.7% vs 8.0%, P < 0.001). The live-birth rate among expectantly managed cases with large chorioangioma was significantly higher compared with that in cases that underwent in-utero intervention (96.0% vs 62.5%, P = 0.01). In the intervention group, preoperative CCO was elevated in all cases with available information and preoperative hydrops was present in 33.3% (3/9) of cases. One patient experienced fetal demise following IUT prior to planned FLP. Among the remaining eight patients, four underwent two-port FLP, two underwent single-port FLP, one underwent ILA and one underwent both ILA and RFA. All three cases in which hydrops was present at the time of intervention resulted in fetal demise. CONCLUSIONS In-utero interventions aimed at cessation of blood flow in the feeding vessels are a therapeutic option for the management of cases with large chorioangioma. The two-port percutaneous technique appears to improve the efficiency of FLP when a large chorioangioma with large feeding vessels is located in the posterior placenta. We propose that in-utero interventions for large chorioangioma should be initiated prior to the development of fetal hydrops. © 2023 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- N Agarwal
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - R Papanna
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - E P Bergh
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - E Hernandez-Andrade
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - S Backley
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - A Salazar
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - A Johnson
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
| | - J Espinoza
- Division of Fetal Intervention, Department of Obstetrics, Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas Health Science Center, Houston, TX, USA
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Ma H, Liu Z, Ruan J. Placental chorioangioma and pregnancy outcome: a ten-year retrospective study in a tertiary referral centre. BMC Pregnancy Childbirth 2023; 23:381. [PMID: 37231382 DOI: 10.1186/s12884-023-05719-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023] Open
Abstract
BACKGROUND Placental chorioangioma is a rare disorder in pregnancy. We retrospectively reviewed the perinatal complications and long-term outcomes in pregnancies with placental chorioangioma and evaluated the factors affecting disease prognosis. METHODS We reviewed pregnant women who delivered at our hospital in the past decade and whose diagnosis of placental chorioangioma was confirmed by pathological diagnosis. Information on maternal demographics, prenatal sonographic findings and perinatal outcomes was obtained by reviewing the medical records. In the latter part of the study, follow-up of children was conducted by phone interview. RESULTS In the 10 years from August 2008 to December 2018, 175 cases(0.17%) were identified as placental chorioangioma histologically and 44(0.04%) of them were large chorioangiomas. Nearly one-third of cases with large chorioangiomas were associated with severe maternal and fetal complications or required prenatal intervention. Although one-fifth of fetuses/newborns complicated with large chorioangiomas were lost perinatally, the long-term prognosis for surviving fetuses was generally good. Further statistical analysis revealed that tumor size and location affect prognosis. CONCLUSION Placental chorioangioma may cause an unfavorable perinatal outcome. Regular ultrasound monitoring can provide the tumor characteristics which can be referred to for predicting the tendency of those complications and indicate when intervention may be necessary. It is not clear which factors lead to complications with fetal damage as the main manifestation or polyhydramnios as the main manifestation.
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Affiliation(s)
- Hongwei Ma
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases in Women and Children of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Ziling Liu
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases in Women and Children of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, 610041, Sichuan, China
| | - Jie Ruan
- Department of Obstetrics and Gynecology, Key Laboratory of Birth Defects and Related Diseases in Women and Children of Ministry of Education, West China Second Hospital, Sichuan University, Chengdu, 610041, Sichuan, China.
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Patidar R, Gowdra Revannasiddappa K, Mestha S. Watchful Expectant Management of a Giant Placental Chorioangioma With Favorable Maternal and Fetal Outcomes: A Case Report. Cureus 2023; 15:e39496. [PMID: 37362464 PMCID: PMC10290547 DOI: 10.7759/cureus.39496] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/25/2023] [Indexed: 06/28/2023] Open
Abstract
Placental chorioangioma is the most common benign tumor of the placenta. However, clinically evident chorioangiomas are less common with an incidence ranging between 1:3,500 and 1:9,000 births. In the majority of cases, it is small or microscopic and of no clinical significance. If it increases more than 5 cm in size, then it may be associated with serious maternal complications such as mirror syndrome, polyhydramnios, preeclampsia, antepartum hemorrhage, preterm labor and delivery, and postpartum hemorrhage, as well as fetal complications such as fetal anemia, fetal thrombocytopenia, fetal hydrops, intrauterine growth restriction, fetal demise, and neonatal death. Giant chorioangioma associated with polyhydramnios leads to high perinatal morbidity and mortality. Chorioangioma with complications before fetal viability needs interventions. Conservative management with close surveillance can be considered in selective cases. We report a case of giant placental chorioangioma complicated with severe polyhydramnios managed conservatively with favorable maternal and fetal outcomes.
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Affiliation(s)
- Rekha Patidar
- Obstetrics and Gynaecology, Zulekha Hospital, Dubai, ARE
| | | | - Suvarna Mestha
- Obstetrics and Gynaecology, American Hospital Clinic, Dubai, ARE
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Saeed B, Tulbah A, Bintalib M, De Vol EB, Almogbel S, BaAli M, Bukhari H, Foudaneel M, Almutairi J, Mahfodh MB, Tulbah M, Alnemer M, Kurdi W. Chorioangioma: a single tertiary care center retrospective study. J Perinat Med 2023:jpm-2021-0085. [PMID: 36809315 DOI: 10.1515/jpm-2021-0085] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2021] [Accepted: 11/16/2022] [Indexed: 02/23/2023]
Abstract
OBJECTIVES Chorioangioma represents a challenge due to the rarity of the condition, paucity of sufficient management guidelines, and controversies regarding the best invasive fetal therapy option; most of the scientific evidence for clinical treatment has been limited to case reports. The aim of this retrospective study was to review the natural antenatal history, maternal and fetal complications, and therapeutic modalities used in pregnancies complicated with placental chorioangioma at a single Center. METHODS This retrospective study was conducted at King Faisal Specialist Hospital and Research Center (KFSH&RC) in Riyadh, Saudi Arabia. Our study population included all pregnancies with ultrasound features of chorioangioma, or histologically confirmed chorioangiomas, between January 2010 and December 2019. Data were collected from the patients' medical records, including the ultrasound reports and histopathology results. All subjects were kept anonymous; case numbers were used as identifiers. Data collected by the investigators were entered into Excel worksheets in an encrypted format. A MEDLINE database was used to retrieve 32 articles for literature review. RESULTS Over a 10-year period between January 2010 and December 2019, 11 cases of chorioangioma were identified. Ultrasound remains the gold standard for diagnosis and follow-up of the pregnancy. Seven of the 11 cases were detected by ultrasound, allowing proper fetal surveillance and antenatal follow-up. Of the remaining six patients, one underwent radiofrequency ablation, two underwent intrauterine transfusion for fetal anemia due to placenta chorioangioma, one had vascular embolization with an adhesive material, and two were managed conservatively until term with ultrasound surveillance. CONCLUSIONS Ultrasound remains the gold standard modality for prenatal diagnosis and follow-up of pregnancies with suspected chorioangiomas. Tumor size and vascularity play a significant role in the development of maternal-fetal complications and the success of fetal interventions. To determine the superior modality of fetal intervention mandates more data and research; nevertheless, Fetoscopic Laser Photocoagulation and embolization with adhesive material seem to be a lead choice, with reasonable fetal survival.
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Affiliation(s)
- Bashayer Saeed
- Department of Obstetrics & Gynecology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Asma Tulbah
- Department of Pathology & Laboratory Medicine, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Marwah Bintalib
- Department of Obstetrics & Gynecology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Edward Bentz De Vol
- Biostatistics, Epidemiology & Scientific Computing, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Samar Almogbel
- Biostatistics, Epidemiology & Scientific Computing, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Mawadah BaAli
- Biostatistics, Epidemiology & Scientific Computing, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Hanifa Bukhari
- Department of Obstetrics & Gynecology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Meshayel Foudaneel
- Department of Obstetrics & Gynecology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Jawaher Almutairi
- Women & Infant Nursing, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | | | - Maha Tulbah
- Department of Obstetrics & Gynecology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Maha Alnemer
- Department of Obstetrics & Gynecology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
| | - Wesam Kurdi
- Department of Obstetrics & Gynecology, King Faisal Specialist Hospital & Research Centre, Riyadh, Saudi Arabia
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Shiraga A, Ohsuga T, Kawasaki K, Mogami H, Minamiguchi S, Mandai M. A case of placental multiple giant chorangioma leading to neonatal death from fetal hydrops. CASE REPORTS IN PERINATAL MEDICINE 2022. [DOI: 10.1515/crpm-2022-0008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Objectives
Although placental chorangiomas are often asymptomatic, larger tumors (>4–5 cm) can cause various perinatal complications, including polyhydramnios, preterm birth, fetal anemia, fetal hydrops, and intrauterine fetal death. Symptomatic placental chorangiomas are often diagnosed prenatally on ultrasonography as a mass on the fetal side of the placenta.
Case presentation
A 37-year-old pregnant woman underwent emergency cesarean delivery at 34 weeks’ gestation due to rapidly progressive fetal hydrops leading to fetal dysfunction, resulting in neonatal death. Placental pathology indicated multiple placental giant chorangiomas that occupied 40% of the placenta. Because of the disk shape of the placenta, prenatal diagnosis by ultrasonography was difficult.
Conclusions
Some placental chorangiomas are difficult to diagnose and lead to fetal hydrops and poor prognosis, even if ultrasonography does not show an obvious mass in the placenta.
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Affiliation(s)
- Aoi Shiraga
- Department of Obstetrics and Gynecology , Kyoto University Hospital , Kyoto , Japan
| | - Takuma Ohsuga
- Department of Obstetrics and Gynecology , Kyoto University Hospital , Kyoto , Japan
| | - Kaoru Kawasaki
- Department of Obstetrics and Gynecology , Kyoto University Hospital , Kyoto , Japan
| | - Haruta Mogami
- Department of Obstetrics and Gynecology , Kyoto University Hospital , Kyoto , Japan
| | - Sachiko Minamiguchi
- Department of Diagnostic Pathology , Kyoto University Hospital , Kyoto , Japan
| | - Masaki Mandai
- Department of Obstetrics and Gynecology , Kyoto University Hospital , Kyoto , Japan
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Zou J, Ding W, Chen Q, Bai X, Li B. Safety of vaginal delivery in women with placental chorioangiomas diagnosed by prenatal ultrasound: A retrospective cohort study. Medicine (Baltimore) 2022; 101:e29672. [PMID: 35866806 PMCID: PMC9302376 DOI: 10.1097/md.0000000000029672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/04/2023] Open
Abstract
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.
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Affiliation(s)
- Jiashan Zou
- Department of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Xueshi Rd No. 1, Hangzhou 310006, Zhejiang, People’s Republic of China
| | - Weimin Ding
- Zhejiang University School of Medicine, Hangzhou 310006, People’s Republic of China
| | - Qin Chen
- Department of Pathology, Women’s Hospital, Zhejiang University School of Medicine, Hangzhou 310006, People’s Republic of China
| | - Xiaoxia Bai
- Department of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Xueshi Rd No. 1, Hangzhou 310006, Zhejiang, People’s Republic of China
| | - Baohua Li
- Department of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Xueshi Rd No. 1, Hangzhou 310006, Zhejiang, People’s Republic of China
- *Correspondence: Baohua Li, Department of Obstetrics, Women’s Hospital, Zhejiang University School of Medicine, Xueshi Rd No. 1, Hangzhou 310006, Zhejiang, People’s Republic of China (e-mail: )
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Hernandez-Andrade E, Huntley ES, Bartal MF, Soto-Torres EE, Tirosh D, Jaiman S, Johnson A. Doppler evaluation of normal and abnormal placenta. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2022; 60:28-41. [PMID: 34806234 DOI: 10.1002/uog.24816] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/24/2021] [Accepted: 11/12/2021] [Indexed: 06/13/2023]
Abstract
Doppler techniques are needed for the evaluation of the intraplacental circulation and can be of great value in the diagnosis of placental anomalies. Highly sensitive Doppler techniques can differentiate between the maternal (spiral arteries) and fetal (intraplacental branches of the umbilical artery) components of the placental circulation and assist in the evaluation of the placental functional units. A reduced number of placental functional units can be associated with obstetric complications, such as fetal growth restriction. Doppler techniques can also provide information on decidual vessels and blood movement. Abnormal decidual circulation increases the risk of placenta accreta. Doppler evaluation of the placenta greatly contributes to the diagnosis and clinical management of placenta accreta, vasa previa, placental infarcts, placental infarction hematoma, maternal floor infarction, massive perivillous fibrin deposition and placental tumors. However, it has a limited role in the diagnosis and clinical management of placental abruption, placental hematomas, placental mesenchymal dysplasia and mapping of placental anastomoses in monochorionic twin pregnancies. © 2021 International Society of Ultrasound in Obstetrics and Gynecology.
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Affiliation(s)
- E Hernandez-Andrade
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - E S Huntley
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - M F Bartal
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - E E Soto-Torres
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
| | - D Tirosh
- Department of Obstetrics and Gynecology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
| | - S Jaiman
- Department of Obstetrics and Gynecology Wayne State University, Detroit, MI, USA
| | - A Johnson
- Department of Obstetrics and Gynecology and Reproductive Sciences, McGovern Medical School, University of Texas, Health Science Center at Houston (UTHealth), Houston, TX, USA
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Clinicopathological characteristics of placental chorioangioma: A clinicopathological study of 77 cases. Ann Diagn Pathol 2022; 57:151873. [DOI: 10.1016/j.anndiagpath.2021.151873] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2021] [Revised: 10/25/2021] [Accepted: 12/02/2021] [Indexed: 11/20/2022]
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Rahimi‐Sharbaf F, Ghalandarpoor‐Attar SN, Moravej‐Salehi F, Ghalandarpoor‐Attar SM. A giant early second-trimester placental chorioangioma associated with isolated proteinuria and histopathologically confirmed placental insufficiency, a novel association: A case report. Clin Case Rep 2022; 10:e05605. [PMID: 35317065 PMCID: PMC8925271 DOI: 10.1002/ccr3.5605] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 02/07/2022] [Accepted: 03/07/2022] [Indexed: 11/12/2022] Open
Abstract
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.
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Affiliation(s)
- Fatemeh Rahimi‐Sharbaf
- Obstetrics and Gynecology DepartmentYas HospitalTehran University of Medical SciencesTehranIran
| | | | - Farnaz Moravej‐Salehi
- Department of PathologyFaculty of MedicineYas HospitalTehran University of Medical SciencesTehranIran
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Nawapun K, Hunsawongsakul D, Phithakwatchara N, Hanamornroongruang S, Viboonchart S, Jaingam S, Wataganara T. Ablative effect of the interstitial laser setting in the human placental model. J Obstet Gynaecol Res 2022; 48:1157-1164. [PMID: 35178830 DOI: 10.1111/jog.15190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2021] [Revised: 01/25/2022] [Accepted: 02/03/2022] [Indexed: 11/26/2022]
Abstract
AIM To assess the impact of laser power and time on interstitial ablation generated by neodymium-doped yttrium aluminium garnet (Nd:YAG) and diode laser in the human placental model. METHODS The experiment was carried out in a simulation model of interstitial laser ablation on ex-vivo placental tissue. One-hundred and forty-four pieces of fresh placentae were interstitially ablated with Nd:YAG or diode laser at various power (15, 20, 25, 30 W)-time (5, 10, 15 s) combinations. The ablation tissues were evaluated using both sonographic and histopathologic measurements. RESULTS Laser generator, power, and time significantly affected the ablation size (p < 0.001). The coagulation zone continuously increased with extending time at the power of 15, 20, and 25 W. When adjusting to the power of 30 W, increased time from 10 to 15 s did not induce the larger coagulation diameter. The maximal diameter was obtained at the laser power of 20 W for 15 s. The ablation from the diode laser was greater than that from Nd:YAG laser. The sonographic evaluation overestimated the ablation size by an average of 24%. CONCLUSION Diode laser destroys greater tissue than Nd:YAG laser. Different power settings of interstitial laser ablation produce diverse patterns of correlation between laser time and coagulation size.
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Affiliation(s)
- Katika Nawapun
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Daungporn Hunsawongsakul
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Nisarat Phithakwatchara
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | | | - Sommai Viboonchart
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Suparat Jaingam
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Tuangsit Wataganara
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
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Kinoshita Y, Inoue M, Sekiguchi K, Maeda T, Ihara K. Feto-maternal hemorrhage with placental chorioangioma: Two case reports. Pediatr Int 2022; 64:e15196. [PMID: 35704465 DOI: 10.1111/ped.15196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2021] [Revised: 02/28/2022] [Accepted: 03/15/2022] [Indexed: 01/05/2023]
Affiliation(s)
- Yuki Kinoshita
- Department of Pediatrics, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Masanori Inoue
- Department of Pediatrics, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Kazuhito Sekiguchi
- Department of Pediatrics, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Tomoki Maeda
- Department of Pediatrics, Oita University Faculty of Medicine, Yufu, Oita, Japan
| | - Kenji Ihara
- Department of Pediatrics, Oita University Faculty of Medicine, Yufu, Oita, Japan
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Ling L, Chen T, Zhang XH, Pan MH, Gong HH, Zhang LN, Zhao M, Chen XQ, Cui SD, Lu C. Risk Factors for Short Stature in Children Born Small for Gestational Age at Full-Term. Front Pediatr 2022; 10:833606. [PMID: 35813392 PMCID: PMC9256917 DOI: 10.3389/fped.2022.833606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 05/16/2022] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE This study aims to identify the risk factors associated with short stature in children born small for gestational age (SGA) at full-term. METHODS This 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. RESULTS Of 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 (f p) 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. CONCLUSION Risk factors for short stature in full-term SGA children at 2 years of age included a decrease of perfusion fraction f p in IVIM of placental MRI, chromosomal abnormalities, and short parental height.
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Affiliation(s)
- Lan Ling
- Department of Pediatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Ting Chen
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xin-Hua Zhang
- Department of Children's Health Care, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Min-Hong Pan
- Department of Pathology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Hai-Hong Gong
- Department of Pediatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Li-Na Zhang
- Department of Pediatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Meng Zhao
- Department of Radiology, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Xiao-Qing Chen
- Department of Pediatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Shu-Dong Cui
- Department of Pediatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
| | - Chao Lu
- Department of Pediatrics, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China
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15
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Karmegaraj B, Ibrahim S, Razeen M, Premasudha V, Rajesh A. Prenatal diagnosis, management, and postnatal outcome of a fetus with massive cardiomegaly secondary to placenta chorioangioma. Echocardiography 2021; 39:157-161. [DOI: 10.1111/echo.15276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Revised: 11/23/2021] [Accepted: 11/27/2021] [Indexed: 11/26/2022] Open
Affiliation(s)
- Balaganesh Karmegaraj
- Department of Pediatric Cardiology Amrita Institute of Medical Sciences and Research Centre Amrita University Kochi Kerala India
- Sowmi Fetal & Pediatric Heart Centre Tirunelveli Tamilnadu India
- Department of Pediatrics Royal Hospital Tirunelveli Tamilnadu India
| | - Syed Ibrahim
- Department of Pediatrics Royal Hospital Tirunelveli Tamilnadu India
| | - Mohamed Razeen
- Department of Pediatrics Royal Hospital Tirunelveli Tamilnadu India
| | | | - Arasi Rajesh
- Department of Pathology Muthamil Hospital Tirunelveli Tamilnadu India
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16
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Solan T, Thomas N, Kee P. Placental chorioangioma: an unusual cause of neonatal cardiomyopathy. BMJ Case Rep 2021; 14:e244956. [PMID: 34625441 PMCID: PMC8504175 DOI: 10.1136/bcr-2021-244956] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/12/2021] [Indexed: 11/04/2022] Open
Abstract
A late preterm baby presented with clinical and echocardiographic features of cardiomyopathy and cardiac failure soon after birth. After extensive metabolic, infective and genetic investigations, the likely cause was established to be due to multiple small placental chorioangiomas. While large placental chorioangiomas are associated with maternal, fetal and neonatal complications, small chorioangiomas are usually asymptomatic and diagnosed incidentally on placental histology. Our case demonstrates that multiple small chorioangiomas might behave like a giant chorioangioma, causing significant neonatal morbidity. This report also highlights the importance of assessing the placental histology where no identifiable cause for neonatal cardiomyopathy can be found.
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Affiliation(s)
- Tom Solan
- Neonatology, Joan Kirner Wome's and Children's, Sunshine Hospital, Saint Albans, Victoria, Australia
| | - Niranjan Thomas
- Neonatology, Joan Kirner Wome's and Children's, Sunshine Hospital, Saint Albans, Victoria, Australia
| | - Penny Kee
- Neonatology, Joan Kirner Wome's and Children's, Sunshine Hospital, Saint Albans, Victoria, Australia
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Bouchghoul H, Benachi A, Senat MV. Prenatal Percutaneous Fetoscopic Laser Photocoagulation of Chorioangioma: Report of Two Cases and Review of the Literature. Fetal Diagn Ther 2021; 48:633-639. [PMID: 34496362 DOI: 10.1159/000517392] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2021] [Accepted: 05/24/2021] [Indexed: 11/19/2022]
Abstract
INTRODUCTION In Doppler flow diagnosis of a large placental chorioangioma with vascularization, there may be fetal consequences as cardiac output failure and polyhydramnios. Prenatal percutaneous fetoscopic laser photocoagulation of chorioangioma is a therapeutic option. First, we present 2 cases of chorioangioma treated by fetoscopic laser photocoagulation. Second, we conducted a narrative review to identify all reported cases of chorioangioma treated by fetoscopic laser photocoagulation. CASE PRESENTATION Case 1 presented a chorioangioma measuring 48 × 36 × 42 mm, and the Doppler flow study showed vascularization with a high flow rate. The fetus showed dilatation of the right cardiac chambers, moderate tricuspid insufficiency, normal Doppler indices, and polyhydramnios. Case 2 presented a chorioangioma measuring 58 × 36 × 31 mm associated with polyhydramnios and elevated peak systolic velocity of the middle cerebral artery at 49 cm/s, that is, 1.65 MoM. The procedure was performed at 22+2 and 23+5 WG for both cases. Photocoagulation of the chorioangioma vessels was performed first on the small superficial vessels (capillaries) and then on the feeding vessels (artery first and then vein), until complete cessation of blood flow on ultrasound. Successful devascularization was achieved when flow within the chorioangioma's feeding vessels was no longer visualized on intraoperative ultrasound examination using Doppler flow. The ultrasound follow-up showed complete cessation of blood flow in the chorioangioma, normalization of fetal signs, and normal fetal growth in both cases. In case 1, a 2,350-g boy was delivered vaginally after spontaneous labor at 33+6 WG. In case 2, a 2,700-g boy was delivered vaginally after spontaneous labor at 39+2 WG. Neonatal findings were normal, and the outcome at 1 year was normal for both children. CONCLUSION Prenatal percutaneous fetoscopic laser photocoagulation improves survival in large chorioangioma, despite a risk of fetal death in utero.
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Affiliation(s)
- Hanane Bouchghoul
- Department of Obstetrics and Gynecology, Bordeaux University Hospital, Bordeaux, France.,Department of Gynecology-Obstetrics, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Saclay, Le Kremlin-Bicêtre, France
| | - Alexandra Benachi
- Department of Gynecology-Obstetrics, Antoine Béclère Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Saclay, Le Kremlin-Bicêtre, France
| | - Marie-Victoire Senat
- Department of Gynecology-Obstetrics, Bicêtre Hospital, Assistance Publique-Hôpitaux de Paris, University Paris Saclay, Le Kremlin-Bicêtre, France
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Kim F, Desiraju S, Joseph J, Debelenko L, Rubenstein SD. Incidental Finding of Hydrops Fetalis in a Full-term Infant. Neoreviews 2021; 21:e421-e424. [PMID: 32482706 DOI: 10.1542/neo.21-6-e421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Affiliation(s)
- Faith Kim
- Division of Neonatology, Columbia University Medical Center, New York, NY.,NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Suneetha Desiraju
- Division of Neonatology, Columbia University Medical Center, New York, NY.,NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - June Joseph
- NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY
| | - Larisa Debelenko
- Division of Pathology, Columbia University Medical Center, New York, NY
| | - S David Rubenstein
- Division of Neonatology, Columbia University Medical Center, New York, NY.,NewYork-Presbyterian Morgan Stanley Children's Hospital, New York, NY
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Hong L, Hua L, Yao P, Zhang L. A rare giant placental chorioangioma with favourable outcome: a case report. J OBSTET GYNAECOL 2021; 42:351-353. [PMID: 34151682 DOI: 10.1080/01443615.2021.1913108] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Affiliation(s)
- Ling Hong
- Department of Obstetrics and Gynecology, Ningbo Women and Children's Hospital, Ningbo City, Zhejiang Province, China
| | - Lingling Hua
- Department of Obstetrics and Gynecology, Ningbo Women and Children's Hospital, Ningbo City, Zhejiang Province, China
| | - Peijun Yao
- Department of Obstetrics and Gynecology, Ningbo Women and Children's Hospital, Ningbo City, Zhejiang Province, China
| | - Li Zhang
- Department of Obstetrics and Gynecology, Ningbo Women and Children's Hospital, Ningbo City, Zhejiang Province, China
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20
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Mo R. Successful expectant management of a giant chorioangioma. BMJ Case Rep 2021; 14:14/3/e239928. [PMID: 33722913 PMCID: PMC7959226 DOI: 10.1136/bcr-2020-239928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Giant chorioangiomas are benign placental tumours, which can have potential severe fetal consequences. Complications in pregnancy include polyhydramnios, fetal hydrops and growth restriction. Such pregnancies can carry a significant risk of poor perinatal outcome and require close monitoring. Therapeutic options include fetoscopic or interstitial vessel ablation, chemosclerosis and embolisation. Where there is no evidence of fetal compromise, such pregnancies can successfully be managed conservatively.
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Affiliation(s)
- Roxana Mo
- Department of O&G, Basildon University Hospital, Mid and South Essex NHS Foundation Trust, Basildon, Essex, UK
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21
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CD133 Expression in Placenta Chorioangioma Presenting as a Giant Asymptomatic Mass. ACTA ACUST UNITED AC 2021; 57:medicina57020162. [PMID: 33670362 PMCID: PMC7917587 DOI: 10.3390/medicina57020162] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/01/2021] [Revised: 02/01/2021] [Accepted: 02/08/2021] [Indexed: 11/17/2022]
Abstract
Background: Placental chorioangioma is the most common benign non-trophoblastic neoplasm of the placenta. Its clinical relevance lies in the size of the tumor since larger masses cause pregnancy complications, including an unfavorable neonatal outcome. Case presentation: We report the case of a 34-year-old second gravida and nullipara at the 35th week of gestation, admitted to the gynecological department for antibiotic-resistant fever. The cardiotocography performed during hospitalization showed an abnormal fetal pattern. A 2250 g newborn was delivered by cesarean section. No complications were observed during childbirth and postpartum was insignificant. On gross inspection a white fleshy intraparenchymal mass blooming on the maternal surface was noted; routinely stained sections revealed features consistent with chorioangioma with vascular channels lined by inconspicuous endothelial cells immunoreactive for CD31 and CD133. Focal expression of CD133 was also observed in placental villi. Discussion: CD133 expression indicated the presence of stem cells in chorioangioma, suggesting their possible role in the development of mesenchymal lesions including chorioangioma.
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22
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Iwahata H, Iwahata Y, Homma C, Kurasaki A, Hasegawa J, Suzuki N. Degenerative type of placental chorioangioma requiring fetal blood transfusion. J Obstet Gynaecol Res 2021; 47:1191-1194. [PMID: 33522070 DOI: 10.1111/jog.14685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2020] [Revised: 01/03/2021] [Accepted: 01/16/2021] [Indexed: 11/30/2022]
Abstract
We experienced a case with fetal hydrops, polyhydramnios, and a well-defined oval anechoic lesion of approximately 9 cm in size, without blood flow at 26 weeks' gestation. As increased middle cerebral artery peak systolic velocity, the fetal hydrops was caused by a placental tumor such as a chorioangioma; however, the tumor was atypical. Fetal blood hemoglobin was 8.3 g/dl on percutaneous umbilical cord blood sampling. After erythrocytes transfusion to the fetus, the mother normally delivered at 38 weeks' gestation. The placental tumor was histologically diagnosed as a necrotic chorioangioma. Obstetricians should note such atypical chorioangiomas when differential diagnosis of placental tumors.
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Affiliation(s)
- Hideyuki Iwahata
- Department Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Yuriko Iwahata
- Department Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Chika Homma
- Department Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Akiko Kurasaki
- Department Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Junichi Hasegawa
- Department Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
| | - Nao Suzuki
- Department Obstetrics and Gynecology, St. Marianna University School of Medicine, Kawasaki, Japan
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Abstract
AbstractChorioangiomas are benign tumors of the placenta, characterised by AV shunting within placenta leading to fetal anemia, cardiomegaly and hydrops. Maternal complications are also known as polyhydramnios, APH and Mirror syndrome. They are seen after 20 weeks, and most of them remain small and are asymptomatic. Large ones (> 4 cm) can create complications for the fetus and expectant mothers. The proximity of the chorioangioma to the placental cord insertion site and its size determines prognosis. Prenatal therapy in the form of interventions like direct injections of various chemicals and laser coagulation of the tumor’s feeding vessels are described in the literature. Conservative management may also be offered in certain circumstances. We report a case of large Chorioangioma managed conservatively. Early diagnosis was made, patient counseling followed by close surveillance with Doppler, MCA PSV was done for fetal wellbeing. The timely intervention led to good neonatal and maternal outcome aided with NICU management.
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Zacharis K, Kravvaritis S, Charitos T, Chrysafopoulou E, Fouka A. A rare case of a giant placental chorioangioma with favorable outcome. Pan Afr Med J 2020; 36:214. [PMID: 32963680 PMCID: PMC7490129 DOI: 10.11604/pamj.2020.36.214.21635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2020] [Accepted: 02/23/2020] [Indexed: 11/11/2022] Open
Abstract
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.
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Affiliation(s)
- Konstantinos Zacharis
- Department of Obstetrics and Gynaecology, General Hospital of Lamia, Lamia, 35131, Greece
| | - Stavros Kravvaritis
- Department of Obstetrics and Gynaecology, General Hospital of Lamia, Lamia, 35131, Greece
| | - Theodoros Charitos
- Department of Obstetrics and Gynaecology, General Hospital of Lamia, Lamia, 35131, Greece
| | - Eleni Chrysafopoulou
- Department of Obstetrics and Gynaecology, General Hospital of Lamia, Lamia, 35131, Greece
| | - Anastasia Fouka
- Department of Obstetrics and Gynaecology, General Hospital of Lamia, Lamia, 35131, Greece
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Choi HJ, Kim GJ. A giant symptomatic placental chorioangioma managed with a histoacryl injection. J Ultrasound 2020; 24:561-565. [PMID: 32372255 DOI: 10.1007/s40477-020-00470-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2019] [Accepted: 04/23/2020] [Indexed: 10/24/2022] Open
Abstract
Chorioangiomas are generally small and associated with favorable outcomes, but large tumors can cause serious fetal complications, such as polyhydramnios, fetal anemia, intrauterine growth restriction, cardiac failure, fetal hydrops, and intrauterine fetal death. Signs of fetal cardiac failure on ultrasonography are indications for urgent in utero interventions. We report a case of a giant chorioangioma causing fetal cardiac failure at 26+3 weeks' gestation, which was treated by embolization of the feeding vessels. We utilized a mixture of n-butyl cyanoacrylate (nBCA, Histoacryl®) and iodized oil (Lipiodol®) as an embolic agent. Fetal hydrops resolved in 4 weeks, and the cardiac size and function normalized 8 weeks after the embolization. A healthy male baby was born at the 37+5th gestational week by cesarean section.
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Affiliation(s)
- Hyun Jin Choi
- Department of Obstetrics and Gynecology, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, 102, Heukseok-ro, Dongjak-gu, Seoul, 06973, Korea
| | - Gwang Jun Kim
- Department of Obstetrics and Gynecology, Chung-Ang University Hospital, College of Medicine, Chung-Ang University, 102, Heukseok-ro, Dongjak-gu, Seoul, 06973, Korea.
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26
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Buca D, Iacovella C, Khalil A, Rizzo G, Sirotkina M, Makatsariya A, Liberati M, Silvi C, Acharya G, D'Antonio F. Perinatal outcome of pregnancies complicated by placental chorioangioma: systematic review and meta-analysis. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2020; 55:441-449. [PMID: 31034661 DOI: 10.1002/uog.20304] [Citation(s) in RCA: 17] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/03/2019] [Revised: 04/09/2019] [Accepted: 04/18/2019] [Indexed: 02/05/2023]
Abstract
OBJECTIVE To report the perinatal outcome of singleton pregnancies complicated by placental chorioangioma diagnosed on prenatal ultrasound. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Affiliation(s)
- D Buca
- Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - C Iacovella
- Department of Gynecology and Obstetrics, Goethe University, Frankfurt, Germany
| | - A Khalil
- Fetal Medicine Unit, St George's University Hospitals NHS Foundation Trust, University of London, London, UK
- Vascular Biology Research Centre, Molecular and Clinical Sciences Research Institute, St George's University of London, London, UK
| | - G Rizzo
- Division of Maternal and Fetal Medicine, Ospedale Cristo Re, University of Rome Tor Vergata, Rome, Italy
- Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - M Sirotkina
- Section of Perinatal Pathology, Department of Pathology, Karolinska University Hospital Huddinge, Stockholm, Sweden
- Division of Pathology, Department of Laboratory Medicine, Karolinska Institutet, Stockholm, Sweden
| | - A Makatsariya
- Department of Obstetrics and Gynecology, I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - M Liberati
- Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - C Silvi
- Department of Obstetrics and Gynecology, University of Chieti, Chieti, Italy
| | - G Acharya
- Division of Obstetrics and Gynecology, Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden
- Center for Fetal Medicine, Karolinska University Hospital, Stockholm, Sweden
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
| | - F D'Antonio
- Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, UiT - The Arctic University of Norway, Tromsø, Norway
- Department of Obstetrics and Gynecology, University Hospital of Northern Norway, Tromsø, Norway
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Prenatal Embolisation of Giant Chorioangioma Using n-Butyl Cyanoacrylate: Technique, Clinical Course and Perinatal Outcome. JOURNAL OF FETAL MEDICINE 2020. [DOI: 10.1007/s40556-019-00235-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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Akbarzadeh-Jahromi M, Soleimani N, Mohammadzadeh S. Multiple Chorangioma Following Long-Term Secondary Infertility: A Rare Case Report and Review of Pathologic Differential Diagnosis. Int Med Case Rep J 2019; 12:383-387. [PMID: 31908545 PMCID: PMC6927595 DOI: 10.2147/imcrj.s227947] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/27/2019] [Accepted: 12/12/2019] [Indexed: 12/04/2022] Open
Abstract
Chorangioma (placental hemangioma) is a benign non-trophoblastic neoplasm of the placenta. Small chorangiomas are usually asymptomatic, but the giant and multiple ones rarely have a favorable outcome. We report a case of 29 weeks of gestational age (after long-term secondary infertility) with premature labor pain and undiagnosed multiple chorangioma leading to hydrops fetalis and neonatal death. Here we report the clinicopathological features of our case and chorangioma in general, along with comparison of different vascular lesions of placenta in terms of incidence, risk factors, complications, histologic origin, macroscopic and light and electron microscopic features.
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Affiliation(s)
| | - Neda Soleimani
- Department of Pathology, Shiraz University of Medical Sciences, Shiraz, Iran
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29
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Ting ELP, Yong SL, Suhashini G, Kang M. A mystery mass on the placenta. Horm Mol Biol Clin Investig 2019; 40:/j/hmbci.ahead-of-print/hmbci-2019-0002/hmbci-2019-0002.xml. [PMID: 31603854 DOI: 10.1515/hmbci-2019-0002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2019] [Accepted: 04/01/2019] [Indexed: 11/15/2022]
Abstract
Chorioangioma or chorangioma is a benign placental tumour which occurs in 1% of the pregnancies. Large lesions of more than 4-5 cm in size, also known as giant chorangiomas, are rare with the incidence of 1:3500 and 1:9000 birth. Unlike small tumours, the giant chorangiomas are highly associated with pregnancy complications. We report a case of multiple large chorangiomas resulting in an extremely preterm delivery. A 24-year-old primigravida presented at 25 weeks of gestation for threatened preterm labour. Transabdominal ultrasound revealed an echogenic mass on the placenta measuring 8.7 × 4.4 cm. Following a successful tocolysis and administration of a course of antenatal corticosteroids, she was discharged home. At 27 weeks of gestation, she developed a second episode of preterm contractions. Besides, the foetus was found to be small for gestational age. In the second episode of preterm contractions, intravenous magnesium sulfate infusion was commenced for foetal neuroprotection. Tocolysis was commenced for severe prematurity. She went into spontaneous preterm labour. Placenta examination revealed multiple solid masses with fleshy and congested dark red surface. A histopathological examination of the placenta confirmed the diagnosis of chorangiomas. The baby was discharged in good condition at 5 months of age. Placental chorangiomas, notably when they are multiple and large in size, are associated with adverse pregnancy outcomes. Therefore, close antenatal surveillance is necessary to allow timely recognition and intervention of pregnancy complications. Our case portrays an unexpected favourable neonatal outcome associated with a giant chorangiomas.
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Affiliation(s)
- Evelyn Lee Pian Ting
- Department of Obstetrics and Gynaecology, Sibu Hospital, Batu ½, Jalan Ulu Oya, 96000 Sibu, Sarawak, Malaysia, Phone: +60135025175
| | - Soon Leong Yong
- Department of Obstetrics and Gynaecology, Sibu Hospital, Ministry of Health Malaysia, Sibu, Sarawak, Malaysia
| | - Ganapaty Suhashini
- Department of Pathology, Sarawak General Hospital, Ministry of Health Malaysia, Sibu, Sarawak, Malaysia
| | - Marcus Kang
- Department of Obstetrics and Gynaecology, Sibu Hospital, Ministry of Health Malaysia, Sibu, Sarawak, Malaysia
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Large placental chorioangioma: a potential effective in-utero treatment modality for radio frequency ablation. CASE REPORTS IN PERINATAL MEDICINE 2019. [DOI: 10.1515/crpm-2018-0040] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
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.
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Willis C, Ferguson S, Soydemir F. Placental chorioangioma associated with polyhydramnios and hydrops fetalis. BMJ Case Rep 2019; 12:12/1/e227828. [PMID: 30700468 DOI: 10.1136/bcr-2018-227828] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 27-year-old multigravida woman was noted on routine growth scan at 27 weeks gestation to have a central placental hypoechoic area measuring 6.7×6.0×4.4 cm. A subsequent magnetic resonance scan confirmed a solid mass in the placenta lying anteriorly; therefore, a preliminary diagnosis of giant placental chorioangioma was made. A repeat ultrasound scan at 30 weeks gestation indicated that the mass had increased, with the presence of polyhydramnios. The patient experienced reduced fetal movements at 31 weeks gestation. There was persistent fetal tachycardia at 33 weeks gestation, and consequently the neonate was delivered by emergency caesarean section. The placenta revealed a large chorioangioma. The neonate's birth weight was 2.85 kg and non-immune hydrops fetalis was diagnosed. The neonate improved significantly in the neonatal intensive care unit and is currently well with no medical problems.
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Affiliation(s)
- Charlotte Willis
- Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
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Papaioannou GK, Evangelinakis N, Kourtis P, Konstantinidou A, Papantoniou N. Giant chorioangioma treated with interstitial laser coagulation. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2018; 52:280-281. [PMID: 29072331 DOI: 10.1002/uog.18941] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/05/2017] [Revised: 10/02/2017] [Accepted: 10/14/2017] [Indexed: 06/07/2023]
Affiliation(s)
- G K Papaioannou
- 3rd Department of Obstetrics and Gynecology, General University Hospital "Attikon", Rimini 1, Chaidari, Athens, Greece
| | - N Evangelinakis
- 3rd Department of Obstetrics and Gynecology, General University Hospital "Attikon", Rimini 1, Chaidari, Athens, Greece
| | - P Kourtis
- Private Fetal Medicine Clinic, Athens, Greece
| | - A Konstantinidou
- Department of Pathology, Medical School, National and Kapodistrian University of Athens, Athens, Greece
| | - N Papantoniou
- 3rd Department of Obstetrics and Gynecology, General University Hospital "Attikon", Rimini 1, Chaidari, Athens, Greece
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Phithakwatchara N, Makarasen P, Nawapun K, Hanamornroongruang S, Viboonchart S, Wataganara T. Time and temperature dependence of radiofrequency ablation in the human placenta. Prenat Diagn 2018; 38:504-510. [PMID: 29722035 DOI: 10.1002/pd.5276] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Revised: 03/20/2018] [Accepted: 04/22/2018] [Indexed: 11/10/2022]
Abstract
OBJECTIVE The objective of the study is to compare radiofrequency (RF) effects on fresh placentae with varying levels of sustained time (Ts) and degrees of target temperature (°t). METHOD A total of 108 pieces of fresh placentae were coagulated with a 2-cm RF needle at 60 W in an organ bath. The vertical and horizontal diameters (Vd, Hd) of tissue coagulation visualized by ultrasound were measured. The impacts of 12 different Ts-°t combinations on the ablation size ascertained on pathological examination (Vdp , Hdp ) were compared using 2-way ANOVA. The agreement between sonographic and pathological findings was assessed using Bland-Altman analysis. RESULTS Considerable changes in the Vdp and Hdp were associated with increasing the Ts and °t. The impact of RF on tissue coagulation was greatest when the °t was set at 100°C, with further destruction as the Ts progressed to 7 minutes of exposure. The ablation size estimated by ultrasound exhibited an overestimation by an average of 5.65% and 21.02% for Vd and Hd, respectively. CONCLUSION A prolonged Ts at a higher °t contributes to progressive placental tissue destruction by RF, with maximum destruction at 100°C for 7 minutes in an ex vivo nonperfused placenta. Tissue injury that is apparent on ultrasound may extend beyond pathological damage.
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Affiliation(s)
- Nisarat Phithakwatchara
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Preechaya Makarasen
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Katika Nawapun
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | | | - Sommai Viboonchart
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
| | - Tuangsit Wataganara
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Faculty of Medicine Siriraj Hospital, Bangkok, Thailand
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Rathi R, Jain A, Mandal S, Khurana N, Tripathi R. Giant chorangioma presenting with an absent foetus: a mystery! J OBSTET GYNAECOL 2018; 38:1021-1022. [PMID: 29620423 DOI: 10.1080/01443615.2017.1399993] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
Affiliation(s)
- Roopal Rathi
- a Department of Pathology , Maulana Azad Medical College , New Delhi , India.,b Department of Obstetrics and Gynaecology , Maulana Azad Medical College , New Delhi , India
| | - Amita Jain
- a Department of Pathology , Maulana Azad Medical College , New Delhi , India.,b Department of Obstetrics and Gynaecology , Maulana Azad Medical College , New Delhi , India
| | - Shramana Mandal
- a Department of Pathology , Maulana Azad Medical College , New Delhi , India.,b Department of Obstetrics and Gynaecology , Maulana Azad Medical College , New Delhi , India
| | - Nita Khurana
- a Department of Pathology , Maulana Azad Medical College , New Delhi , India.,b Department of Obstetrics and Gynaecology , Maulana Azad Medical College , New Delhi , India
| | - Reva Tripathi
- a Department of Pathology , Maulana Azad Medical College , New Delhi , India.,b Department of Obstetrics and Gynaecology , Maulana Azad Medical College , New Delhi , India
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Arnáez M, Miceli A, Manzotti C, Barrena I, Rojo S. Corioangioma placentario gigante, polihidramnios y parto pretérmino. A propósito de un caso. CLINICA E INVESTIGACION EN GINECOLOGIA Y OBSTETRICIA 2018. [DOI: 10.1016/j.gine.2016.07.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Fadl S, Moshiri M, Fligner CL, Katz DS, Dighe M. Placental Imaging: Normal Appearance with Review of Pathologic Findings. Radiographics 2017; 37:979-998. [PMID: 28493802 DOI: 10.1148/rg.2017160155] [Citation(s) in RCA: 64] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
The placenta plays a crucial role throughout pregnancy, and its importance may be overlooked during routine antenatal imaging evaluation. Detailed systematic assessment of the placenta at ultrasonography (US), the standard imaging examination during pregnancy, is important. Familiarity with the normal and abnormal imaging appearance of the placenta along with the multimodality and methodical approach for evaluation of its related abnormalities is necessary, so that radiologists can alert clinicians regarding appropriate prompt management decisions. This will potentially decrease fetal and maternal morbidity and mortality. This article reviews early placental formation and the expected imaging appearance of the placenta during pregnancy, as well as variations in its morphology. It also discusses various placental diseases and their potential clinical consequences. Placental pathologic conditions include abnormalities of placental size, cord insertion, placental and cord location, and placental adherence. Other conditions such as bleeding in and around the placenta, as well as trophoblastic and nontrophoblastic tumors of the placenta, are also discussed. US with Doppler imaging is the initial imaging modality of choice for placental evaluation. Magnetic resonance (MR) imaging is reserved for equivocal cases or when additional information is needed. Computed tomography (CT) has a limited role in evaluation of placental abnormalities because of the ionizing radiation exposure and the relatively limited assessment of the placenta; however, CT can provide important information in specific circumstances, particularly evaluation of trauma and staging of choriocarcinoma. This article also addresses recent techniques and updates in placental imaging, including elastography, diffusion-weighted MR imaging, and blood oxygen level-dependent (BOLD) MR imaging. These advanced imaging techniques may provide additional information in evaluation of abnormal placental adherence and new insights into placental pathophysiology in selected patients. Online supplemental material is available for this article. ©RSNA, 2017.
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Affiliation(s)
- Shaimaa Fadl
- From the Departments of Radiology (S.F., M.M., M.D.) and Pathology (C.L.F.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; and Department of Radiology, Winthrop Radiology Associates, Mineola, NY (D.S.K.)
| | - Mariam Moshiri
- From the Departments of Radiology (S.F., M.M., M.D.) and Pathology (C.L.F.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; and Department of Radiology, Winthrop Radiology Associates, Mineola, NY (D.S.K.)
| | - Corinne L Fligner
- From the Departments of Radiology (S.F., M.M., M.D.) and Pathology (C.L.F.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; and Department of Radiology, Winthrop Radiology Associates, Mineola, NY (D.S.K.)
| | - Douglas S Katz
- From the Departments of Radiology (S.F., M.M., M.D.) and Pathology (C.L.F.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; and Department of Radiology, Winthrop Radiology Associates, Mineola, NY (D.S.K.)
| | - Manjiri Dighe
- From the Departments of Radiology (S.F., M.M., M.D.) and Pathology (C.L.F.), University of Washington Medical Center, 1959 NE Pacific St, Seattle, WA 98195; and Department of Radiology, Winthrop Radiology Associates, Mineola, NY (D.S.K.)
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Abbasi N, Johnson JA, Ryan G. Fetal anemia. ULTRASOUND IN OBSTETRICS & GYNECOLOGY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY OF ULTRASOUND IN OBSTETRICS AND GYNECOLOGY 2017; 50:145-153. [PMID: 28782230 DOI: 10.1002/uog.17555] [Citation(s) in RCA: 38] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/27/2017] [Revised: 06/13/2017] [Accepted: 06/16/2017] [Indexed: 06/07/2023]
Affiliation(s)
- N Abbasi
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada
| | - J-A Johnson
- Department of Obstetrics and Gynaecology, University of Calgary, Calgary, Alberta, Canada
| | - G Ryan
- Fetal Medicine Unit, Department of Obstetrics and Gynaecology, Mount Sinai Hospital, Toronto, Ontario, Canada
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N-terminal pro-B-type natriuretic peptide in amniotic fluid of fetuses with known or suspected cardiac load. PLoS One 2017; 12:e0177253. [PMID: 28545116 PMCID: PMC5436674 DOI: 10.1371/journal.pone.0177253] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2016] [Accepted: 04/25/2017] [Indexed: 12/14/2022] Open
Abstract
Background Myocardial dysfunction occurs in a variety of fetal disorders. Findings from adult cardiology, where n-terminal pro-B-type natriuretic peptide (nt-proBNP) is an established biomarker of left ventricular dysfunction have been extended to fetal life. Since fetal blood sampling is technically challenging we investigated amniotic fluid nt-proBNP for its suitability to diagnose fetal myocardial dysfunction. Methods Ultrasound, Doppler examination and echocardiography was applied to classify cases and controls. Amniotic fluid nt-proBNP to amniotic fluid total protein ratio was calculated and compared to the gestational age-dependent reference intervals. In a subset of cases, fetal and maternal plasma nt-proBNP levels were determined. Results Specimen from 391 fetuses could be analyzed (171 cases, 220 controls). There was a high correlation between amniotic fluid and fetal blood nt-proBNP levels (r = 0.441 for cases; r = 0.515 for controls), whereas no correlation could be detected between maternal and fetal (blood and amniotic fluid) nt-proBNP concentrations. Specificity and positive likelihood ratio of amniotic fluid nt-proBNP to amniotic fluid total protein ratio were high (0.97 and 4.3, respectively). Conclusion Amniotic fluid nt-proBNP measurement allows diagnostic confirmation of fetal myocardial dysfunction. It may serve as a useful adjunct in addition and correlation to existing tests of myocardial function, particularly in the context of invasive fetal therapy, where access to the amniotic cavity is part of the procedure.
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Schneider H, Hentschel R, Enderle-Ammour K. Large multiple chorangiomas of the placenta causing acute neonatal respiratory failure. CASE REPORTS IN PERINATAL MEDICINE 2017. [DOI: 10.1515/crpm-2016-0070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Abstract
Chorangioma is the most common benign tumor of the placenta. Tumors larger than 5 cm can cause adverse fetal outcomes. We describe the case of a term infant presenting with acute respiratory failure due to fetal heart insufficiency. In this particular case, the presence of a multifocal chorangiomatosis causing fetal heart failure was not diagnosed prenatally by ultrasound but first by the histopathological report of the placenta.
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Affiliation(s)
- Hendryk Schneider
- Neonatology and Pediatric Intensive Care Medicine, University Medical Center Freiburg , Mathildenstr. 1 , 79106 Freiburg , Germany , Tel.: +49 761 270 44510, Fax: +49 761 270 29840
| | - Roland Hentschel
- Neonatology and Pediatric Intensive Care Medicine, University Medical Center Freiburg , Mathildenstrasse 1 , 79106 Freiburg , Germany
| | - Kathrin Enderle-Ammour
- Department of Pathology , University Medical Center Freiburg , Breisacher Str. 115A , 79106 Freiburg , Germany
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40
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Saxena A, Faujdar M, Kaur A, Gupta S. Large Placental Chorangioma with an Unusual Uneventful Course. J Gynecol Surg 2017. [DOI: 10.1089/gyn.2016.0076] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Alekh Saxena
- Department of Pathology, Santokba Durlabhji Memorial Hospital, Jaipur (Rajasthan), India
| | - Mansi Faujdar
- Department of Pathology, Santokba Durlabhji Memorial Hospital, Jaipur (Rajasthan), India
| | - Ashmeet Kaur
- Department of Pathology, Santokba Durlabhji Memorial Hospital, Jaipur (Rajasthan), India
| | - Shubha Gupta
- Department of Pathology, Santokba Durlabhji Memorial Hospital, Jaipur (Rajasthan), India
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Michelfelder E, Allen C, Urbinelli L. Evaluation and Management of Fetal Cardiac Function and Heart Failure. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2016; 18:55. [DOI: 10.1007/s11936-016-0477-3] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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42
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Clinical analysis of 26 patients with histologically proven placental chorioangiomas. Eur J Obstet Gynecol Reprod Biol 2016; 199:156-63. [DOI: 10.1016/j.ejogrb.2015.12.009] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2015] [Revised: 11/28/2015] [Accepted: 12/10/2015] [Indexed: 11/20/2022]
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Kataria N, Singh A, Bedi PK. Giant Placental Chorangioma: A Rare Case Report. J Clin Diagn Res 2016; 10:ED03-4. [PMID: 27190814 DOI: 10.7860/jcdr/2016/17222.7540] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2015] [Accepted: 01/04/2016] [Indexed: 11/24/2022]
Abstract
Chorangioma is a nontrophoblastic benign vascular tumour of the placenta, arising from the primitive chorionic mesenchyme. The clinical significance is related to the size of the tumours. Small chorangiomas, with a frequency of about 1%, are often asymptomatic. On the contrary, giant chorangiomas, greater than 5 cm in diameter, are rare tumours, with prevalence ranging from 1:9,000 to 1:50,000, and often associated with a variety of pregnancy complications and a poor perinatal outcome. We report a case of 26-year-old female who presented to us at 36 weeks of gestation with pain in the lower abdomen. Ultrasonograpy revealed polyhydramnios and a vascular tumour on the surface of placenta. Proper conservative antenatal management was done and a full term healthy baby was delievered. Histopathological examination of the extracted mass confirmed the diagnosis of chorangioma. The novelty of this report lies in the presence of large nontrophoblastic vascular placental tumour and the absence of any fetal complications. We emphasise the need of regular and timely antenatal management to diagnose and treat the complications of chorangioma at an early stage.
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Affiliation(s)
- Nidhi Kataria
- Pathologist, Department of Pathology, Government Medical College , Amritsar, Punjab, India
| | - Amarjit Singh
- Professor, Department of Pathology, Government Medical College , Amritsar, Punjab, India
| | - Preet Kamal Bedi
- Professor, Department of Obstetrics and Gynaecology, Government Medical College , Amritsar, Punjab, India
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Hosseinzadeh P, Shamshirsaz AA, Javadian P, Espinoza J, Gandhi M, Ruano R, Cass DL, Olutoye OA, Belfort MA. Prenatal Therapy of Large Placental Chorioangiomas: Case Report and Review of the Literature. AJP Rep 2015; 5:e196-202. [PMID: 26495184 PMCID: PMC4603846 DOI: 10.1055/s-0035-1558829] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 06/04/2015] [Indexed: 11/04/2022] Open
Abstract
Objective To review techniques and outcomes of different prenatal treatments for large placental chorioangiomas. Study Design Presentation of a case of laparoscopic-assisted laser coagulation and a systematic review of the literature for articles related to intervention for placental chorioangioma. Results A total of 37 cases of definitive (n = 23) and supportive therapy (n = 14) were evaluated, including one case treated in our center. Approximately 35% of the patients had a spontaneous preterm delivery in definitive treatment group versus 36% in the supportive group. The infant survival rates were 65 and 71% in the two groups, respectively. We further compared the two types of laser ablation (fetoscopic [n = 10] and interstitial [n = 4]). Approximately 30% of the patients in the fetoscopic and 25% in interstitial group, had a spontaneous preterm delivery. Survival rates were 60 and 100% in fetoscopic and interstitial groups, respectively. Conclusion Laser ablation and embolization of chorioangiomas via minimally invasive approach may prevent or reverse fetal hydrops due to high cardiac states. However, further studies are needed to refine the appropriate selection criteria that will justify the risk of this invasive in utero therapy for chorioangiomas.
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Affiliation(s)
- Pardis Hosseinzadeh
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Alireza A Shamshirsaz
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas ; Division of Fetal Intervention, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Pouya Javadian
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Jimmy Espinoza
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas ; Division of Women's and Fetal Imaging, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Manisha Gandhi
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Rodrigo Ruano
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas ; Division of Fetal Intervention, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
| | - Darrell L Cass
- Division of Pediatric Surgery, Texas Children's Fetal Center and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Oluyinka A Olutoye
- Division of Pediatric Surgery, Texas Children's Fetal Center and Michael E. DeBakey Department of Surgery, Baylor College of Medicine, Houston, Texas
| | - Michael A Belfort
- Division of Maternal Fetal Medicine, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas ; Division of Fetal Intervention, Department of Obstetrics and Gynecology, Baylor College of Medicine and Texas Children's Hospital, Houston, Texas
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Miyake H, Miyazaki-Igarashi M, Suzuki S. Placenta with Old, Diffuse Infarction that Was Difficult to Differentiate from a Placental Tumor. J NIPPON MED SCH 2015; 82:156-8. [PMID: 26156670 DOI: 10.1272/jnms.82.156] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
Placental lesions, including placental infarction, are associated with fetal and neonatal mortality and morbidity. We present a case of fetal growth restriction associated with an old, diffuse placental infarction. Because the placenta had only a single viable cotyledon, the others being atrophic, the lesion appeared to be a placental tumor on prenatal ultrasonography. The patient did not have pregnancy-induced hypertension. At 31 weeks of gestation, a cesarean delivery was performed because of fetal growth arrest and breech presentation. A small-for-gestational age infant was delivered with Apgar scores of 8 at both 1 and 5 minutes, and the infant had cleft palate and cleft lips. Pathological examination of the placenta revealed an old, diffuse infarction without neoplastic change. In cases in which a placental tumor causing fetal growth restriction is strongly suspected, diffuse placental infarction should be considered as part of the differential diagnosis, because placental tumors are associated with poor maternal prognosis.
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Fan M, Mootabar H. A rare giant placental chorioangioma with favorable outcome: A case report and review of the literature. JOURNAL OF CLINICAL ULTRASOUND : JCU 2015; 43:254-256. [PMID: 25043806 DOI: 10.1002/jcu.22187] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/17/2012] [Revised: 11/18/2013] [Accepted: 05/27/2014] [Indexed: 06/03/2023]
Abstract
We describe a rare giant placental chorioangioma in a patient who had a favorable outcome with close prenatal surveillance in a 28-year-old primigravida who was referred to our clinic for ultrasound evaluation of a suspected placental mass at 23 weeks' gestation. A detailed ultrasound scan revealed a well-circumscribed, echogenic lesion measuring 11.0 × 10.3 × 7.3 cm and protruding into the amniotic cavity. A diagnosis of placental chorioangioma was made and intensive prenatal surveillance was scheduled. A small-for-gestational age (2,325 g) but normal female neonate was delivered at 37 weeks by cesarean section and discharged from hospital on the second day of the delivery. A giant chorioangioma may not cause any adverse effect to the fetus and may not require any medication or invasive intervention. © 2014 Wiley Periodicals, Inc. J Clin Ultrasound 43:254-256, 2015.
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Affiliation(s)
- Miaoying Fan
- Department of Obstetrics and Gynecology, Columbia University, PH12-15, 622W, 168th Street, New York, NY, 10032
| | - Hamid Mootabar
- Department of Obstetrics and Gynecology, Columbia University, PH12-15, 622W, 168th Street, New York, NY, 10032
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Mathis J, Raio L, Baud D. Fetal laser therapy: applications in the management of fetal pathologies. Prenat Diagn 2015; 35:623-36. [DOI: 10.1002/pd.4587] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/30/2014] [Revised: 02/21/2015] [Accepted: 02/26/2015] [Indexed: 12/23/2022]
Affiliation(s)
- Jérôme Mathis
- Swiss Fetal Laser Group; University Hospital of Bern, University Hospital of Lausanne CHUV; Lausanne Switzerland
| | - Luigi Raio
- Swiss Fetal Laser Group; University Hospital of Bern, University Hospital of Lausanne CHUV; Lausanne Switzerland
| | - David Baud
- Swiss Fetal Laser Group; University Hospital of Bern, University Hospital of Lausanne CHUV; Lausanne Switzerland
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Jhun KM, Nassar P, Chen TS, Sardesai S, Chmait RH. Giant chorioangioma treated in utero via laser of feeding vessels with subsequent development of multifocal infantile hemangiomas. Fetal Pediatr Pathol 2015; 34:1-8. [PMID: 24941233 DOI: 10.3109/15513815.2014.925018] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
We report a case of a giant placental chorioangioma (15.6 cm diameter) complicated by polyhydramnios and severe fetal heart failure. Fetoscopic laser occlusion of a dominant feeding vessel was performed at 29 weeks' gestation and partial devascularization was achieved. In the 33rd week of the pregnancy, the decision was made to preemptively deliver the fetus due to persistent signs of fetal cardiac failure. After birth, the infant developed multifocal infantile hemangiomas with extracutaneous involvement. We posit that the development of infantile hemangiomas may be linked to the presence of the large chorioangioma. Further study is required to ascertain if fetal treatment of the chorioangioma may have been an exacerbating factor.
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Affiliation(s)
- Katrina M Jhun
- 1Department of Pediatrics, Division of Neonatal Medicine, Los Angeles County + University of Southern California, Keck School of Medicine, Los Angeles, CA, USA
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Satapornteera P, Raveesunthornkiat M, Sukpanichnant S, Tongdee T, Homsud S, Wataganara T. Effects of Power and Time on Ablation Size Produced by Radiofrequency Ablation: In vitro Study in Fresh Human Placenta. Fetal Diagn Ther 2015; 38:41-7. [DOI: 10.1159/000368602] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2014] [Accepted: 09/21/2014] [Indexed: 11/19/2022]
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Color Doppler score: a new approach for monitoring a large placental chorioangioma. Case Rep Obstet Gynecol 2014; 2014:723429. [PMID: 25295202 PMCID: PMC4177183 DOI: 10.1155/2014/723429] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2014] [Accepted: 09/03/2014] [Indexed: 12/05/2022] Open
Abstract
We employed color Doppler score as an innovative approach for the prenatal diagnosis and monitoring of a large placental chorioangioma case diagnosed at 26 weeks and the subjective semiquantitative assessment of the vascularization. The blood flow was assessed by a color Doppler score based on the intensity of the color signal with the following value ranges: (1) no flow, (2) minimal flow, (3) moderate flow, and (4) high vascular flow. Weekly examinations were programmed. Initially, a color Doppler score 3 was assigned, remaining unchanged at the following two exams and decreasing to Score 2 in the following 2 exams and to Score 1 thereafter. The ultrasonographic scan showed an increase of the mass size at the second and third exams and was followed by an arrest of the growth persisting for the rest of the pregnancy. Some hyperechogenic spots inside the mass appeared at the end. Expectant management was opted for, and the delivery was at 39, 2 weeks and maternal and fetal outcomes were favourable. The color Doppler score employed for assessment of vascularization in successive examinations proved to be an important tool for the prediction of the chorioangioma involution, and this new approach of monitoring allowed effective surveillance and successful tailored management.
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